HomeMy WebLinkAboutInsurance Certificate: TC Chevrolet Inc
AC DATE IMM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 0129=14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS
CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms
and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder
in lieu of such endorsements .
PRODUCER CoxrwCT CLIENT CO A CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328 A CNNO Ex1 : 888-3334949 a/c No): 507-4464664
OWATONNA, MN 55060 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC N
INSURER A: FEDERATED SERVICE INSURANCE COMPANY 28304
INSURED 276-176-5 INSURER B:
TC CHEVROLET INC INSURER C:
PO BOX 249
ASHLAND, OR 97520 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: 0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE DL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD MMI IVYYV MMI I V
GENERAL LIABILITY EACH OCCtE $500,000
X COMMERCIAL GENERAL LIABILITY PREMISES $100,000
CLAIMS-MADE ~ OCCUR MED EXP ()$5,000
A N N 9918174 03/01/2014 03/01/2015 PERSONAL Y $500,000
GENERAL A$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PERPRODUCTS GO $1,000,000
X POLICY j Co- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea a fddwO
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident)
NON-OW
HIRED AUTOS AUTOS NED PROPERTY DAMAGE
AUTOS e
I H ,.W ii
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $10,000,000
A EXCESS LIAR CLAIMS-MADE N N 9918175 03/0112014 03/01/2015 AGGREGATE
DED RETENTION
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY y y N TORY LIMITS ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N I A
(Merrsetory in NH) E.L. DISEASE - EA EMPLOYEE
If yes, describe under
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT
GARAGE UASILITY N N 9918174 03/01/2014 03/01/2015 AUTO ONLY-EA ACCIDENT $500,000
A OTHER THAN AUTO ONLY
- EACH ACCIDENT $500,000
- AGGREGATE $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Mbn:h ACORD 101, Additional Remarks Schedule, If mare span ie required)
CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR
GENERAL LIABILITY.
CERTIFICATE HOLDER CANCELLATION
276-176-5 1 0
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
i
EEDEMTED
INSURANCEqFTo Whom It May Concern,
RE: TC CHEVROLET INC
Enclosed is a certificate of insurance that has been renewed for a new policy term. If a copy
of an additional insured or policy endorsement was requested, the document will be sent in a
separate envelope.
If you have any questions regarding this please contact: the Federated Insurance Client
Contact Center at:
Phone: 1-888-333-4949
Fax: 507-446-4664
E-mail: clientcontactcenter@fedins.com
Thank you,-
Client Contact Center
Federated Insurance Companies
Enclosed: I
Certificate of Insurance
MISC-0974 (04-13)