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HomeMy WebLinkAboutInsurance Certificate: AccuSource ACCUS-1 OP ID: AD CERTIFICATE OF LIABILITY INSURANCE 04/1 UATn14 i oan 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(ies) 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 endorsement(s). PRODUCER 909-435-0230 NAMEACT Robbin McGinnis Sawyer Cook Insurance 909-798-7971 PAHIC°N E,d:909.435-0237 acNO:909-798-7971 1200 California St., Ste 260' Redlands, CA 92374 aooalEss: rmcginnis@sawyercook.com Robbin Mc Ginnis INSURERS) AFFORDING COVERAGE NAIC tl INSURER A: Maryland Casual 19356 INSURED AccuSource INSURER B: Preferred Employers Insurance LianneCharton-Holder INSURER C: Houston Casual Company 1240 E. Ontario Ave #102 - 140 Corona, CA 92881 INSURER D: INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 rypE OF INSURANCE POLICY NUMBER MMDDY/YYYY MMU ADDLSUBR INRR MD Lm DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY X PAS40515489 05123114 05123115 PREMISES Ea occurrence $ 2,000,00 CLAIMS-MADE O OCCUR MED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ exclude GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 4,000,00 POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000100 Ea accitlenl A ANY AUTO PAS40515489 05/23114 05123115 BODILY INJURY IPer person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accitlent) 8 X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accitlent Ded $ 50 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY - B ANY PROPRIETOWPARTNERIEAECUTIVE Y❑ N/A WKN11788711 09101/13 09/01/14 E.L. EACH ACCIDENT $ 13000,00 OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,00 IIYas, describe under DE SCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,00 C Professional Liab H714103351 05104114 05/04115 EI10 13000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured per attached form CG20100704. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE R o b b i n Mc Ginnis, r © 1988-21010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: - COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization (a): Locations Of Covered Operations CITY OF ASHLAND TROPICANA ENTERTAINMENT HOLDIN 20 EASE MAIN STREET ASHLAND OR 97520 1195 ELLIOT DR. CORONA CA 92881 Information required b complele this Schedule, if not shg vn above, At be shown in the Declarations. A. Section II Who Is An Insured is amended to B. With respect to the nsuranoe afforded to these inhale as an additional insured the person(s) or additional insureds, the followig additional exclu- organ¢aton(s) shown in the Schedule, but any sions appy: with respect to liability for 'bodily ny,ry', 'property This insurance does not to 'bodily n' damage" or 'personal and advertising injury' ~y . yam,a caused, in vvtole or in "property damage" occurring after: Part. by: 1. All vwrK including materials, parts or equp- 1. Your acts or omissions; or ment fianshed in connection wttin such vvoh, 2. The act's or omissions of those acting on your on the project (other than service, maintenance behallt or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desg- covered operations has been completed; or nated above. 2. That potion of 'your vvotf' out of which the injury or damage arses has been put to is in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project CG 20100704 Copyright, ISO Properties, Inc., 2004 Page 1 oft ❑ BILL rPOLICY NUMBER TC PRODUCER NUMBER AC ACCOUNT NUMBER AUDIT D PAS 40515489 17632951 F001205647-001-00001 NONE BRANCH GR GRAND RAPIDS EFF 05/23/2014 FOREMOST' INSURANCE GROUP PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (CONTINUED) COVERAGE PART(S) AND FORM°FORM OR ENDORSEMENT NAME AND OR ENDORSEMENT NUMBER FORM OR ENDORSEMENT SUPPLEMENTAL INFORMATION ADDITIONAL INSURED - OWNERS, LESSEES OR LIABILITY CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION NAME OF ADDITIONAL INSUREDS PERSONS I OR ORGANIZATION(S) CG2010 0704 NAME 1 CITY OF ASHLAND NAME 2 ADDRESS 1 20 EAST MAIN STREET ADDRESS 2 CITY ASHLAND STATE OR ZIP 97520 LOCATION(S) OF COVERED OPERATIONS 1195 ELLIOT DR. CORONA CA 9288 COMMERCIAL GENERAL LIABILITY 9S5008 Ed. 3-00 INSURED'S COPY 04/10/2014 PAGE 6 OF 6