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Home My WebLink AboutInsurance Certificate: SME Solutions o:Delinda Ratts To:14/15 Renewal CertiFicates issued for SHE Solut (15414885320) 18:43 06/17/14 EST Pg 2-3 SMESOLU-CL DWAT`rS I (MIWDDIYYYY) ACORD' CERTIFICATE OF LIABILITY INSURANCE W DATE 2ou r 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 pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: George Petersen Insurance Agency, Inc. alc° No Etl ; 707 5254150 P.O. Box 3539 (Vic. No): ; 707 5254175 Santa Rosa, CA 95402 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC B INSURER A: Homeland Insurance Company Of New York INSURED INSURER e: Samsung Fire & Marine Insurance 38300 SME Solutions, LLC INSURER C 3224 Regional Parkway INSURER D: Santa Rosa, CA 95403 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 CONTRACTOR 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. LITR TYPE OF INSURANCE POLICY EFF POLICY DIP POLICY NUMBER (MM(DDNYYY) MMIDDfYYY LIMITS A X COMMERCIAL GENERALLIA ILDY EACH OCCURRENCE S 7,000,000 CLAIMSIAADE N OCCUR X 793.80.22-82-0000 0611412014 06114/2015 PREMISES Ea xcunen e S 50,000 X Pollution MED EXP(An, one mmn) S 5,000 PERSONAL S ADV INJURY S 7,000,00 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 7,000,0011 POLICY T JET F-1 LOC PRODUCTS - COMPIOPAGG S 7,000,0011 OTHER: A Stop Gap Cov S 1,000,000 AUTOMOBILE LIABILITY S 1,000,0 Ea accident B JXANy AUTO CA 0000746-00 03115/2014 0311512015 BODILY INJURY (Per person) S ALL OWNED SCHEDULED BODILY INJURY Pera."t E AUTOS AUTOS ( ) HIRED AIfTOS X NON-OWNED S AUTOS Per acdtlent S UMBRELLA JAB OCCUR EACH OCCURRENCE E EXCESS LIAB CLAIMS-MADE AGGREGATE E DIED RETENTIONS S WORKERS COMPENSATION PER OTH- ANDEMPLOYERVUABILTTY YIN STATUTE ER ANY PROPRIETORIPARTNERYEXECUTNE E.L. EACH ACCIDENT S OFFCERMIEWER EXCLUDED? NIA (Man"oq, In NH) El DISEASE'-EA EMPLOYE S IT ee,, .Cnbo.m. DESCRIPTION OF OPERATIONS Ielow E.L. DISEASE - POLICY LIMIT E DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Ada A Ramarka SohsOala, m ba aaachae N mora ap. le regWr ) RE: Labor and Materials - City's Petro Vend Card reader system City of Ashland is named as Additional Insured with respects to General Liability per form OBENV GE 301 (0211) , attached. 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 90 N. Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD o:Delinda Watts To:14/15 Renewal Certificates issued for StE Solut (15414885320) 18:44 06/17/14 EST Pg 3-3 Policy Number: 793-00-22-82-0000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - FORM I This endorsement only modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for which the Named Insured has agreed to provide insurance prior to loss as provided by this policy but only to the scope of insurance agreed to by the Named Insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the SCHEDULE above, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury, property damage or environmental damage occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in perform ng operations for a pdncipal as a part of the same project. All other terms and conditions remain the same. OBENV GE 301 (02 11) Includes copydghled material of Insurance Services Office, Inc. 1 oft Copyright 2011,0neBeacon Insurance Group E-INSURED inda Watts To:14/15 Renewal CertiFicates issued for SME Solut (15414885320) 18:43 06/17/14 EST Pg 1-3 Enclosed please find the certificate issued per your request. A copy was sent to the holder. Should you have any questions please contact our office. Sincerely, Delinda Watts George Petersen Insurance Agency Ph. 707-360-4156 F 707-546-4518 dwatts@gpins.com www.gpins.com George Petersen Insurance Agency and its Affiliates Note: The information in this E-Mail message is confidential. It is intended solely for the use of the individual(s) named above, If you are the intended recipient, be aware that your use of any confidential, proprietary and/or personal information may be restricted by state and federal privacy laws. If you are not the intended recipient, you should notdistribute or forward this E-mail message. 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