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Home My WebLink AboutInsurance Certificate: AccuSource (2) ACCUS-1 OP ID: AD F DATE(MM/DD/YYYY) ,atcoRC~► CERTIFICATE OF LIABILITY INSURANCE 08/11/2014 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 CONTACT NAME: Robbin McGinnis Sawyer Cook Insurance PHONE 909-435-0230 a/c N° :909-798-7971 1200 California St., Ste 260 A/c No Ext Redlands, CA 92374 E-M /less: rmcginnis@sawyercook.com Robbin Mc Ginnis INSURERS AFFORDING COVERAGE NAIC ff INSURER A: Zurich Insurance Company INSURED ACCUSOurce INSURER B: Preferred Employers Insurance Lianne Charton-Holder INSURERC: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. TN -SR ADD UB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 DAMAGE T RENTED 2,000,000 ~ OCCUR X PAS40515489 05/23/2014 05/23/2015 CLAIMS MADE PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ excluded GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,00 - POLICY F7 PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 4,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 Ea accident ,000,00 A ANY AUTO PAS40515489 05/23/2014 05/23/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED Per OPERTntDAMAGE $ HIRED AUTOS AUTOS DED $ 50 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WKN11788712 09/01/2014 09/01/2015 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below i E.L. DISEASE - POLICY LIMIT $ 1,000,00 C Professional Liab H714103351 05/04/2014 05/04/2015 E&O 1,000,00 ' I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTA VE Ro in c innis , e 1,14411-2 1988-26f4 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD i a20 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(s): Location(s) Of Covered Oplerations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to 'bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All v,Hxk, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; 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) desig- covered operations has been completed; or nated above. 2_ That portion of "you- work" out of which the injury or damage arises has been put to its 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 20 10 07 04 Copyright, ISO Properties, Inc., 20D4 Page 1 of 1 ❑ J' SILL ?OuCY NUMBER TG PRODUCER NUAABER AG ACCOUNT NUMBER AL)PIT 0 I PAS 40515489 17632951 1 F001205647-001-00001 NONE BRANCH GR GRAND RAPIDS ENDORSEMENT EFF 05/23/2014_ INSURANCE GROUP PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (WWINUED) COVERAGE PART(S) AND FORM! KORM OR ENDORSEMENT NAME AND OR ENDORSEMENT NUMBER FORM OR b-ND 3RSEWNT SUPPLEMENTAL iNFORMA-nON ADDITIONAL INSURED - OWNERS, LESSEES OR LIABILITY CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION NAME OF ADDITIONAL INSUREDS PERSONS ) 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 i Ct?TVIMMCIAL GENERAL LIABILITY 955CC8 Ed. 3-00 INSURED'S COPY 05/19/2014 PAGE 5 OF 6