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HomeMy WebLinkAboutInsurance Certificate: Ross Recreation Equipment Jf J ROSSR-1 OP ID: SL 1 ) CERTIFICATE OF LIABILITY INSURANCE DATE 10!1412014 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). CONTACT PRODUCER NAME: Jeff State, CRIS, CWCS Suhr Risk Services PHONE No Ext :408-510-5440 rc, No): 5300 Stevens Creek Blvd. E-MAIL San Jose, CA 95129 ADDRESS: Jeff State -House INSURER(S) AFFORDING COVERAGE NAIC INSURERA: Indian Harbor Insurance Co. 36940 INSURED Ross Recreation Equipment INSURER B:QBE Insurance Company 11515 Company, Inc. INSURERC:Oak River Insurance Co. 34630 100 Brush Creek Road, Ste 206 Santa Rosa, CA 95404 INSURERD: 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. LTR F MMIDDY X LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMA A X COMMERCIAL GENERAL LIABILITY X ESG3000514 1011512014 10/15/2015 PRREMI EMI E TO ENE 50,000 SES (Ea occurrence $ CLAIMS-MADE OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY X PRO LOC Emp Ben. $ 1,000,00 1 PE AUTOMOBILE LIABILITY Ea accid Dt)INGLE LIMIT $ 1,000,00 B X ANY AUTO PX810031 10115/2014 10115/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS PROPERTY DAMAGE OWNED (PER ACCIDENT) $ NON- HIRED AUTOS AUTOS LAUTOS UTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X TORY W LIMRY . I TS T- OTH- AND EMPLOYERS' LIABILITY 2200014814141 10/0112014 10/0112015 E. L. EACH ACCIDENT $ 1,000,00 C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ER OFFICER/MEMBER EXCLUDED? N / A 1,000,00 (Mandatary in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under D ESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PW: The City of Ashland, Oregon, and its elected officials, officers and employees are named as additional insured per attached endorsement form CG2010. RE: Garfield Park CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland, Oregon ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ESG3000514 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Locations Of Covered Operations As required by written contract signed by both All Locations parties prior to loss. 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 organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" u " or damage" or "personal and advertising injury" "property damage" occurring aer: y , rycaused, in whole or in part, by: 1. Your acts or omissions or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations fur on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section Ili - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13