HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group (2)
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- Ac a~ CERTIFICATE OF LIABILITY INSURANCE 12/DATE17/ (MMIDDIYYYY)
2014
N 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 LL
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. N
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to O
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the rV
certificate holder in lieu of such endorsement(s).
PRODUCER LIC 1163238 1-610-941-7751 CONTACT
NAME:
Keystone Risk Partners, LLC PHONE FAX M
LAIC,
604 E. Baltimore Pike E-MAIL
ADDRESS:
PRODUCER W
Media, PA 19063 Qt
INSURES AFFORDING COVERAGE NAIC N
INSURED INSURER A : Ace American Insurance Company
Tristar Insurance Group INSURERS:
100 Oceangate INSURER C :
Suite 700
INSURER D
Long Beach, CA 90802
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 42393269 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OFF INSURANCE LISTED BELOW FIAVE 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 ADDL SUER POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDOIYYYY MMIDDM'YY
GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED
_ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $
CLAIMS-MADE 1-1 OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $
-I POLICY , PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
- - (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
_ NON-OWNED AUTOS $
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
_ DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION WLR C48138998, SCFC48139 012/31/1 12/31/15 $ WC STATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE I~ N / A E.I. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? t_J
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1, 000, 000
It yes, describe under 1, 000, 000
DESCRIPTION OF OPERATIONS Wow E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
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.
ATTN: Kari Olson, Purchasing Rep
90 N. Mountain Avenue
AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
USA ~ c) 1
1jarvis 01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
42393269
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Keystone Risk Partners, LLC
604 E. Baltimore Pike
Media, PA 19063
2014121)1144
Electronic Service Requested EB IX BPO
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ALL FOR AADC 970 ^
4432 0.5234 AB 0.403
1111,61J1111111J1IN 1111 Jill 116111111"1111111111"
CiN ty of Ashland 123
90 MOUNTAIN AVE
ASHLAND, OR 97520-2014 w
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