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HomeMy WebLinkAboutInsurance Certificate: Twedells Automotive Towing & Wrecking Inc CERTIFICATE OF LIABILITY INSURANCE (MWDD/YYYY) VCRRTIPICATE ~ TWEDE-1 OP ID: RODO !08/2015 TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTIEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 815LOW. THIS CERTIFICATE QF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy les) must be endorsed. 0 SUBROGATION IS WAIVED, subject to the terms and cgndltions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to tho certiflcote holder in lieu f such endorsements . ' PRDOUCaR °O 4onna Rove N W Insurance Solutions, Inc PNDNB' DBA American Insurance Agency JA/G. Na : Sa1.66T-1915 8 Nd ; 541-687-0277 _ Rm 077 4il Rcve lllakenzie Rd 0 8 RPM DRass: donna nylrlnssalutlans,eom ugene, f?R 97x01 T- NAIC A I euRflR s) AFirORDINO CCVCRAg9 INsUR RA: Markel Insurance Company INSURED Twedell'v Automotive, ToW169 & INSURER ; Wrecking, Inc - 3116 N Pacific Highway INauuERC: ry Medford, OR 97501 INSURER D INSURER E : INSURER P , COVERAC3ES ERTIFICATE NUMBER: REVISION NUMBER, THIS (S TO CORTIFY THAT THE PQLIGIEIS OF'INSURANCE LISTED 0~ OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FQR THE RQLICY PERI0Q IND(CAT6D. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY C©NTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE„ ARFQRDIW BY THE POLICIES DESCRIBED HERRRIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID QLAIMS. LT TYPE OF INSURANCE PO NUMOCH MMIDD/YYYY LIMITS OENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAI, LIABILITY 502RB011022 0110212016 01/0212016 p ry T g ~ ^ercO Ce) 100,00 CLAIMS-MADE IT I OCCUR MED EXP Am one person) 16,00 PERSONAL 8 AOV INJURY $ 1,000,00 GENERAL AGGREGATE I 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PEk: PRODUCTS - COMP/OP AGG S 1,000,00 R POLICY PRO- LOC $ AUTOMOBILE LUASILrry COMBINED SINGLE LIMIT Es seddent 1,000,00 A ANY AUTO 8602RB011022 0110212015 01/02/2016 BODILY INJURY (Per parson) $ ALL AUTOS NED X qSUT~8~E0 BODILY INJURY (Per socldent) S X MIRED AUTOS X NONIWNED AUTOS R P $ $ UMOR@LLA LIAR H OCCUR EACH OCCURRf;NCS I "ces 3 LIAe CLAtigg ApE AGGREGATE I o NTIONS 3 WORK ERSCOIYIPEN8A. N' C TA 0TH- ANQ EMPLOYSRB* WABILITY YIN ANY PROPAIE,TORIPARYNEWEXECUTIVE OPFICERIMEMbER EXCLUDED? NIA E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE • EA EMPLOYEE I Ifyee, deaerlbe under DES R PTION OF OPE T N8 Wow E.L. DISEASE • POLICY LIMIT I A n Hook/Cargo 8502RB011022 0110212015 01102/2015 $1000 ded $0,00 A [Garagakeepen; 8602RO011022 .01/02/2016 01/02/2016 $1000 ded 600,000 bk DESCRIPTION OR OPpRATIONB I LOCATIONe I VEHICLES (Adaeh AOORD 1b1, Addldonsr Remarks Schedule, M man apace In required) CERTIFICATE HOLDER CANCELLATION ASHLA-1 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. '90 N. Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE JR ®1980-2010 ACOR0 CORPORATION. All rights reserved. ACORD 25 (2010106) ' ~(J AJ' The CORD name and logo are registered marks of ACORD OP ID: RODO ACORDVEHICLE SCHEDULE DATE 1/6/2015 PRODUCER bil. APPLICANT ~ueq: IS41'- Plrel N W Insurance Solutions, Inc ~,.nwd Twedell's Automotive, Touring 8 DOA !American Insurance Agency 2077 Wiu»kenzig Rd 0 8 EFFECTIVE DATE EkPIRATION PATE DIRECT BILL PAYMRNT PLAN AUDIT I i,, OR 97401 01/02115 01104116. X AQENCY BILL Jim R Roova FOR COMPANY CODS: SUB CODE: USE ONLY AGENCY CUSTOMER ID TWEDE-1 VEHICLE DESCRIPTION VENN YEAR MAKE: Chevy BYWA66 COST NEW 1 1992 MODEL: Wrecker V.LN,: 1GCGK24F6NE181151 $ CITY,BTATfi, SATE TERR OVWJOCW CLp88 91C FACTOR DEATCP RADIUS PARTHEBTTHRM ZIP WHERE OARAOED pppp O W I K/bCHOOI. USE U COMM1 cNVERAGfis FAL7NQ MOTORS P ILsp DEDUCTIBLES CV C OMP ~~l 4OEC ISo SCK 16 MILE S PLEASURE RETAL LIAe MEP PAY d pFT COMAA 8T AMT q OTAL PREM FARM SERVCE NOU IN BVEC FTW LOLL $ VEH# YEAR MAKE: Intention T'YPL+: BYM/AQ9 -608T NEW 2 1988 MooEL: Wrecker v.L i_: 1 H8ZEGGR1JH592637 $ CITY. STATE, 8T TERR GVWIGCW CLASS SIC FACTOR ZIP WHERE SEAT CP RADIUS FARTHEST YERM GARAGEO DRIVE TO USE CHE K ADD'L NO- UNDRINS KIBCMOOL COMWL COVERAGES FAULT MOTOR F LSP DEDUCTIBLES CV COMP SPEC MISC C OF L R/CR: < 15 MILES PLEASURE RETAIL LM MED PAY L g~R FT COMP AA ST AMT $ TOTAL PREM 16 MILE6 + FARM SERVICE N0- INS PEO FTW COLL $ m COLL $ YEH A YEAR MAKE: Ford r°E SYM/ACE COST NEW 3 12004 Momw Wrecker V.I.N.: 1 "X33PUEA62849 $ CITY STATE, DUC TERR pVW~GCW CLASS ZIP 81C FACTOR SEAT CP RADIUS FARTHEST TERM Min; GARAOtp use CHECK ADD'L NO UNDRI S DEDUCTIBLES SPEC MIS WORKISCHOOL COMWL COVERAOEB FAULT MpgWTQIR F LOP CV COMP C OF L < 16 MILES PLEASURE RETAIL LIAR MED PAY ATLABOR FT COMP AA ST AMT $ TOTAL PREM 15 MILES + FARM SERVICE NO. UNINB SPEC FTW COLL S $ LOLL $ VEIN YEAR MAKE: Chevy 8YM/AOE CAST NEW TYPE. 4' 1995 MODEL: Rollback V.I.N,: 1GBKC34FBSJ103958 $ LIC CITY, 8TATE, STATE' TERR OVW/OCW CLADS . SIC PACTOR BEATCP.. RADIUS ZIP WHERE PARTHEBTTERM GARAGED PR VE TO USE CHECK AOD'L NO- UNNDRINS F LSP DEDUCTIBLES ACV COMP SPEC MI WORKJSCHOOL CQMM'L COVERAOED FAULT MOTOR C OF L DRIOR: <15 MILES PLEASURE RETAIL LIAR MED PAY T & LABOR OWING F7 COMP AA 9T AMT $ TOTAL PREM 16 MILES + FARM ERVIC6 NO-, UNINB SPEC FTW COLL $ $ COLL $ VEN a YEAR MAKE: terlin E TYPE; SYM/A5R COp7 NEW 5 2001 MODEL: Wrecker V_LN.: 2F2AAKAK41AJ18512 B _ CITY. STATE, b ATE TERR GVWIOCW CLASS SIC FACTOR SHAT OP RACIUQ FARTHEST TERM 7JP WHER& GARAGED DRIVE OU ODfi CHECK ADD•L N0= UNDRINS F LSP IVHOOL LLJ COMM'L ERAgfiB FAULT MOTOR CI:000TIELEe CV COMP . SPEC MISC G OF L OR/CR: < 76 MILI S PLEASURHSERVICE RETAIL LIAR MED PAY &OLA~BOGR FT COMP AA 8T AMT S TOTAL PREM 16'MIL'ES FARM NO- UNINB SPEC . FTW COLL CO LL 3 VEH 0 YEAR MAKE: Ford EOp Y BYWAGE COST NEW 6 2000 MODEL: Wrecker 1 FDAF56FOYEE27691 s CITY, STATE. STATE TEAR OVW/GCW CLA88 SIC ;PFACTO BEAT CP R ADIUS FARTNE87 TERM ZIP WHERE GARAGED DRI E TO USE AbD'L N UNNDRINS pED 71BSPEC MISC ORCOMM'L V RAGEFAULT M~OyTyO~NR F L$P CV COMP C E L lo_ 15 MILES PLEASURE RETAIL LIAR MED PAY R LA9R FT POMP AA MT $ TOTAL. PREM 15 MILES + ^ I FARM SERVICE FAL UNINB M9191 FTW COLL S S COIL S YEN M YEAR MAKE: Internatio E Q SYMIAGE COST NEW 7 2004 MODEL: Rollback v.I.N,: 1 HTMMAAL94H656972 $ CITY, STATE, STATE TERR OVWIOCW CLASS BIC FACTOR JSRADIUS FARTHEST TMMM ZIP WHERE GARAGED PR VIE Tu- USE NECK . ADD•L NO- UNDRINe, DEDUCTIf~LEB SPEC MIS RKISCNOOL COMM L GES FAULT MOTOR F C8P ACV COMP C OF L < 16 MILE6 PLEASURE RETAIL LIAB MED PAY BLAB OR FT COMP AA $T AMT S TOTAL PREM IS MILES- FARM SERWGR NQ UNINS SPEC FTW COLL $ S COLL $ ACORD 129 (1/98) OACORDCORPORATION1903 OP ID, RODO ACORD . VEHICLE SCHEDULE aizol5 PRODUCER PU"g-N 41-887.1 . APPLICANT Plat N W Insurance Solutions, Inc =1 Twedell's Automotive, Towing 8 DBA American Insurance Agency Insured) 2677 Willakenzie Rd # 8 EFFECTIVE DATE r-xpIRA=m oAT@ DIRECT BILL PAYMENT PLAN AUDIT Eugene, OR 97401 01102115 01102116 X AGENCY SILL Jim Rova FOR COMPANY CODS: SUB CODE: U8I ONLY AGENCY CUSTOMER 10 TWEVE-1 VEHICLE DESCRIPTION VEN III YEAR MAKE: Inten18t1O TYPQ SYM/AGE COST NEW 8 1999 rlwoEL Wreck®r vlw: 1HTSCAAMXXH88i239 CrrY,BTATB, STATE TERR GVWIOCW DLA88 $IC FACTOR ISEATCPI RADIUS PARTHEBTTIRM ZIP WHERE OARAG6D 9PEC MISC 6 TO USE CNfi K ADD'L NO- UNNDRINS DEDUCTIBLES YWORKISCHOOL. COMWIL ERAGEB FAULT MQTOR F LSP CV COMP C OF L 0 _ s 16 MILES PLEASURF-RETAIL LIAR MED PAY AOjAABOR FT COMP AA ST AMT $ TOTAL PREM NO- UNINS OPEC 16 MILES + FARM SERVICE F- CALL 3 $ LOLL $ ,X M,,T C1 _1 E VEH N YtAR MAKE: Ford I TYPE! ~DY BYMIA05 COST NEW _ 9 T2008 nloosu Wrecker v-I-N.: 1 FTXW43R38ED59002 $ CITY, STATE, 8T C S TERR OVWIGCW CLASS 81C FACTOR BIAT CP RADIUS FARTHEST TERM ZIP WHERE GARAGED 7 i I I DRIV@ TO USE W COMM L ICHECK SPEC ADVIL FAULT MOTOIRS F LSP n$UCTIBLrS CV COMP LLJC OP L MISC IWRIK/UCHOOL C _jSP < 16 MILES PLEASURE RETAIL LIAR MED PAY 8 BOR FT COMP AA ST AMT S TOTAL PREM 18MILES + FARM SERVICE NO- UNINS SPEC FTW COLL $ COLL $ VIN 0 YEAR MAKE: Edzu TYPE. EIQWY BYMIAGE COST NEW 10 2006 MaDEL:.Traller V.I,N-: 51-128121-P85W011773' $ CITY. STATE, STAG TERR OVWIGM CIA88 SK) FACTOR ISPATCPI RADIUS FARTHESTTERM ZIP WHERE U CT18LE8 V CDMP CPOF L MISC_ GARAGED ECK AD DRIVE TO USE COMML CNVERAOEB FA TNO MOTRORS F LSP PD ~Y RKIBCMOOL 15 MILES PLEASURE RETAIL LIAR MED PAg L BOR FT COMP AA ST AMT 6 TOTAL PREM NO. 15 MILES +FARM SERVICFAU UNINS SPEC F'Iw COLI 8 COLL $ VEH N YPJ1R BODY SYMIAGE COST NEW MAKE: BI T TYPE: 11 ~ 2003 MODEL: Trailer V.I.N.: '16VCX182631 E59440' $ CIT Y STATE, BY C TERR GVWIOCW CLA88 SK: FACTOR SRADIUS PARTHEBT TERM 2 e VACRI GARAGED One DRIVE U8E COMWL CCHECK 'L OVERAGES fAULTNa MOTORS F LSP DEDUCTIBLES . CV COMP C OF L Dag: WORKIS CHOOL < 15 MILES PLEASURE RETAIL LIAR MED PAY TOWING FT COMP AA ST AMT $ TOTAL PREM 15 MILES + FARM SERVICE N - UNINS SPEC FTW COLL 6 $ COLL 6 VEHM YEAR MAKE: HQUI SYMIAGE COSTNEW 12 2003 MoDkL: Trailer va,N.: 16HC8121X3U030971 s CITY, STATE; STATE Q TERR GVWIOCW CLABO SIC FACTOR ~SRATCPJ RADIUS PARTHEBT TERM ZIP WHERE . GARAGEA DRIVE TO USE CQMM'L fiERAG@B FAULTNO MOTORUNDRIN F LSP DEDUCTIBLES. ACV L_JCOMP CDFL MISCR < 15 MILES PLEAgVR RETAIL LIAR MEG PAY TOWING FT COMP AA ST AMT $ TOTAL PREM 7715 MILES+ FARM SERVICE NO- "UNINS ` SPE FTW COLL $ $ COLL $ ' VEHa YEAR MAKE: Roadrunner I TYPE! BODY SYM/AOE COSTNEW 13 . 2006 MouEL: Trailer V.I.N.: 5UOSCIO16R000810 s CITY, STATE, BT TE TERR GVWIOCW CLASS SIC FACTOR SEATCP RADIUS #ARTHEBTTERM ZIP WHERE - GARAGED _ p OF L DISC y WORKIBCHOOL U8E COMM-L C EIRAGES _ FAULTNa MOTORS F LSP DED~ICTI9l E8 CV COMP C SPEC MC 15 MILES PLEASURE RETAIL LIAR MEO PAY ggOR FT COMP AA ST AMT $ TOTAL PaaM 15 MILES + FARM SERVICE NO. UNINS P C FTW COLL $ - COLL $ VEH'A YEAR MAKE: Internati0 TYPE; 6YWAGE COST NEW 14 2065 MODEL: Trailer V.I.N.: 4RACS18285NO32236 s Lie CITY, STATE, STATE TERR OVWIGCW' CLASS' 91C FACTOR ISFATOP RADIUS PARTHtMBT'TERM ZIP WHERE . GARAGED 08E K L NO TRINE DEDUCTIBLES SPEC MISC DRIVE TO COMM'L WORKlSCHOOL ERAG63 F FA UL T MOTOR F LSP ACV COMP C OF L DR/CR: 15 MILES PLEASURE RETAIL UAB MED PAY TO LA OG R FT COMP AA ST AMT $ TOTAL PRLM INS P C FTW COLL $ $ COLL $ 15MILES+ FARM S~RVIC NQ' UNMOT ACORD 129 (1198 CACORDCORPORAT10N1993 OP ID: RODO DATE ACORD-. VEMCLE SCHEDULE vs/zo.1s vRODUCER ONE 1-687.1915 APPLICANT N W Insurance Solutions, Inc ~p"' Twedell's Automotive, Towing a insuro0l DBA American Insurance Agency 2677WillakenzisRd#8 EFPECTNEDATE Ex iRATIONDATE DIRECT BILL PAYMRNTPLAN AUDIT Eugene, OR 97401 01/02/16 01/02/16 X .AOENCYBIII Jim Rova FOR COMPANY CODE: BUD CODE; USE ONLY AGENCY CUSTOMER ID TWEDE-1 VEHICLE DESCRIPTION VzH 0 YEAR MAKE: TPD rnE BYWAGE COST NEW 15 1998 MODEL: Trailer V.I.N.: 1T9G29033W1090148 $ CITY, STATE, LICATE TERR GVW/GCW CLA88 sic KACTOR IsEATI RADIUS FARTHEBTTERM ZJP WHERE GARAGED DRIVE TO USE CQMM'L CHECRK ADD'L NQ- UNDRINS F LSP acv COMP MISC K48CHOOL EEAOEB FAULT OF L W1 C OTAL PRRM MOTM MOTOR PS UCTIpLES SPEC T < 16 MILES PLEASURE RETAIL LIAR MED PAY &OLABOR 1 FT COMP AA ST AMT 6 TOTAL DREM 15 MILES + FARM SERVICE NO, UNINS !PE FTW COLL $ COLL 6 VEH # YsAR MAKE: U VW SYWAGE COST NM TYPE! MODEL: V.I. N.; is CITY, STATE, STATE TERM ovW/ocw CLASS 81C FACTOR ISEATOPI RADIUS FARTHEST TERM ZIP WHERE GARAGED RIVE U8E ON EC ADD'! NO- UNDRINS PEC CTIBLES PE MC U 7K/BCMOOL COMM'L RA0E8 FAULT MOTOR F JLSP CV COMP pL R/CR: 15 MILES PLEASURE RETAIL LIAR MED PAY g gTR FT COMP Aa sT AMT TOTAL PREM 15 MILES 4 FARM SERVICE FANO- L UNIN6 SPEC FTW COLL $ COLL $ VON # YEAR MAKE: SYM/AQR COST NEW TYPE; MODEL: V.I.N.: 6 CITY STATE, STATE TERM GVWIGOW CLASS sic PACTOR SEEATCP RADIUS FARTHEBTTERM 7JP 1/UHERE GARAGED WORKJSCHOOL USE COMMT COVEKRAGES FAUULTNO MODTOIR S F LSp DEEDUCTiEiLEB ACV COMP C OF L < 1 S MILES PLEASURE RETAIL UAB _ MED PAY g& FT COMF AA 8T AMT $ TOTAL PROM 18 MILES + FARM 9ERVIC NO. UNINS PEC FTW COLL $ $ COLL $ VENA YEAR BODY MAKE; pE, _ 9YMtgOE COST NEW MODEL: VAN.: 6 CITY, STATE, LEC TERR j fOCW CLASS SIC FACTOR 18EATCP1 RADIUS PARTHESTTERM ZIP WHERE STATE OARAOED . '15RIV9,10 UaE C OCK- ADO'L NO- NDRINS LSP EC MISO WO K/BCNOOL COMM'L yEiRAG63 FAULT OTQR F DEDUCACV COMP !OF N L < 16 MILES PLEASURE RETAIL UAB MED PAY OR FT COAA ST AMT $ TOTAL PR EM 15 MILES + FARM SERVICE p" UNIVN OF P&C FTW HCOMLLP $ $ W~ COL4 6 VEH # YEAR MAKE: B BYMIAG E COST NEW MODEL: !Ny E1 CITY STATE, LIC TERR GVW/GCW CLASS SIC FACTOR SEATCP RADIUS PARTHESTTERM ZIP VARE STATE GARAGED DRIVE UBfi CHECK ADULD'L NO" MOUNDRINS F LSP LAA B CVCOMP COF L MI C K/SCNOpL COVERAGES FA SPEC ISMiLES PLEASURE RETAIL LIAR MED PRY LABOR FT LES COMP STAMT $ TOTAL PREM i5 MILES FA13M SERVIC T TOR E NO- V N R 1; OF I SPED FTUV COLL E COLL S VHN # YEAR MAK BODY BYMIAQE COST NEW MODEL: CITY, STATE, STATE TERM • OVW/QCW CLASS ' SIC FACTOR SRADIUS PARTHEST TERM LP WHERE GARAGED DRIVRR TO USE CHECK ADD'L NO- UNDRINS DEDUCTIDI E8 SPEC 18C KI60HOOL COMM'L COVERAGES FA LT MOTOR F LSP CV COMP C OF L DR/CR: < 15 MILES PLEASURE RETAIL LIAB MED PAY TOWING FT COMP AA ST AMT 6 TOTAL PREM Q LABOR NO. 1 UNINS 15MILES + FARM SERVIC EA ILT SPEC FTW COL 6 COLL 6.+ vow # YEAR MAKE: , EIYMIAGN COST NEW MODEL: V.I.N.: $ TERM GVW/OCW CLASS SIC FACTOR SEATCP RADIUS FARTNESTTERM CITY, STATE,, BT! ATr 7JP WHERE GARAGED . DRIVE T O U8E CHECK.. ADD'L NO- UNDRINS COMP C OF SPEC L DISC DRIVE COMM'L jFRAGke FAULT MOTOR F Lgp b1=DUCTIELES CV TOTAL DRICR: a IS MILES PLEASURE RETAIL LIAB MED PAY 64ggp FT COMP AA fSrMT $ TOTAL PREM 15MILE$+ FARM SERVICE N,0 UNIQTQR NS SPEC F1Vy COLT $ $ COLL s ACORD 129 (1/90) g1ACORDCORPORATION1993