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HomeMy WebLinkAboutInsurance Certificate: Emergency Reporting Systems Inc Y - ,a►c o® CERTIFICATE OF LIABILITY INSURANCE F,,DA,,TE~',mM/DDNYYY) 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 endorsements . PRODUCER A NAME: HUB International Northwest LLC PHONE FAX (A/c. No. Ext;3609000 3608496 -MAIL - 47- Alc No : -734- 110 Unity Street E Bellingham WA 98225 ADDRESS: W ni 'nf h i I. m INSURERS AFFORDING COVERAGE NAIC # INSURERA:Lloyd' L n INSURED EMERG-1 INSURER B dba Emergency Reporting INSURER C : Reporting Systems Inc INSURER D : 851 Coho Way Ste 301 Bellingham WA 98225-2021 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1455521919 REVISION NUMBER:1 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. INTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMID IYYYY MM/DDIYYYY LIMITS A GENERAL LIABILITY Y Y ESD02108359 /6/2015 /6/2016 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $250,000 CLAIMS-MADE K OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 POLICY PRO LOC Deductible $5,000 JECT IED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ #DED RETENTION $ $ A WORKERS COMPENSATION ESD02108359 /6/2015 /6/2016 WC STATU- X OTH- Sto Ga AND EMPLOYERS' LIABILITY Y/ N T RY 1 IT p p ANY PROPRIETOR/PARTNER/EXECUTIVE FEL.DISEASE EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) DISEASE - EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Per forms and conditions. Additional Insured form 873598 04; Waiver of Subrogation form 873599 04. 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. 90 N Mountain Ave Ashland OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD • e HUB NW's Customer Name: Reporting Systems Inc To better service our customers and certificate holders we have implemented a new program for issuing certificates. An email address to send certificates expedites processing and ensures a very timely and accurate delivery. In an effort to be more Eco Friendly we are not including copies of the endorsement forms noted on the certificate. If the enclosed certificate references any policy forms, we would like to email them forms to you. so that we may update our files to deliver these forms to you and to service your future certificate requests. Please complete and return this form or email the information to Now.unityinfo@hubinternational.com If you choose not to use this form please include our CUSTOMERS NAME in your correspondence. Our mailing address: HUB NW, PO Box X, Bellingham WA 98227. Our fax number: 360-734-8496. Certificate Holder Name: Mailing Address: City, State, Zip Code: Email address: Please email me endorsement forms: Yes or No Thank you for your assistance. Commercial Insurance Department