HomeMy WebLinkAboutInsurance Certificate: TC Chevrolet Inc
I DATE (MM/DD/YYYY)
A ° CERTIFICATE OF LIABILITY INSURANCE 01/262015
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 CONTACT
NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX
HOME OFFICE: P.O. BOX 328 A/C No Ext : 888-333-4949 A/c No : 507-446-4664
OWATONNA, MN 55060 E-MAIL
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: FEDERATED SERVICE INSURANCE COMPANY 28304
INSURED 276-176-5 INSURER B:
TC CHEVROLET I NC INSURER C:
PO BOX 249
ASHLAND, OR 97520 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: 0
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.
INSR DL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY
GENERAL LIABILITY EACH OCCURRENCE $500,000
X COMMERCIAL GENERAL LIABILITY PREMISES DAMAGE ( RENTED $100,000
Ea occurrence) CLAIMS-MADE Fx] OCCUR MED EXP (Any one person) $5,000
A N N 9918174 03/01/2015 03/01/2016 PERSONAL & ADV INJURY $500,000
GENERAL AGGREGATE $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $1,000,000
PROJECT - LOC
X POLICY
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea acciden
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident)
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per accident)
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $15,000,000
A EXCESS LIAB CLAIMS DE N N 9918175 03/01/2015 03/01/2016 AGGREGATE
DED RETENTION
TUSS OTH-
WORKERS COMPENSATION WCY STAT LIMI ER
AND EMPLOYERS' LIABILITY Y TOR
ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE
(Mandatory in NH)
If yes, describe under E.L DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS bel.w
AUTO DEALER LIABILITY N N 9918174 03/01/2015 03/01/2016 AUTO LIAB - EA ACCIDENT $500,000
GENERAL LIABILITY
A - EACH ACCIDENT $500,000
• AGGREGATE $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR
GENERAL LIABILITY.
CERTIFICATE HOLDER CANCELLATION
276-176-5 10
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD