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HomeMy WebLinkAboutInsurance Certificate: TRISTAR Insurance Group Inc (2) PJ21IN1?NIN1~ I ® DATE (MMIDDIYYYY) A~ ° CERTIFICATE OF LIABILITY INSURANCE 02/12/2015 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 M w REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. O IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to rv 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). _ PRODUCER 1-818-539-2300 CONTACT NAME: Corbee Simoneau Arthur J. Gallagher & Co. PHONE FAX c+i Insurance Brokers of California, Inc. License #0726293 (A/C, No, Eat): 8185391225 (AIC, No): 8185391525 > 505 North Brand Boulevard, Suite 600 pODRESS: corbee_simoneau@ajg.com z Glendale, CA 91203-3944 INSURER(S) AFFORDING COVERAGE NAIC# Corbee Simoneau INSURERA: AMERICAN ZURICH INS CO .40142 INSURED INSURERS: AMERICAN GUAR & LIAB INS 26247 TRISTAR Insurance Group, Inc. INSURER C : ACE AMER INS CO 22667 100 Oceangate Avenue, Suite 700 INSURER D: WESTCHESTER FIRE INS CO .21121 Long Beach, CA 90602 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 43020389 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. INSR IADDL.SUBR.. POLICY EFF ! POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MMIDDIYYYY A GENERAL LIABILITY CP0554360202 01/01/15 01/01/16 EACH OCCURRENCE $1,000,000 X ;COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES {Ea occurrence) $1,000,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 10,000 X Incl. Contractual Liao !I PERSONAL & ADV INJURY $1,000,000 I! ICI GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. lit ! PRODUCTS - COMP/OP AGG s2,000,000 POLICY PRO' X LOC $ JECT A AUTOMOBILE LIABILITY CP0554360202 01/01/15 01/01/16 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 X ANY AUTO ! BODILY INJURY (Per person) $ ALL OWNED !I SCHEDULED BODILY INJURY (Per accident) $ ! AUTOS 'AUTOS ! NON-OWNED ! PROPERTY DAMAGE $ HIREDAUTOS AUTOS ! (Per accident) Comp. Ded.l Coll. Ded. Comp. Ded. $500 $Coll. Ded. $50 B IIX UMBRELLA LIAB X AUC554347902 OCCUR 01/01/1$ O1/O1/16,EACH OCCURRENCE $ 5,000,000 EXCESS LIAR I CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION $ None ! (Products/Coop Agg $ 5,000,000 WORKERS COMPENSATION WC STATU- 0TH-' AND EMPLOYERS' LIABILITY TORY LIMITS, FIR YIN ANY PROPRIETOR/PARTNEWEXECUTIVE ❑ I ail E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA', (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C (Errors & Omissions G25659223 002 01/31/1 03/02/15'Aggregate 10,000,000 D (Crime G23670410 003 01/31/1$ 01/31/16 Limit of Liability 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland is named additional insured under General Liability as respects their interest in the operations of the Named Insured. GL AI FORM U-GL-1175-C CW (07/10) 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: Xari Olson 90 N. Mountain Ave. AUTHORIZED REPRESENTATIVE n, JA Ashland, OR 97520 19 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD jasonwest 43020389 P5261N12iNM12 3 w Additional Insured - Automatic - Owners, Lessees Or ZURICH CA Contractors M O~ M 7 Policy No. Eff. Date of Pol. Exp. Dale of Pol. Eff. Date of End. Producer No. AWL Prem Return Prem. w CP0554360202 01/0t/2015 01/01/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code: This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A_ Section II - Who Is An Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agreement. B- The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or "personal and advertising injury" covered under Section I - Coverage A - Bodily Injury And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1_ Your acts or omissions; or 2_ The acts or omissions of those acting on your behalf, and resulting directly from your ongoing operations or "your work" as included in the "products-completed operations hazard", which is the subject of the written contract or written agreement, performed for the additional insured person or organization. C_ However, regardless of the provisions of Paragraphs A. and B. above: We will not extend any insurance coverage to any additional insured person or organization: a. b- That is not provided to you in this policy; or That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2_ We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: b- The Limits of Insurance provided to you in this policy, or D. The Limits of Insurance you are required to provide in the written contract or written agreement. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render 4Pv professional architectural, engineering or surveying services including. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field 2_ orders, change orders or drawings and specifications; and Supervisory. inspection, architectural or engineering activities. u-GL-1175-C CW (07/10) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P5261N12%1N12 Arthur I Gallagher & Co. 505 North Brand Boulevard, Suite 600 Glendale, CA 91203-3944 2U 151121601711 Electronic Service Requested ` u EBIX BPO M 0 MIXED AADC 970 ^ 3931 0.6871 MB 0.432 "II~~1'1"~'~~"11111'~I~rl~l~~~l~l'~IIrIrl~urrrlllllrlrlr~lll) City of Ashland 164 M 90 N MOUNTAIN AVE z ASHLAND, OR 97520-2014 w This document was brought to you by Ebix/CertificatesNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. in Glendale, CA.- Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate.- If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance. - The data included in this notice and in the attached document is confidential to - Ebix/CertificatesNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc.- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 P5261N12MI1112 E. The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim; M 2. We receive written notice of a claim or suitas soon as practicable; and M 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non-contributory. F. For the coverage provided by this endorsement: uz, 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV- Commercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non-contributory with respect to any other policy upon which the additional insured is a Named Insured. In that event, we will not seek contribution from any other such insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV-Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence, offense, claim or "suit. This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. All other terms and conditions of this policy remain unchanged. U-GL-1175-C CW (07/10) Paget of2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.