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HomeMy WebLinkAboutInsurance Certificate: TRISTAR Insurance Group P52MN1281N12 l ® DATE (MMIDDNYYY) A~ CERTIFICATE OF LIABILITY INSURANCE 03/03/2015 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 LL REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. O IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsement(s). sn PRODUCER 1-818-539-2300 CONTACT COrbee Simoneau _ r4 -NAME' 011 Arthur J. Gallagher & CO. PHONE m Insurance Brokers of California, Inc. License #0726293 Nn Eel• 8185391225 A/ No): 8185391525 > 505 North Brand Boulevard, Suite 600 ADDRESS: corbee_simoneaueajg.com w Glendale, CA 91203-3944 INSURER(S) AFFORDING COVERAGE NAIC0 Corbee Simoneau INSURER A: ANKRICAN ZURICH INS CO 40142 INSURED INSURER B: AMERICAN GUAR & LIAB INS 26247 TRISTAR Insurance Group, Inc. INSURER CWESTCHESTER FIRE INS CO 21121 100 Oceangate Avenue, Suite 700 INSURER D: ACE AMER INS CO 22667 Long Beach, CA 90802 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 43181802 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 AODL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE vivil POLICY NUMBER iMMIODNYYY) IMMIDDIYYYMYI A GENERAL LIABILITY CP0554360202 Ol/01/1 01/01/16 rEACH OCCURRENCE $1,000,000 DAMA' E TO 1, X COMMERCIAL GENERAL LIABILITY SES EaEoxurre nce S 1, 000, 000 CLAIMS-MADE L-J OCCUR XP (Any one person) $ 10, 000 X Incl. Contractual Liab ONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE 52.000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY PRO- % LOC f A AUTOMOBILE LIABILITY CP0554360202 01/01/1 01/01/16 EaaBINEDSINGLELIMIT 1,000,000 ANY AUTO BODILY INJURY (Per person) _ R ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS H NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) Camp. Ded. Coll. Ded. Comp. Ded. $500 $Coll. Ded. $50 B X UMBRELLA LIAB % OCCUR AUC554347902 01/01/1 01/01/16 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 CEO R RETENTIONS None Products/Coop Agg $ 5,000,000 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE E It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT E C Cr G23670410 003 01/31 L t o Liability 5,000,OUU D Errors & Omissions 025659223 003 03/02/1 01/31/16 Aggregate 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more spikes Is required) City of Ashland is named additional insured under General Liability as respects their interest in the operations of the Named Insured. GL Al 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: Bari Olson 90 N. Mountain Ave. AUTHORIZED REPRESENTATIVE ^ J Ashland, OR 97520 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD jasomreat 43181802 P511.UU2M11112 LL Additional Insured -Automatic Owners, Lessees Or ZURICH' ° Contractors N Q7 Policy No. Eff- Date of Pol. Exp- Date of Pol. Eff- Date of End. Producer No. MO. Prem Return Prem. w CP0554360202 01/01/2015 01101/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY- Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided wider the. Commercial General Liability Coverage Part A- Section If -Who Is An Insured is amended to include as air 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: 7. 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 2 in the written contract or written agreement; and ke 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 4py 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 Ii Supervisory, inspection, architectural or engineering activities. U-GL- f !75-C M'(07/10) Fate 1 of 2 Includes copyrighted material of Insurance Serv.oes Office, Inc with its permission. 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 u_ 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: 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. w• U-GL-1175-C CW (07/10) Paget of2 Includes copyrighted material of Insurance Services Office, Inc.,with ils permission. Arthur J. Calla her & Co. 505 North Brand Boulevard, Suite 600 Glendale, CA 91203-3944 20150304M40 N Electronic Service Requested ' X PO " LJ 0 MIXED AADC 970 8925 0.6871 M8 0.432 City of Ashland 204 > 90 N MOUNTAIN AVE 7 ASHLAND, OR 97520-2014 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