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HomeMy WebLinkAboutInsurance Certificate: AccuSource ACCUS-1 OP ID: AMY DATE (MM/DD/YYYY) AcoRa CERTIFICATE OF LIABILITY INSURANCE 05/15/2015 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 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 endorsement(s). PRODUCER CONTACT -NAME: Sawyer Cook Insurance Sawyer Cook Insurance PHONE FAX 1200 California St., Ste 260 aC No _Ext):909-435-0230 (vc No): 909-798-7971 Redlands, CA 92374 E"MAIL Sawyer Cook Insurance ADDRESS: - - - - INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Zurich Insurance Company _ INSURED AccuSource INSURER B : Preferred Employers Insurance Lianne Charton-Holder INSURER C : Houston Casualty Company 1240 E. Ontario Ave #102 - 140 Corona, CA 92881 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMLDD YYYY FOLIC YYYY LIMITS LTR IN D WVD MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE 1XI OCCUR X PAS40515489 05/23/2015 05/23/2016 DAMAGE PREMISES TO Ea RENTED occurrence $ 2,000,000 MED EXP (Any one person) $ 10,000 P PERSONAL & ADV INJURY $ excluded GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO- 1] CT LOC j PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY 1:1 E OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ~Ea accident) A ANY AUTO PAS40515489 05/23/2015 05/23/2016 j BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident Ded $ 50 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS MADE AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY _ STATUTE ER _ B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WKN11788712 09/01/2014 09/01/2015 E.LEACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑j N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 I If yes, describe I under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ C 1,000,000 Professional Liab H714103351 05/0412015 05/04/2016 E & O 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per attached form CG20100704. 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. 20 East Main Street Ashland, OR 97520 AUTHORIZEDR ESENTATIVE Sa yer Cao Ins © 1988 P14 ACORD CORPORATION. All rights reserved. i ACORD 25 (2014/01) The ACORD name and logo are registered marks 'p ACORD Wo POLICY NUMBER: CONWERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Narra Of Additional Insured Person(s) Or Or anization(s): Location(s) Of Covered PpEations Information required to cornplete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 V1fio Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization{sj shown in the Schedule, but only sions apply: with respect to liability for "bodily injury "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; cx° repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the bcation of the the additional insured(s) at the location(s) desig-- covered operations has been completed,, or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 D