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HomeMy WebLinkAboutInsurance Certificate: Boterman's Inc -1 BOTER-1 OP ID: SKA E(MM/DD/YYYY) ~ R~ CERTIFICATE OF LIABILITY INSURANCE 70T6/22/2015 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). CONTACT PRODUCER NAME: Franchise Division Dawson Franchise Insurance Div PHONE 440-333-9000 aFAX c No): 440356-2126 1340 Depot Street AC, Lo Ext Cleveland, OH 44116-1799 ADDRESS: Franchise Division INSURERS AFFORDING COVERAGE NAIC # INSURER A: American Cas Co of Reading, PA 20427 INSURED Boterman's Inc. INSURER B: American Fire & Casual Co. 24066 2821 Bullock Road INSURER C : The Travelers Insurance Co. Medford, OR 97504 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. ADDL SUB POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 ❑X B2084358897 07/01/2015 07/01/2016 DAMAGE TO RENTED 300,00 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,00 PRODUCTS - COMP/OP AGG $ 4,000,00 POLICY ❑ PRO ❑ LOC JECT OTHER: AUTOMOBILE LIABILITY EOa aBINEDtSINGLE LIMIT $ 1,000,00 B X ANY AUTO BAA1556124220 07101/2015 07/01/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ - WORKERS COMPENSATION PERSTATUTE EROTH AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N11 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below C Professional 105636058 07/01/2015 07/01/2016 Limit 500,00 Liability Deduct 10,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured: The City of Ashland, Oregon, and it's elected officials, officers and employees are additional insured only with respect to the contractor's services to be provided under contract. 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 Avenue Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD