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HomeMy WebLinkAboutInsurance Certificate: Ross Recreation Equipment ROSSR-1 OP ID: CH 2015 ) CERTIFICATE OF LIABILITY INSURANCE 0 F D9/30/ /2015 09/30 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 _Jeff Suhr Risk Services NAME; State, CRIB, CWCS 5300 PHONE FAX 5300 Stevens Creek Blvd. aHC No Ext :408-510-5440 vc No San Jose, CA 95129 E-MAIL - Jeff State - House ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A : Indian Harbor Insurance Co. 36940 INSURED Ross Recreation Equipment INSURER B :OBE Insurance Company 11515 Company, Inc. 100 Brush Creek Road, Ste 206 INSURER C : Oak River Insurance Co. 34630 Santa Rosa, CA 95404 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS iS TO CERTIFY THAT THP POLICIES OF INSUR-' NCE 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 DDL UB - LTR TYPE OF INSURANCE POLICY NUMBER MM DD/YYYY MM1DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X ESG3000514 10/15/2014 10115/2015 IIEMISES Ea occurrence $ 50,00 CLAIMS-MADE OX OCCUR I MED EXP (Any one person) _ Exclude Deductible $5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-GO OP/AGG $ 2,000,00 POLICY jF-- PjFCT 17 RO- LOC I Emp Ben. { $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea acci ED _ $ B X ANY AUTO q PX810031 10/15/2014 10115/2015 BODILY INJURY (Per person) I $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS i ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS I PER ACCIDENT $ $ UMBRELLA LIAR LJ OCCUR EACH OCCURRENCE f EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N X TORY LIMITS ER_ C ANY PROPRIETOR/PARTNER/EXECUTIVE I ROWC603433 10/01/2015 10/01/2016 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? r N ! A - (Mandatory in NH) I, E.L. DISEASE - EA EMPLOYE $ 1,000,00 I. If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 I I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PW: The City of Ashland, Oregon, and its elected officials, officers and employees are named as additional insured per attached endorsement form CG2010. RE: Garfield Park CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland, Oregon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD