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HomeMy WebLinkAboutInsurance Certificate: AccuSource (2) ACCUS-1 OP ID: RB A~oRO CERTIFICATE OF LIABILITY INSURANCE 1 D2/21/20YYYY) 12/21 /2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DS)ES 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 Sawyer Cook Insurance PHONE __Sawyer Cook Insurance FAX 1200 California St., Ste 260 -(A LC No, EXtl: 909-435-0230 (A/C 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 110900 Lianne Charton-Holder - INSURER 1240 E. Ontario Ave #102 - 140 INSURER c :Houston Casualty Company 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 TYPE OF INSURANCE ~DDL,~SURI -F POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 r CLAIMS-MADE A X PAS40515489 05/23/2015 05/23/2016 DAMAGE TO RENTED L-i OCCUR ;PREMISES Ea occurrence $ 2,000,000 _ _ MED EXP (Any one person) $ 10,000 ~PERSONAL & ADV INJURY $ _ _excluded GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4'000,000 _X POLICY _Jr--1 JECT L LOC III ~ - PRODUCTS -COMP/OP AGG $ 4,000,000 OTHER'. $ AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A - ANY AUTO PAS40515489 05/23/2015 j 05/23/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) 1 X NON-OWNED PROPERTY DAMAGE ~ HIRED AUTOS X AUTOS ; - i Per accident $ Ded $ 50 UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ j - EXCESS LIAB CLAIMS-MADE AGGREGATE DED RET ENTION $ $ - WORKERS COMPENSATION PER OTH- !AND EMPLOYERS' LIABILITY Y / N !X -L STATUTE ER B i:ANY PROPRIETOR/PARTNER/EXECUTIVE WKN11788712 09/01/2015 09/01/2016 E.L. EACH ACCIDENT Is 1,000,000 OFFICER/MEMBER EXCLUDED? N/A I (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under j - DESCRIPTION OF OPERATIONS below ~ E.L. DISEASE - POLICY LIMIT $ 1,000,000 C 'Professional Liab H714103351 05/04/2015 05/04/2016 E & 0 1,000,000 I I I DESCRIPTION OF OPERATIONS / LOCATIONS / 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 City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Sawyer Cook Insurance ©1988 2014 ACORD CORP RATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 6762 BILL ' POLICY NUMBER '7C PRODUCER NUM13ER. ~ AG ACCOUNT NUMBER 1 AUDJT D PAS 40515489 17632951 F001205647-001-00001 NONE BRANCH GR GRAND RAPIDS ENDORSEMENT EFF 12/09/2015 FOREMOST' INSURANCE GROUP PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (CONTINUED) COVERAC PART(S) AND FORM FORM OR ENDORSEMENT NAME AND OR ENDORSEMENT NUMBER FORM OR ENDORSEMENT SUPPLEMENTAL INFORMATION ADDITIONAL INSURED - OWNERS, LESSEES OR LIABiLiTY CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION NAME OF ADDITIONAL INSUREDS PERSON(S ) OR ORGANIZATION(S) CG2010 0704 NAME 1 CITY OF ASHLAND NAME 2 ADDRESS 1 90 N. MOUNTAIN AVE ADDRESS 2 CITY ASHLAND STATE OR ZIP 97520 LOCATION(S) OF COVERED OPERATIONS TBD COMMERCIAL GENERAL LIABILITY BS5008 Ed. 3-00 INSURED'S COPY 12/10/2015 PAGE 5 OF 8