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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group (2) P52e1M12a1g2 ACt>Ri® DATE(MMIDD/YYYY) - CERTIFICATE OF LIABILITY INSURANCE 12/21/2015 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. TM,IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED w REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. N IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to O 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 LIC #63238 1-610-941-7751 CONTACT NAME: Keystone Risk Partners, LLC PHONE 'FAX (A/C, No. Ego: (ac, No): EMAIL 604 E. Baltimore Pike ADDRESS: PRODUCER Media, PA 19063 CUSTOMER 10 N, INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED INSURER A: Ace American Insurance Company Tristar Insurance Group INSURER B: 100 Oceangate INSURER C: Suite 700 INSURER0 Long Beach, CA 90802 INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER: 45658349 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 ADDL SUER - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDOMYY MMIDDNYYY GENERAL LIABILITY EACH OCCURRENCE $ 'DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ ,II GENERAL AGGREGATE iV$ GEN'L. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICYI PRO- LOC $ AUTOMOBILE LIABILITY X11 COMBINED SINGLE LIMIT $ (Ea accidenQ ANY AUTO BODILY INJURY (Per person) $ I i ALL OWNED AUTOS j BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE$ HIREDAUTOS (Per accident) I NON-OWNED AUTOS II $ $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE li AGGREGATE $ DEDUCTIBLE $ RETENTION $ I, $ ICER A I, WORKERS COMPENSATION IWLR C48593343 (AOS) 12/31/1'~ 12/31/16 X WC STATU-$ I ER AND EMPLOYERS' LIABILITY Y I H TORY LIMIT j ANY PROPRIETOR)PARTNER)EXECUTIVE j E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? I N/A 1, 000, 000 (Mandatory in NH) j E.L. DISEASE - EA EMPLOYEE, $ It yes. describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ WC-Agri Genera Insurance WLR 048593367 Tennessee WC-ACE Fire Underwriters ISCF 048593355 12/31/15 12/31/16 Wisconsin DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) 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: Kari Olson, Purchasing Rep 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 USA ~ a ljarvis ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 45658349 ~Y521AN1251 Nil Keystone Risk Partners, LLC 604 E. Baltimore Pike Media, VA 19063 Electronic`'Service Requested Epp I/~ B PO w 0 MIXED AADC 975 17039 0.5234 M8 0.436 11111-11111111 Jill City of Ashland Ij7 90 N MOUNTAIN AVE ASHLAND, OR 97520-2014 w This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed - on the notice of cancellation/reinstatement.- To find out how you can send and receive all of your certificates of insurance- either by email, high speed fax or standard mail, email customercare@confirmnet.com- or visit our website at www.confirnmet.com- 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