HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group
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AC" DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 116/2016
,ii THIS CERT:'ACATE 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 endorsements .
PRODUCER CONTACT
NAME: COrbee Slmoneau
Arthur J. Gallagher & Co. PHONE 818-539-1225 FAX (Atc No): 818-539-1525
Insurance Brokers of CA, Inc. License #0726293 E-MNo, EXt): ,
E-MAIL corbee_simoneau@ajg.com
505 N. Brand Boulevard, Suite 600 ADDRESS.
Glendale CA 91 203 INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A:American Guarantee and Liability In 26247
INSURED TRISINS-03 INSURER B:ACE American Insurance Company 22667
TRISTAR Insurance Group, Inc. INSURERc:WESTCHESTER FIRE INS CO 21121
100 Oceangate Avenue, Suite 700 INSURERD:Zurich American Insurance Company 16535
Long Beach, CA 90802
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 1711843199 REVISION NUMBER:
THIS IS 10 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,
I XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR - - - - - ADDL SUBRI - POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD'. POLICY NUMBER MM/DDIYYYY MM/DD/YYYY
D X COMMERCIAL GENERAL LIABILITY CPO5543602-03 11112016 11112017 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $1,000,000
MED EXP (Any one person) $10,000
X Contractual Liab PERSONAL & ADV INJURY $1,000,000
GENT. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000
POLICY PRO-- JECT X I C1C PRODUCTS - COMP!OP AGG $2,000,000
OTHER: R
D AUTOMOBILE LIABILITY CP05543602-03 11112016 1/112017 (Ea accident) $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
X HIRED AUTOS X AUTOS (Per accident)
Comp. & Coll Dod. $500
A UMBRELLA LIAB X OCCUR AUC5543479-03 1/112016 11112017 EACH OCCURRENCE $7,000,000
X EXCESS LIAB CLAIMSMADE AGGREGATE $7,000,000
DED RETENTION $ R
-
WORKERS COMPENSATION PER OTH
STATUTE ER
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNEWEXECUTIVE r" -I. N /A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCUJDFD7
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE, $
It yes, describe under E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
F- Crime G23670410 003 1/3112015 1/31/2016 Limit of Liability $ 5,000,000
B Errors & Omissions 625659223 003 3/2/2015 1/31/2016 Aggregate $ 10,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
GL AI FORM U-GL-1175-C CW (07/10)
City of Ashland is named additional insured under General Liability as respects their interest in the operations of
the Named Insured.
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 Ave.
Ashland OR 97520 USA AUTHORIZED REPRESENTATIVE
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(c) 1988-2014 ACORD CORPORATION. All rights reserved.
arnon 2r, 17ni4init The ACORD name and logo are registered marks of ACORD
Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc.
505 N. Brand Boulevard, Suite 600
Glendale, CA 91203
3568 2 MB 0.436
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CITY OF ASHLAND
C-3568
90 N MOUNTAIN AVE
ASHLAND, OR 97520-2014