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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group (2) A~~ ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DCE3 NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TlIS 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 818-539-1525 Insurance Brokers of CA, Inc. License #0726293 (A/C, No, EXt): - - (A/C. No): E-MAIL u@a 505 N. Brand Boulevard, Suite 600 ADDRESS; corbee_simonea J9.com Glendale CA 91203 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :American Guarantee and Liability In .26247 INSURED TRISINS-03 INSURE:RB:ACE American Insurance Company 22667 TRISTAR Insurance Group, Inc. INSURERc.Zurich American Insurance Company__ 16535 100 Oceangate Avenue, Suite 700 INSURER D : - - Long Beach, CA 90802 - - INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 457138560 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY C X COMMERCIAL GENERAL LIABILITY CP05543602-03 1/1/2016 11112017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) 31,000,000 MED EXP (Anv one person) $10,000 X Contractual Liab PERSONAL & ADV INJURY 31,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL. AGGREGATE $ 2,000,000 POLICY PRO- JECT X LOC PRODUCTS - COMP,/OP AGG $2,000,000 OTHER: C AUTOMOBILE LIABILITY CP05543602-03 1/1/2016 1/1/2017 (Ea accident) I $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ AUTOWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS X HIRED AUTOS X NON-OWNED AUTOS er ac R entDAMAGE Comp, & Coll Ded. 3500 A UMBRELLA LIAB X OCCUR AUC5543479-03 1/1/2016 1/1/2017 EACH OCCURRENCE $ 7,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 7,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? LJ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Crime 625659223 003 1/31/2016 2/10/2016 Aggregate S 10,000,000 Errors & Omissions DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland is named additional insured under General Liability as respect.,, 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 4 . i © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD