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HomeMy WebLinkAboutInsurance Certificate: Emergency Reporting Reporting Systems ,aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 2/9/2016 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 endorsements . PRODUCER NCONTACT AME: HUB International Northwest LLC CO.N No Ext :360-647-9000 ac N.):360-734-8496 110 Unity Street E-MAIL Bellingham WA 98225 ADDRESS:now.uni info hubintern tion I.com INSURER(S) AFFORDING COVERAGE NAIC INSURER A :Lloyd's of London INSURED EMERG-1 INSURER B : dba Emergency Reporting INSURERC: Reporting Systems Inc INSURER D: 851 Coho Way Ste 301 - - Bellingham WA 98225-2021 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 863045760 REVISION NUMBER:1 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. INSRT-- ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y ESE03170977 2/6/2016 2/6/2017 EACH OCCURRENCE l $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence $250,000 ~i CLAIMS-MADE 1 OCCUR ~MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY 1 $1,000,000 f GENERAL AGGREGATE I $4,000,000 - HGEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO- LOC Deductible $5,000 AUTOMOBILE LIABILITY COMBINED IN L L I Ea accident s ANY ALL OWNED SCHEDULED BODILY INJURY (Per person) $ AUTOS TO AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ NON-OWNED - - HIRED AUTOS AUTOS Per accident $ I UMBRELLA LIAB I OCCUR EACH OCCURRENCE 1 $ EXCESS LIARETENTION$ CLAIMS-MADE AGGREGATE I,I $ $ DED A WORKERS COMPENSATION ESE03170977 2/6/2016 2/6/2017 WC STATU-OTH- Stop Gap AND EMPLOYERS' LIABILITY TORY LIMITS YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N / (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Per forms and conditions. Additional Insured form 873598 04; Waiver of Subrogation form 873599 04. 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 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD HUB International, Northwest Customer Name: Reporting Systems Inc dba Emergency Reporting To better service our customers and certificate holders we have implemented a new program for issuing certificates. An email address to send certificates expedites processing and ensures a very timely and accurate delivery. In an effort to be more Eco Friendly we are not including copies of the endorsement forms noted on the certificate. We would like to email these forms to you. Please complete and return this form or email the information to NOVY.unityinfocOhubititernational.coiai so that we may update our files to deliver these forms to you and to service your future certificate requests. If you are changing the name on the certificate, please put the name that is currently on the certificate that we sent and then the name you wish to have it changed to, so that we may locate the certificate and get it corrected. If you choose not to use this form please include our CUSTOMER'S NAME in your correspondence. Our mailing address: HUB International, Northwest, P 0 Box X, Bellingham WA 98227. Our fax number: 360-734-8496. Certificate Holder Name: Mailing Address: City, State, Zip Code: Email address: Please email me endorsement forms: Yes or No Thank you for your assistance, Commercial Insurance Department