Loading...
HomeMy WebLinkAboutInsurance Certificate: Designer Signs LLC Policy Number: Date Entered: 05/04/2016 A~ Q® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/ 4/2016 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 endorsement(s). CONT PRODUCER NAMEACTHOlly Spitz Spitz Insurance Agency PHONE (541) 582-3123 AFAX/C No(541) 582-2239 111 E. Main Street c E-MAIL holly@spitzins. com Rogue River, OR 97537 A D DRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:western World Insurance Company INSURED Designer Signs LLC INSURER 8: SAIF Corporation Stephen Morgan INSURER C :Truck Insurance Exchange 842 S Front St INSURER D : Central Point, OR 97502 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 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. ADDL SUBR POLICY EFF POLICY EXP LIMITS rA rCOMMERCIALL PE OF INSURANCE POLICY NUMBER MM/DD/YYY MM/DD/YYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED lOO,OOO MS-MADE ® OCCUR X NPP8192478 5/7/2016 5/7/2017 PREMISES Ea occurrence $ MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY LOC PRODUCTS -COMP/OP AGG $1,000,000 ~ JECT 7] OTHER: $ COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY Ea accident 60545-82-08 5/7/2016 5/7/2017 BODILY INJURY (Per person) $ ANY AUTO C ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS DAMAGE NON-OWNED PROPER TYt $ HIRED AUTOS AUTOS (Per acciden $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ NIA 784 962 12/1/2015 12/1/2016 E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER (Mandatory in NH) ) EXCLUDED? Y E.L. DISEASE - EA EMPLOYEE $ 500 r 000 (Mandatory in If yes, describe under E.L. DISEASE -POLICY LIMIT $500r000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate holder is named as Additional Insured as follows: Blanket Additional Insured applies to General Liability per form WW433 (09/12) attached. Certificate holder's name is City of Ashland, Oregon, and its elected officials, officers and employees CERTIFICATE HOLDER CANCELLATION City of Ashland 20 East Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR E REPRESE In ©1 718-20114 OR CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com, Impressive Publishing 800-208-1977 This Endorsement Modifies Your Policy. Please Review It Carefully. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONTRACT OR A CONSTRUCTION AGREEMENT WITH YOU INCLUDING PRIMARY AND NONCONTRIBUTORY PROVISION AND WAIVER OF SUBROGATION PROVISION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who is an Insured is amended to include as an additional insured any owner, lessee or contractor for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: 1. Your acts or omissions, 2. The acts or omissions of those acting on your behalf, and 3. "Your work", as included in the "products-completed operations hazard"; in the performance of your operations for the additional insured. B. This insurance shall not apply to claims, "suits" and/or damages arising out of the acts, omissions and/or negligence of the additional insured(s). C. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. D. Primary and Noncontributory Provision The insurance afforded to the additional insured will be Primary Insurance and Noncontributory, but only if such claims, "suits" and/or damages arise out of the sole negligence of the Named Insured. E. Waiver of Subrogation Provision The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against those who are added as additional insureds by this endorsement because of payments we make for injury or damage arising out of your ongoing operations or "your work" performed under a contract with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions, and/or negligence of those added as additional insureds by this endorsement. WW433 (09112)