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HomeMy WebLinkAboutInsurance Certificate: AccuSource ACCUS-1 OP ID: RB CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/09/2016 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). PRODUCER CONTACT NAME: HUB International Insurance Sawyer Cook Insurance PHONE FAX 1200 California St., Ste 260 A/c No Ext : 909-379-1322 A/C, No : Redlands, CA 92374 AD RIESS: Robbin.McGinnis@hubinternational.com Sawyer Cook Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich Insurance Company INSURED AccuSource INSURER B : Preferred Employers Insurance 10900 Lianne Charton-Holder INSURER C : Houston Casualty Company 1240 E. Ontario Ave #102 -140 Corona, CA 92881 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N,AI IED 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 IN D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS-MADE X OCCUR X PAS40515489 105/23/2016 05/23/2017 DAMAGE TO RENTED 2,000,00 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ exclude GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 POLICY F-] PRO- ❑ JECT LOC PRODUCTS -COMP/OP AGG $ 4,000,00 I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS AUTOS I Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N WKN11788712 09/01/2015 09/01/2016 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N / A j (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under OESCRIP i iON OF OPLRAI IONS below I I ! C.L. Di3EASE -POLICY LltvilT $ 1,00!',00 C Professional Liab H716-107801 05/04/2016 05/04/2017 E&O 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per attached form CG20100704. 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. 90 N. Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Sawyer Cook Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 0826 Bft L AQLI 1 )11J ER Tf✓ f'R©DUCE( NUMBER Afv I CC©LJN :NUMBER DIM: D PAS 40515489 17632951 F001205647-001-00001 NONE BRANCH GR GRAND RAPIDS RENEWAL EFF 05/23/2016 [~]*FOREMOST INSURANCE GROUP PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (CON i iNUED) . :FART#S ; ill .EQR[Uf f : . R ENT: ~ NUMBER: a= CSR :>;4t{10 M QR. ;:1V1AOR>~MENT::;:S~ JPP1htT4lr;:::kNFC~RMATt+I: ADDITIONAL INSURED - OWNERS, LESSEES OR LIABILITY CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION NAME OF ADDITIONAL INSUREDS PERSONS ) OR ORGANIZATION(S) CG2010 0704 NAME 1 CITY OF ASHLAND NAME 2 ADDRESS 1 90 N. MOUNTAIN AVE ADDRESS 2 CITY ASHLAND STATE OR ZIP 97520 LOCATION(S) OF COVERED OPERATIONS TBD COMMERCIAL GENERAL LIABILITY 955008 Ed, 3-00 INSURED'S COPY 04/12/2016 PAGE 7 OF 10