HomeMy WebLinkAboutInsurance Certificate: Ashland Towing & Texaco
Ate" ® CERTIFICATE DATE (MM/DD/YYYY)
~ OF LIABILITY INSURANCE 07/22/2016
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 j
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 policu(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorseineiit. A statement on this certificate does not confer rights to the ~
j certificate holder in lieu of such endorsement(s). _
CONTACT
PRODUCER 541-895-4515 541-741-9175 NAME_ _Ryan HOffstot
Hoffstot Insurance Agency Inc. to C. E . xt)_ 541-_8.95-4515 Fax - -
tA/c Not: 541-741-_917.5 _
PO Box 219 I.ADDOESS.;_ rhOffstotl@farmersagent.com -
!Creswell, OR 97426 'INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Truck Insurance Exchnae 21_709 INSURED mSURER B :
- - -
Mawje Inc. iVSURER C :
DBA Ashland Towing and Texaco INSURER D :
PO Box 715 I INSURER E :
Ashland OR 97520 INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA\/E 3EEN ISSUED TO THE INSURED NAMFn ABOVE FoR THE PCI,-ICY PERIOD
iNDII-ATED. NOI-WITHSTANDING 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 i ADDL;SUBR POLICY EFF POLICY EXP j
LTR TYPE OF INSURANCE I D : WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY , LIMITS
V , COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE S1,000,000
A DAMAGE TO RENTED
CLAIMS MADE OCCUR PREMISES (Ea occurrence) $ 100,000
604-72648
08/19/2016 08/19/2017 ; MED EXP (Any one person) $ 5,000 _
PERSONAL & ADV INJURY $ 1'000'0)0
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,0(0,000
PRO `PRODUCTS - COMP/OP AGG I
{ ! POLICY JECT
I.OC $ 2,000,000
- _
i--- OTHER: - i $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
JEaaccident $ 1,000,000
A ANY AUTO BODILY INJURY (Per person) I $ 1
I~ ALL OWNED -7 SCHEDULED
I AUTOS AUTOS 604672648 08/ 10!2016 08/19/2017 ; BODILY INJURY (Per accident) ; $
NON-OWNED
HIRED AUTOS PROPERTY DAMAGE
AUTOS $ I
Per accident)
i Garage 77 Aggregate $ 2,000,000
UMBRELLA LfA6 f OCCUR J EACH OCCURRENCE S 1 ,000,000
A EXCESS LIAe - -
CLAIMS-MADE, 604672650 _
i AGGREGATE $ 1,000,000
DED ! RETENTION $ - - 08/19i2016 08/1912017
i WORKERS COMPENSATION PER ! 0TH-
} AND EMPLOYERS' LIABILITY Y / N STATUTE ER
{ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE; S
If yes, describe under - j-
DESCRIPTION OF OPERATIONS below E.I_. DISEASE -POLICY LIMIT ' $
A Garagekeeper/On Hook ✓ 604672648 08/19/2016 08/19/20171$250,000 !
$1,000 Comp ded/$500 Coll Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORO 101, Additional Re.-marks Schedule, may be attached if more space is required)
There is 30 day notice of cancellation on all policies
The City of Ashland, Oregon, and its eie%cted officials, officers and employees are named as an
additional insured
I
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CERTIFICATE BOLDER CANCELLATION
Additional Insured:
! The City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
i 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS. 1
Ashland, OR 97520 i
y AU iHOR1Zc0 RE SE TIVE
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1W-2014 ACORD A ON. All rights reserved.
ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD X