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HomeMy WebLinkAboutInsurance Certificate: Newco Inc ~C01Ra CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/31/2016 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 CONTACT NAMEO DML Insurance Services P HONE (206)838-9077 FAX (206)838-9076 4005 20th Ave W Ste 132 E-MAIL Seattle WA 98199-ADDRESS6 INSURER S AFFORDING COVERAGE NAIC # INSURER A :ACE Property & Casualty Ins Co INSURED Newco, Inc INSURER B: Illinois Union Insurance . Cascade Columbia Distribution Company INSURER C : 6900 Fox Ave S INSURER D : Seattle WA 98108- 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 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 NUMBER (MMIDDIYYYY) POLICY EFF POLICY EXP LIMITS _LTR B X COMMERCIAL GENERAL LIABILITY APC G28181279 001 10/31/2016 1 0/31/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ~ OCCUR DPREMISES (Ea occurrence) AMAGE TO RENTED $ 1,000,000 X Pollution Liability 10,000 MED EXP (Any one person_ _ - - 1,000,000 X Vendors Liability PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2+000+000 POLICY JERT a LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER- $ A AUTOMOBILE LIABILITY PMU H08464327 001 10/31/2016 10/31/2017 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) B UMBRELLA LIAB X OCCUR XOO 628181280 001 10/31/2016 10/31/2017 EACH OCCURRENCE $ 20,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 20+000+000 X 10,000 QFn B WORKERS COMPENSATION APC 628181279 001 10/31/2016 :10/31/2017 PER oTH-ISTATUTE ER AND EMPLOYERS' LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Ga E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A p (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION F OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Al 1570 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Kari Olson - Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. 90 N Mountain Avenue Asland OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD