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HomeMy WebLinkAboutInsurance Certificate: Galli Group 0 DATE (MM/DD/YYYY) A~~ 0 CERTIFICATE OF LIABILITY INSURANCE 11/29/2016 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 have ADDITIONAL INSURED provisions or 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). C NTACT PRODUCER NAME: Mist D Whorle Hart Insurance Agency PHONE PO Box 1240 (A/C. No. x : (541) 479-5521 Arc No: E-MAIL ADDRESS: Grants Pass OR 97528 INSURERS AFFORDING COVERAGE NAIC # INSURER A : Ohio Security Insurance Co 41939 INSURED (541) 955-1611 INSURER B: SAIF Corporation 36196 The Galli Group PC INSURER C : 612 NW 3rd Street INSURER D : Grants Pass OR 97526 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 2000 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. ADDL SUB POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE rxl OCCUR BZS56410713 01/11/2017 01/11/2018 PREMISES Ea occurrence $ 11000,000 MED EXP (Any one person) $ 15,000 000 PERSONAL BADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000, 000 i O 0 0 , 0 0 0 POLICY ~ JE PRO ~ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000 Ea accident A X ANY AUTO BAS56410713 01/11/2017 01/11/2018 BODILY INJURY (Per person) $ OWNED SCHEDULED . BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS I PROPERTY DAMAGE HIRED NON-OWNED i $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ I ! $ PER WORKERS COMPENSATION i 1948255 11/O1/2016f' 11/01/2017 X I STATUTE I OERH B AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN N ! A E.L. EACH ACCIDENT $ 500,000 OFFICERWEMBEREXCLUDED? y 500,000 (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ _ If yes, describe under I I 500, 000 DESCRIPTION OF OPERATIONS below t E.L. DISEASE - POLICY LIMIT $ S j i I $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Ashland Loop reservoir project CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1