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HomeMy WebLinkAboutInsurance Certificate: Stephen Morgan ' Policy Number: Date Entered: 12/07/2016 AC~RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDDIYYYY) 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). PRODUCER NAMEACTHO~ly Spltz Spitz Insurance Agency PHONE (541) 582-3123 Fax (541) 582-2239 111 E . Main Street Alc No Ext : AIC No E-MAIL holly@ spitzins . com ADDRESS: Rogue River, OR 97537 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA;Western World Insurance Company INSURED Designer Signs LLC INSURER B ;SATE 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYY A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1, 000, 000 5/7/2016 5/7/2017 DAMAGE TO RENTED $ 100 , 000 CLAIMS-MADE ~ OCCUR X NPP8192478 PREMISES Ea occurrence MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1, 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2 r 000 , 000 PRO- PRODUCTS -COMP/OP AGG ~ 1, 000, 000 POLICY ~j JECT ~ LOC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000, 000 Ea accident 160545'82-08 5/7/2016 5/7/2017 BODILY INJURY (Per person) I ~ ANY AUTO C ALL OV'JNED SCHEDULED BODILY INJURY (Per accident) ~ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE ~ HIRED AUTOS I AUTOS Per accident UMBRELLA LIAB j II OCCUR EACH OCCURRENCE i $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ ~ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN 12/1/2016 12/1/2017 E.L. EACH ACCIDENT 5 500 , 000 B OFFICERIMEMBEREXCLUDED? ~ NIA 784962 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE ~ tf yes, describe under 500 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ r DESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ii more space is required) Certificate Holder's name is City of Ashland, Oregon, and It's Elected Officials, Officers and Employees Certificate holder is named as Additional Insured as follows: Blanket Additional Insured applies to General Liability per form WW433 (09/12) attached. 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 {N Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE P SENTATIVE ©1988-201 ORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977