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HomeMy WebLinkAboutInsurance Certificate: TLC Yellow Cab dba A-Town Taxi From: Alex Haley Fax: (888) 820-9228 To: Fax: (541) 552-2059 Page 2 of 2 12/23/2016 11:52 AM qC~ a DATE (MMfDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/23/2016 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). CONTA PRODUCER N AME: CT Roxanne Principe American Business Insurance Services, Inc. AIC, No Ex :800-980-1950 ext 24 Aic,No : (800) 980-1960 32107 W. Lindero Cyn Rd, Ste 120 a DRESS: roxanne abiweb.com Westlake Village, CA 91361 INSURER(S) AFFORDING COVERAGE NAICN INSURERA : AmTrust Insurance Co of Kansas INSURED Tom Whisenant & Alice Scott INSURER B: dba TLC Yellow Cab, dba A-Town Taxi INSURER C: 3555 S. Pacific Hwy #224 INSURER D : Medford, OR 97501 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 DDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 10 REN-TED CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY CEa OMacBIN cid eEDnt SINGLE LIMIT $ 500,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCH=DULED BODILY INJURY (Per accident) $ A AUTOS X au Tos x KP P 1036080-01 01/03/2017 01/03/2018 NON-OWNED FR'OPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ UM $ 25/50 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRI=TOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 1. 1998 Pontiac Grand Prix 1G2WP52K2WF275770 Certificate holder is listed as additional insured. *30 Day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Stree ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 FAX 541-552-2059 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPO ATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD