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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group (3) I'i?hl N)?}SIN Il DATE (MM/DDIYYYY) ACC>RV CERTIFICATE OF LIABILITY INSURANCE 12/29/2016 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. u IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to C 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 LIC #63238 1-610-941-7751 CONTACT NAME: _ Keystone Risk Partners, LLC PHONE FAX -(ate. Hs ~xf)_ - - - - - - - A1clNo - - - - E-MAIL 604 R. Baltimore Pike ADDRESS; PRODUCER Media, PA 19063 Su6TQMER-1Qi--------------------____ - INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A : Ace American Insurance Company Tristar Insurance Group INSURER B : AGRI GRN INS 100 OCeangate INSURER C_ Suite 700 INSURER 0: Long Beach, CA 90802 - - - - - INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 48803949 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 DGCvi1ENT WITH RESPECT TO WHICH 1 HIS 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 !NSR POLICY NUMBER MMIDDIYYYY MMIDDNYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES LEa occurrence) $ CLAIMS-MADE CJ OCCUR MED EXP (Any one person) PERSONAL $ ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO - - - BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ _ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE - $ - ` _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DEDUCTIBLE RETENTION $ $ WC STATU- OTH- A WORKERS COMPENSATION SCF C49102756 (WI) 12/31/1( 12/31/17 _~XIIDBYIAIffal L-0- AND EMPLOYERS' LIABILITY - - B ANY PROPRIETORPARTNEREXECUTIVE Y WLR 049102768 (TN) 12/31/1 12/31/17 E.L. EACH ACCIDENT - $ 1,000,000 - OFFICERIMEMBEREXCLUDED9 0 NIA WLR 044102744 (A05) 12/31./1 12%31/i7' _ 1,0U-0 ,ti0U A (Mandatory in NH) E.L. DISEASE, EA EMPLOYE $ yes, describe under - 1, 000, 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: Kari Olson, Purchasing Rep 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520( USA c~ \1 ljarvis ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 48803949