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HomeMy WebLinkAboutInsurance Certificate: TC Chevrolet A +I °R°® CERTIFICATE OF LIABILITY DATE 1"~°D'm"' INSURANCE 011102017 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 FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER PHONE FAX HOME OFFICE: P.O. BOX 328 A/c No Ext : 888-333-4949 AJC No : 507-446-4664 OWATONNA, MN 55060 E-MAIL ADDRESS: CLIENTCONTACTCENTER FEDiNS.COM INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: FEDERATED SERVICE INSURANCE COMPANY 28304 INSURED 276-176-5 INSURER B: TC CHEVROLET INC INSURER C: PO BOX 249 ASHLAND, OR 97520 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: 0 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 DL SUER POLICY NUMBER POLICY EFF POLICY EXP LTR INSR WVD MM/DD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $500,000 CLAIMS-MADE I X] DAMAGE TO RENTED $100,000 OCCUR PREMISES Ea occurrence MED EXP (Any one person) $5,000 A N N 9918174 03/0112017 03/01/2018 PERSONAL & ADV INJURY $500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 POLICY 1-1 JECT PRO- LOC X PRODUCTS - COMPlOP AGG $1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per acciden X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $15,000,000 A EXCESS LIAR CLAIMS-MADE N N 9918175 03/01/2017 03/0112018 AGGREGATE -1 RETENTION DED I WORKERS COMPENSATION PER STATUTE OTH- AND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE EA EMPLOYEE 11 yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT AUTO DEALER LIABILITY N N 9918174 03/01/2017 03/0112018 AUTO LIAB - EA ACCIDENT $500,000 GENERAL LIABILITY A EACH ACCIDENT $500,000 -AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 276-176-5 10 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD FEDEMTED IINSURANCEqF@ To Whom It May Concern, RE: TC CHEVROLET INC Enclosed is a certificate of insurance that has been renewed for a new policy term. If a copy of an additional insured or policy endorsement was requested, the document will be sent in a separate envelope. If you have any questions regarding this please contact: the Federated Insurance Client Contact Center at: Phone: 1-888-333-4949 Fax: 507-446-4664 E-mail: clientcontactcenter@fedins.com Thank you, Client Contact Center Federated Insurance Companies Enclosed: Certificate of Insurance MISC-0974 (04-13) CE N RA S~ 1N concern, d Insurance hom It May of a Federaten a separate 1o don behalf t Will be sent Interest issues end°rsemen n Additional related to th a copy ,°f es of Insurance Encl°sed ~s ny Ge~il4Cat cost°mer ~ A envelope. ~h~~k you, contact Cent ~ ~ompan~es ~ljen rated Insuranc Fede ed~ Endorsement Encl°sonal Interest Add'it~ CSC 1og1 ~~~-151 M Additional Insured Copy POLICY NUMBER: 9918174 COMMERCIAL GENERAL LIABILITY CG 20 24 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS OR OTHER INTERESTS FROM WHOM LAND HAS BEEN LEASED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises Name Of Person(s) Or Organization(s) (Part Leased To You) CITY OF ASHLAND 403 DEAD INDIAN RD, ASHLAND, OR =20 E MAIN ST ASHLAND OR 97520 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to 2. Structural alterations, new construction or include as an additional insured the person(s) or demolition operations performed by or on organization(s) shown in the Schedule, but only behalf of the person(s) or organization(s) - with respect to liability arising out of the shown in the Schedule. ownership, maintenance or use of that part of the C. With respect to the insurance afforded to these land leased to you and shown in the Schedule. additional insureds, the following is added to However: Section III - Limits Of Insurance: 1. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted by required by a contract or agreement, the most we law; and will pay on behalf of the additional insured is the amount of insurance: 2. If coverage provided to the additional insured is required by a contract or agreement, the 1. Required by the contract or agreement; or insurance afforded to such additional insured 2. Available under the applicable Limits of will not be broader than that which you are Insurance shown in the Declarations; required by the contract or agreement to whichever is less. provide for such additional insured. This endorsement shall not increase the B. With respect to the insurance afforded to these applicable Limits of Insurance shown in the additional insureds, the following additional Declarations. exclusions apply: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to lease that land; DESCRIPTION OF INTEREST IF APPLICABLE: Insured: TC CHEVROLET INC PO BOX 249 ASHLAND OR 97520 © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 24 04 13 Policy Number: 9918174 Transaction Effective Date: 03-01-2017