HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group
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AC"Rn® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDO/YYY`f)
12 2812016
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 CONTACT
NAME: COrbee Slmoneau
Arthur J. Gallagher & Co. PHONE 818-539-1225 FAX 818-539-1525
Insurance Brokers of CA, Inc. License #0726293 (AIC, No,_Ext) - (A/c, No)
corbee_simoneauPajg.com
505 N. Brand Boulevard, Suite 600 E-MAIL
Glendale CA 91 203 INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: American Guarantee and Liability In 26247
INSURED TRISINS-03 INSURERB:ACE American Insurance Company 22667
TRISTAR Insurance Group, Inc. INSURER C: Zurich American Insurance Company 16535
100 Oceangate Avenue, Suite 700 INSURER D:Great American E&S Insurance Cam an 37532
Long Beach, CA 90802 P
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 123772544 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEI_N ISSUED TO THE INSURED NAMED AE30VE 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
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS
C X COMMERCIAL GENERAL LIABILITY CP05543602-04 11112017 1/1/2018 F-ACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR [DAMAGE TO RENTED
PREMISES (E:aoccurrence) $1,000,000
MED EXP (Any one person) $10,000
X 'Contractual Llab_ _ PERSONAL & ADV INJURY $1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
.,PCT
POLICY X LUC; PRODUCTS -COMP/OP AGG $2,000,000
OTHER: _ $
COMBINED SINGLE LIMIT
C AUTOMOBILE LIABILITY CPO5543602-04 1/1/2017 1/1/2018 (E
a accident) $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS F30DILY INJURY (Per accident) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
AUTOS (Per accident) $
Comp. & Coll Ded. $500
A UMBRELLA LIAR X OCCUR AUC5543479-04 1/1/2017 1/112018 EACH OCCURRENCE $7,000,000
X EXCESS LIAB CLAIMS MADE' AGGREGATE $7,000,000
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY Y / N STATUTE ! ER_
ANY PROPRIETOR/PARTNER/EXECUTIVE Cl N/A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) F.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
B Crime DON (323670410 004 1/31/2016 1/31/2017 Aggregate $ 10,000,000
Errors & Omissions TER 317-74-31 2/10/2016 1/31/2017 Aggregate $10,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Ashland is reamed additional. insured under- c4'eraera1 i iability as respects their interest in the
operations of
the Named Insured.
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
90 N. Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland OR 97520
USA
AUTHORIZED REPRESENTATIVE
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