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HomeMy WebLinkAboutInsurance Certificate: Village Taxi - Trent Kimball From: Alex Haley Fax: (8^08) 320-9228 To: +15415522059 Fax: (541) 552-2059 Page 2 of 2 01/2512017 3:12 PM DATE (MMIDDIYYYY) ACOR[~® CERTIFICATE OF LIABILITY INSURANCE 01/25/2017 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: Roxanne Principe American Business Insurance Services, Inc. AIC No EX : 800-980-1950 ext 24 A/C No): (800) 980-1960 32107 W. Lindero Cyn Rd, Ste 120 a DRESS: roxanne@abiweb.com Westlake Village, CA 91361 INSURER(S) AFFORDING COVERAGE NAIC a INSURERA : New York Marine & General Insurance Co 16608 INSURED INSURER B : Trent Kimball dba Village Taxi INSURER C: 75 Coolidge Street INSURER D : Ashland, OR 97520 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 LTR INSD WVD POLICY NUMBER MM/DDIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -DATTAG EIaTEL CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP (Any ore person) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER : GENERALAGGREGATE $ POLICY F-] PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ JE CT OTHER: $ AUTOMOBILE LIABILITY CC""BINED SINGLE LIMIT $ 500,000 Ea accident ANY AUTO EODILY INJURY (Per person) $ ALL OWNED SCHEDULED EODILY INJURY (Per acciden') $ A AUTOS X AUTOS AU2017TLP04661 01/25/2017 01/25/2018 NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UM/UIM $ 25/50 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y I N STA-UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTICN OF OPERATIONS below E.L. DISEASE - PCLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 1. 4 2006 Buick Lucerne 1G4HD57256U145415 2. 03 2007 Kia Sedona KNDMB233176118806 3. 2012 Kia Sedona KNDMG4C78C6468928 *10 Day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION CI of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax: 541-552-2059 ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE \44 © 1988-2014 ACORD CORPO ATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD