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HomeMy WebLinkAboutInsurance Certificate: Brammo Inc ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/07/2012 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: Lumbermens Insurance / RiskPoint Ins Advisors HONloeXt.541.382.2421 AX No: 541.385.3231 965 SW Emkay Drive E-MAIL ADDRESS: PO Box 940 PRODUCER CUSTOMER ID Bend, OR 97709 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A : Essex Insurance Co Brammo Inc. INSURER B : 550 Clover Lane INSURER C : Ashland, OR 97520 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: Garage Keepers 2011/2012 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE ❑ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ 1,000,000 SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) 1,000,000 NON-OWNED AUTOS $ X Garage & Dealers DRL10026 07/10/2011 07/10/2012 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLLDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 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) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION FAX: 541.488.6006 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE ~~--~j~ attn : Adam hanks 20 East Main Street Ashland, OR 97520 Kathy Kaufmann/KKAUF ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ,CORD AGENCY CUSTOMER ID: LOC ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Lumbermens Insurance / RiskPoint Ins Advisors Brammo Inc. ,OLICY NUMBER Ashland, OR 97520 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance Garage Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS DLR100266 0711012011 07/10/2012 AUTO ONLY - EA ACCIDENT $ 1,000,000 A ANY AUTO OTHER THAN EA ACC $ 1,000,000 X All Owned Autos AUTO ONLY: AGG $ 2,000,000 Automobile Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) Excess/Umbrella Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS Other Liability INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS CORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD