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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance ACS ® CERTIFICATE DATE (MM/DD/YYYY) OF LIABILITY INSURANCE 2/2/2017 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: Corbee Simoneau Arthur J. Gallagher & C o, PHONE 818-539-1225 FAX 818-539-1525 Insurance Brokers of CA, Inc. License #0726293 _(A/C, No, EXt): - _ (A/c, No): E-MAIL DDR corbee_simoneau@a 505 N. Brand Boulevard, Suite 600 ADDRESS: J9-com Glendale CA 91203 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 Long Beach, CA 9080' INSURERD:Great American E&S Insurance Compan 37532 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1374291839 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 CON)ITIONS OF SUCH POLICIES, t_IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A I,SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY CP05543602-04 11112017 11112018 E=ACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 XContractual Liab_ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMI- APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO X L.OC JECT PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY CP05543602 04 11112017 11112018 $ (Ea accident) 1,000,000 X ANY AUTO [30DILY INJURY (Per person) $ ALL OWNED SCHEDULED E30DILY INJURY (Per accident) $ AUTOS AUTOS ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS (Per accident) $ 'Comp. & Coll Ded $500 A UMBRELLA uAB X OCCUR AUC5543479-04 1/1/2017 1/1/2018 EACH OCCURRENCE $7,000,000 X EXCESS LIAR CLAIMS MADE AGGREGATE $7,000,00 DIED RETEW ION $ $ WORKERS COMPENSATION SPER TATUTE EORH AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNI:R/EXECUTIVE L !N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ] (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Crime DON 623670410 005 1/31/2017 1/31/2018 ,Aggregate $ 10,000,000 D Errors & Omissions TER 317-74-31 1/31/2017 1/31/2018 Aggregate $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS J VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland. Ls darned additicrnal insured under GenerEii IA-ability as respects their interest in the operaticris of the Named Insurers. 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 i © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD