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HomeMy WebLinkAboutInsurance Certificate: Workplace Resource of OR HMIOR-1 P I : AD ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY) 05!26!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 have ADDITIONAL INSURED provisions or 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER 360-695-3301 rcia°,N"IEACT Richard Biggs Biggs Insurance Services PHONE 360-695-3301 FAx 360-828-3801 P.O. Box 189 (AIC, No, Ext): (A1C, No): 916 Main Street ADORIESS: Rich.Biggs@Biggsinsurance.com Vancouver, WA 98666 Richard Biggs INSURERS AFFORDING COVERAGE NAIC # INSURER A :American Fire and Casualty Co 24066 INSURED HMI Oregon Dealership, Inc. INSURER B :Ohio Casualty Insurance CO 24074 dba: Workplace Resource of OR INSURER c :Ohio Security Insurance Co 24082 825 NE Multnomah St. Ste 270 Portland, OR 97232 INSURER D 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN D WVD MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BKA55589489 0610112017 0610112018 DAMAGE TO RENTED 1,000,000 X X PR MI E a occurrence $ MED EXP An one erson $ 15'000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY ~ JER~ ~ LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER _ $ A AU°,'JMOBILF. LIABILITY ~I I I COMBINED SINGLE LIMIT 1,000;(.lO(1 Ea ac~~dei~i~ _ ~ $ X ANY AUTO BAA55589489 06101/2017 06/0112018 BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'000,000 EXCESS LIAB CLAIMS-MADE US055589489 0610112017 06/0112018 AGGREGATE $ 5,000,000 DED X RETENTION $ 1 $ C WORKERS COMPENSATION X PER OTH- ANDEMPLOYERS' LIABILITY XWS55589489 06101/2017 0610112018 TAT TE ER 1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under x,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Crime 106083592 0410112017 04/0112020 ERISA 50,000 ~~SCRI~T10NhQF OP~RyTIONS ! LOCATIQN~ 1 VE}IICLES (AC~RD,1~1, Ad~~onal Remark Schedgle, may be attached if more space is required) ity o s Ian , regon, anaa i s elected o icia s, o icers an employees are primary and non-contributory additional insured with Waiver of Subrogation per CG8810 attached CERTIFICATE HOLDER CANCELLATION CITY086 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Avenue Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ~~~~i~~ ~~fii~~~9~ ~G~~6~1~~ ~~~a7~ ~94~~tid~~~~7Ff~i5E~ ~V~~~Br~. lr~~s~~~~~ 6 . 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