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HomeMy WebLinkAboutInsurance Certificate: Emergency Reporting ,acoR~ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/1612017 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 endorsements . PRODUCER CONTACT NAME: HUB International Northwest LLC P"c No Ext :360-647-9000 a No :360-734-8496 110 Unity Street E-MAIL Bellingham WA 98225 ADDRESS:now.unit info hubinternation Isom INSURER S AFFORDING COVERAGE NAIC # INSURER A :Ohio Securlt Insurance Com an 4 82 INSURED REPOSYS-01 INSURER B :Underwriters at Llo d's London 15792 Reporting Systems, Inc. INSURER c DBA Emergency Reporting INSURER D 2200 Rimland Drive, Ste. 305 Bellingham WA 98226 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 2121068799 REVISION NUMBER:1 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 LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS B GENERAL LIABILITY Y Y ESF04237170 21612017 61112018 EACH OCCURRENCE $2,000,000 X ~ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $250,000 CLAIMS-MADE a OCCUR ~ i MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 X POLICY PRO LOC Deductible $5,000 A AUTOMOBILE LIABILITY BAS58032894 6/112017 6/112018 Ea accdentSlN L LI I 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION ESF04237170 21612017 611/2018 WC STATU- X oTH- Sto Ga AND EMPLOYERS' LIABILITY YIN Y IMI R p A ANY PROPRIETORlPARTNER(EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N ! A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT ~1,DOG,000 ~I DESCRIPTION OF OPERATIONS !LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Per forms and conditions. Additional Insured form 873598 04; Waiver of Subrogation form 873599 04. 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 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010!05) The ACORD name and logo are registered marks of ACORD