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HomeMy WebLinkAboutInsurance Certificate: Designer Signs LLC ' Policy Number: Date Entered:05/12/2017 ACOI~~® DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/4/2016 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT H011 S 1 t:Z PRODUCER NAME: y p Spitz Insurance Agency PHONE (541) 582-3123 A!c No ; (541) 582-2239 A!C No Ext ; 111 E. Main Street EMAIL holly@spitzins.com ADDRESS: Rogue River, OR 97537 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A ; W@Stern World Insurance Company INSURED Designer Signs LLC INSURER B ; SAIF COrpOratlon Stephen Morgan INSURERC;Truck Insurance Exchange 842 S Front St INSURER D Central Point, OR 97502 INSURER E INSURER F ; COVERAGES CERTIFICATE NUMBER: 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 REQU{REMENT, TERM OR CONDITION OF ANY CONTRACT OR Ol-HER 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. ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LTR 1 000, 000 j~ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ~ 5/7/2017 5/7/2oie DAMAGE TO RENTED $ 100 ~ 000 CLAIMS-MADE ®OCCUR >C NFP8192968 PREMISES Ea occurrence MED EXP (Any one person) $ 5 ~ 00~ PERSONAL & ADV INJURY $ 1 r 000 ~ GENERAL AGGREGATE $ 2 r 000 r 000 GEN'LAGGREGATE LIMIT APPLIES PER: PRO- n PRODUCTS - COMPlOP AGG $ 1 ~ ~ POLICY ~ JECT ~I LOC $ OTHER: COMBINED SINGLE LIMIT I $ 1 ~ add ~ AUTOMOBILE LIABILITY Ea accident _ ANY AUTO 60545-82-08 5/7/2017 5/7/2oie BODILY INJURY (Per person) I $ OWNED SCHEDULED BODILY INJURY (Per accident) $ C I AUTOS ONLY I~. AUTOS ~ PROPERTY DAMAGE ~ HIP,ED NON-OWNED ~ Per accident) II $ AUTOS ONLY I AUTOS ONL`' $ UMBRELLA LlAB I ~ OCCUR EACH OCCURRENCE ~ $ EXCESS LIAB CLAIMS-MADE AGGREGATE ~ $ DED RETENTIONS PER OTH- WORKERS COMPENSATION STATUTE ~ ER AND EMPLOYERS' LIABILITY 500 QQQ ~ ANY PROPRIETOR/PARTNER/EXECUTIVE i~ NIA 784962 12/1/2016 12/1/2017 E.L. EACH ACCIDENT $ ~ OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500 ~ (Mandatory in NN) If yes, describe under E.L. DISEASE -POLICY LIMIT $ 500 ~ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder's name is City of Ashland, Oregon, and It's Elected Officials, Officers and Employees Certificate holder is named as Additional Insured as follows: Blanket Additional Insured applies to General Liability per farm WW433 (09/12) attached. CERTIFICATE HOLDER CANCELLATION City of Ashland 20 East Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashland, OR 97520 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT RlZ REPRESS ATIVE 88-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD _ _ - ~.«,..r~,~~~„n D~ihliehinn S2nn_~nR_~a~~ This Endorsement Modifies Your Policy. Please Review It Carefully. ITIONAE. INSURED -OWNERS, LESSEES OR CONTRACTORS AUTOMATIC ADD TATUS WHEN REQUIRED IN A WRITTEN CONTRACT OR A CONSTRUCTION S GREEMENT WITH YOU INCLUDING PRIMARY AND NONCONTRIBUTORY A PR©ViSION AND WAIVER OF SUBROGATION PROVISION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who is an insured is amended to include as an additional insured any owner, lessee or contractor for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage or personal and advertising injury" caused in whole or in part by: 1. Your acts or omissions, 2, The acts or omissions of those acting on your behalf, and 3, "Your work", as included in the "products-completed operations hazard"; in the performance of your operations for the additional insured, B. This insurance shall not apply to claims, "suits" and/or damages arising out of the acts, omissions and/or negligence of the additional insured(s), C. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does nc.}t appiy to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. D. Primary and Noncontributory Provision The insurance afforded to the additional insured will be Primary Insurance and Noncontributory, but only if such claims, "suits" and/or damages arise out of the sole negligence of the Named Insured. E. Waiver of Subrogation Provision The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENEF~AL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against those who are added as additional insureds by this endorsement because of payments we make for injury or damage arising out of your ongoing operations or "your work" performed under a contract with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions, and/or negligence of those added as additional insureds by this endorsement. WW433 (U9112)