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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group (4) 1510Hi2mxr2 - y 1 ® DATE (MMIDDfYYYY) ACOZ CERTIFICATE OF LIABILITY INSURANCE 12/28/2017 111.~ r 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. O 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). PRODUCER LIC #63238 1-610-941-7751 CONTACT NAME: _ ~ Keystone Risk Partners, LLC PHONE FAX INC. NQ.ExU - - - - - A/C. No): - > E-MAIL 7_ 604 B. Baltimore Pike ADDRESS:. INSURERS AFFORDING COVERAGE NAIC I Media, PA 19063 INSURERA: Ace American Insurance Company INSURED INSURERB: AGRI GEN INS CO Trlstar Insurance Group INSURERC: 100 Oceangate INSURER D. Suite 700 INSURER E: Long Beach, CA 90802 INSURER F: COVERAGES CERTIFICATE NUMBER: 51754824 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. NOI WITHSTANDING 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 INADDL SD U D POLICY NUMBER MMIDDYIYYYY _ - LTR MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE___ DAMAGE TO RENTED CLAIMS-MADE F] OCCUR PREMISES Eaocourenceef-_- S _ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE - $ PRO- _ POLICY ECT t_ LOC PRODUCTS -COMP/OP AGG- $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea,awdent ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per aaWent) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Ler_acadenQ_ - S I UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _ f EXCESS LIAR -CLAIMS-MADE AGREGATE $ DED I RETENTIONS $ WORKERS COMPENSATION % A AND EMPLOYERS'LIABILITY SCF C64621725 (FL,OR,WI) 12/31/17 12/31/18 STATUTE ER - - - - - B ANYPRGPRIETORIPARTNERIEXECUTIVE YI❑ WLR 064621762 (TN) 12/31/17 12/31/18 E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? NIA - 12/31/18 1,000,000 A (Mandatory In NH) WLR C64621683 (AIDS) 12/31/17 E.L. DISEASE - EA EMPLOYEE $ _ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 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 ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: Rari Olson, Purchasing Rep 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ljarvis 51754824 1•• IIA FI!%I xl kc►;stonc Risk Partners, LLC 664 1.. Baltimore Pike Media, PA 19063 Electronic Bernice Requested EBIX BPO G MIXED AADC 975 6664 0.5738 MB 0.420 City of Ashland 37 10 90 N MOUNTAIN AVE > ASHLAND, OR 97520-2014 This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the insured listed - on the notice of cancellation/reinstatement.- To find out how you can send and receive all of your certificates of insurance- either by email, high speed fax or standard mail, email customercare@confirmnet.com- or visit our website at www.confirmnet.com- cc: II I III The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. ~I Certificate Delivery by CertificatesNow - www.CoritirmNet.com - 877.669.8600