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HomeMy WebLinkAboutInsurance Certificate: Cygnet Enterprises Inc ACO ® DATE (MMIDDIYWY) CERTIFICATE OF LIABILITY INSURANCE 02/01/2018 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). PRODUCER NCONTACT AME: Heather Skinner Peabody Insurance Agency, Inc HONK Ext : (810) 629-1504 .AC, No l: (810) 629-2822 265 N, Alloy Dr. h-MAIL s: hskinner@peabodyinc.com DDRES INSURER(S) AFFORDING COVERAGE NAIC 0 Fenton MI 48430 INSURER A : Associated Industries Ins Co 524126 INSURED INSURER B : Cincinnati Insurance Company 10677 Cygnet Enterprises Inc INSURER C : Cincinnati Casualty Co. 28665 1660 Bagwell St INSURER D : Capitol Specialty Ins Corp INSURER E Flint MI 48503 INSURER F COVERAGES CERTIFICATE NUMBER: CL182102447 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE13 CLAIMS-MADE F_]OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 A Y AES104461500 02/01/2018 02/01/2019 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000 POLICY El PRO JECT El LOC PRODUCTS - COMP/OP AGG $ OTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED CPA 1070419 02/0112018 02/01/2019 BODILY INJURY (Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accdent X Uninsured motorist BI $ X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS LIAB CLAIMS-MADE CPP 1070419-UMB 02101/2018 02/01/2019 AGGREGATE 5 3,000,000 DED RETENTION $ $ WORKERS COMPENSATION PEAT EMPLOYERS' LIABILITY YIN STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE F-] NIA EWC 0420547 02101/2018 02/01/2019 E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED' (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Transportation Pollution Aggregate 2,000,000 D ENVP00770502 02/01/2018 02/0112019 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland and its elected officials, officers and employees are named Additional Insured with regards to the General Liability. 30 day notice of cancellation applies. This insurance is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD