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HomeMy WebLinkAboutInsurance Certificate: Trent Kimball dba Village Taxi From: Taylor Naud Fax: (888) 820-9228 To: Fax: (541) 552-2059 Page 2 of 2 01/26/2012 9:22 AM DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/25/2018 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 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 CONTACTNAME: Roxanne Principe American Business Insurance Services, Inc. PHONE: 800-980-1950 ext 24 FAX: 800-980-1960 32107 W. Lindero Cyn Rd, Ste 120 EMAIL ADDRESS: roxanne@abiweb.com Westlake Village, CA 91361 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New York Marine & General Insurance Co 16608 INSURED INSURER B: Trent Kimball dba Village Taxi INSURER C: 75 Coolidge Street INSURER D: Ashland, OR 97520 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURENCE CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence MED FXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE POLICY PRO JECT LOC PRODUCTS - COMP/OP AGG OTHER AUTOMOBILE LIABILITY COMBINED SIGNLE LIMIT 500,000 Ea occurrence ANY AUTO BODILY INJURY (Per Person) ALLOWNED SCHEDULED BODILYINJURY(PerAccident) A AUTOS X AUTOS X AU2018TLP04661 01/25/18 01/25/19 HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEC RETENTION $ PER OTH- WORKERS COMPENSATION AND STATUTE ER EMPLOYER' LIABILITY YIN ANY PR OF 'R I ETOR/FARTN ER /EXECUTIVE/ ❑ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE Ityes, describe under E L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below A Uninsured Motorist AU2018TLP04661 01/25/18 01/25/19 25,000 per person / 50,000 per accident A Underinsured Motorist AU2018TLP04661 01/25/18 01/25/19 25,000 per person / 50,000 per accident DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) 1. 2012 Kia Sedona KNDMG4C78C6468928 2. #03 2007 Kia Sedona KNDMB233176118806 3. #4 2006 Buick Lucerne 1G4HD57256U145415 Certificate holder is listed as additional insured. '10 Day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Fax: 541-552-2059 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE q1 k V_, ea r ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD