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HomeMy WebLinkAboutInsurance Certificate: Owen Equipment Holdings Corp DATE (MM/DD/YYY1) CERTIFICATE OF GARAGE INSURANCE 03/2012018 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 endorsements . PRODUCER CONTACT SenCustomer Service NAME Mod Matt Forman aONNo, Est: 800-447-0633 PA/C, No. 888-533-7827 EMAIL ADDRESS. bustnessproducts-ssdo@sanN/.com INSURER(S) AFFORDING COVERAGE NAIC 4 INSURER A: Sentry Select Inswance Company 21180 INSURED INSURER B: Owen Equipment Holdngs Carp INSURER C: PO Box 30959 Portland, OR 97294-3959 INSURER D : INSURER E: INSURER F : COVERAGES PROD / CUSTOMER ID: CERTIFICATE N: 1144930 REVISION 1l: 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 POLICYNUMBER POLICY EFF POLICY EXP LIMITS Lm INSRD WVD (MM/DD/YYYY) (MM/DD/YYYY) GARAGE LIABILITY (HIRED AUTOS AUTO ONLY (Ea accidon) $500,01)0 ANY AUTO IIU-II ONLY A X OWNED NON-OWNED X 2471309005 01101/2018 W10112019 OTHERTHAN EAACCIDFNT $500,000 AU--OS US AUTOS ONLY BUSINESS E AUTO ONLY AGGREGATE $ 2,500,000 GARAGE KEEPERS LIABILITY X COMP / LOC 1 $ 7,000,000 LEGAL LIABILITY PERILS LOC $ 2471309005 0110112018 01/01/2079 A' X DIRECT BASIS X X COLLISION LOC 1 $1,000,000 Mx PRIMARY EXCESS LOG $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F-] OCCUR DAMAGE TO RBNTED PREMISES aocamence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICV ❑ JECT ❑ LOG PRODUCTS - COMP/OP AGG $ OTHER $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A X EXCESS LIAB CLAIMS-MADE 2471309006 0710112078 01/01/2019 AGGREGATE $12,000,000 DED RETEYnON$ PRODUCTS-COMP/OP AGG T{{ $12,01)0,000 WORKERS COMPENSATION X STATIJIE ~R - AND EMPLOYERS' LIABILITY ANY PROPRIEFORMARTNER/D(ECUTME NIA 2471309001 W10112018 01/01/2019 91. EACH ACCIDENT $500,000 A OFRCER/MEMBERD(CWDED7 YIN (Mandatory in NH) ❑ E.L. DISEASE - EA EMPLOYEE $500,001) If yes, describe under REMARKS below EL DISEASE- POLICY LIMIT $ 500,000 REMARKS (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2D E Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Ashand, OR 97520-1814 WITH THE POLICY PROVISIONS. AU RIZ ESENTA / ACORD 30 (2016/03) Pagel of 2 © 2010-2015 ACORD CORPORATION. All rights reserved. 2471309 The ACORD dame and logo are registered marks of ACORD 03/20/2018 Sentry Select Insurance Company 1 00001 0000004464 18080 0 N E4D439DA-4FE7-40CA-9D8F-CSF9D325618A 0027020044344453392997520185020 AGENCY CUSTOMER ID: )DO0J3cees3 ACO/ZO® LOC ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Matt Farman Owen Equipment Holdings Corp POLICY NUMBER 2471308005 CARRIER NAIC CODE Sentry Salsot Insurance Company 21180 EFFECTIVE DATE 01/0112018 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Gara a Insurance Auto Dealers The City of Ashland, Oregon, its Officers, Agents and Employees are named as Additional Insured on a Primary and Non-Contributory basis. General Liability is included within the Garage Liability(ncluding products/completed operations) Garagekeepers Liability Location # State Basis Collision Limit Comp/OTC/Specified Perils Limit 2 OR Direct Coverage (Primary) $ 1,000,000 $ 1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 2471309 The ACORD name and logo are registered marks of ACORD 03/2012018 Sentry Select Insurance Company COMMERCIAL AUTO CA 88041013 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name of Person or Organization: City of Ashland Start Date of Show: End Date of Show: Event Name: Event Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section 11 - General Liability Coverages, Paragraph The person or organization listed in the Schedule D. Who Is An Insured is amended by the addition of above, but only with respect to liability arising out of the following: your "auto dealer operations" or premises owned by The following are "insureds" for "auto dealer or rented to you. operations"; All other terms and provisions of the policy remain unchanged. Change effective 03/19/2018 CA 88 04 1013 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 2471309 with its permission- 03/20/2018 Sentry Select Insurance Company 1 00002 0000004465 18080 0 N 3C7CC1 B7-622F-4D7D-9013-OAE1064DAD1 D 0027020044344453392597520185020 IL 70 58 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modes insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s) or Organization(s) including mailing address: City of Ashland 20 E Main St Ashland, OR 97520-1814 All other terms and conditions of this policy remain unchanged. Change effective 03/19/2018 - IL 70 58 0214 Page 1 of 1 2471309 03/20/2018 Sentry Select Insurance Company 3 00002 0000004465 18080 0 N 3C7=B7-622F4D7D-9013-0AE1064DAD1D 0027020044344453392597520185020