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HomeMy WebLinkAboutInsurance Certificate: Owen Equipment Holdings Corp • / ' DATE(MDD/YYYY) ACORN® M/ 4......----- CERTIFICATE OF GARAGE INSURANCE 02/04/2019 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 CONTACT Sentry Customer Service — NAME: Cameron Scott WC,No,Et): 800-473-6879 I FA,No):800-514-7191 EMAIL busine roducts_dired @sentycom ADDRESS: uP INSURER(S)AFFORDING COVERAGE NATO N INSURER A:Sentry Select Insurance Company 21180 INSURED INSURER B: Owen Equipment Holdings Corp INSURER C: PO Box 30959 Panland,OR 97294 INSURER D: INSURER E: INSURER F: COVERAGES PROD/CUSTOMER ID: CERTIFICATE 8: 1457626 REVISION H: 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. IN$R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY E%P LIMITS LTR INSRD WVD (MM/DD/YYYY) (MM/DD/YYYY) GARAGE LIABILITY HIRED AUTOS AUTO ONLY(Ea accident) $500,000 ANY AUTO ONLY A OWNED AUTOS USED X A0120217004 01/01/2019 01/01/2020 OTHERTHAN EA NT $500,000 AUTOS ONLY IN GARAGE BUSINESS AUTO ONLY AGGREGATE $2,500,000 GARAGE KEEPERS LIABILITY X COMP P/ LOC 1 $1,000,000 LEGAL LIABILITY SPECIFIED LOC $ A DIRECT BASIS X A0120217004 01/01/2019 01/01/2020 — X X COLLISION LOC 1 $1,000,000 X PRIMARY n EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE n OCCUR PREMISEES TO(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMB"APPLIES PER: GENERAL AGGREGATE $ POLICY ri JEGO"f- ❑ LOC PRODUCTS-COMP/OP AGG _ $ OTHER I 1 $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $10,000,000 A X EXCESS LIAR CLAIMS-MADE A0120217009 01/01/2019 01/01/2020 AGGREGATE $30,000,000 DED I I RETENTION$ _ PRODUCTS-COMP/OP AGG $30,000,000 R- ! WORKERS COMPENSATION X I STATUrE I I AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/D(ECUTNE N/A A0120217001 01/01/2019 01/01/2020 E.L.EACH ACCIDENT' $500,000 A OFFICER/MEMBER EXCLUDED? Y/N (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe undo REMARKS below E.L.DISEASE-POUCY LIMIT $500,000 REMARKS(ACORD 101,Additional Remarks Schedule,may be 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 20 E Main St THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE Ashland,OR 9752 0-1 61 4 WITH THE POLICY PROVISIONS. AU Rlli( BErESENTA71VQ / ACORD 30(2016/03) Page 1 of 2 02010-2015 ACORD CORPORATION.All rights reserved. A0120217 The ACORD name and logo are registered marks of ACORD 02/04/2019 Sentry Select Insurance Company 1 00001 0000007340 19035 0 N BCCF89E4-161C-4D75-BC61-B81E44D05481 0027020044349612950897520185020 AGENCY CUSTOMER ID:)00000(6858 ACO O LOC e: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Cameron Scott Owen Equipment Hdtlings Cap POLICY NUMBER A0120217004 CARRIER NAIC CODE Senty Select Insurance Company 21180 EFFECTIVE DATE: 01/01/2019 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Garage 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 Uability(including products/completed operations). Garagekeepers Liability Location # State Basis Collision Limit Comp/OTC/Specified Perils Limit 2 UT Direct Coverage(Primary) $ 3,250,000 $ 3,250,000 3 CA Direct Coverage (Primary) $ 750,000 $ 750,000 4 WA Direct Coverage(Primary) $ 1,000,000 $ 1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All tights reserved. A0120217 The ACORD name and logo are registered marks of ACORD Sentry Select Insurance Company 02/04/2019 COMMERCIAL AUTO CA88041013 THIS ENDORSEMENT CHANGES 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 II - 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. CA 88 04 10 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0120217 with its permission. 02/04/2019 Sentry Select Insurance Company 00002 0000007341 19035 0 N FC5DAE7B-E219-413D-BCF9-ED89657604D5 0027020044348612903097520185020 IL 70 58 0214 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies 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. IL 70 58 0214 Page 1 of 1 A0120217 02/04/2019 Sentry Select Insurance Company 3 00002 0000007341 19035 0 N FC5DAE7B-E219-4130-BCF9-ED896576040.5 0027020044348612903097520185020