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HomeMy WebLinkAboutInsurance Certificate: Beynon Sports SurfacesC Page 1 of 2 A EP e, CERTIFICATES' LIABILITY INSURANCE DATE(hiMIOD/YYVY) - - 06/01/2019 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(lea)must have ADDITIONAL INSURED provisions or be endorsed. II SUBROGATION IS.WAIVED, subject to the terms and.conditions of the policy, certain policies may remilre an endorsement. A statement on this certificate does not confer rights to the certificate'holder In lieu of such endorsement(s), PRODUCER COMACT Willis Towers Watson Certificate Center Willis of Pennsylvania, Ina. - NAME: PHONE c/o 26.Century.Blvd _ , {NC No.Path 1-877-949-7378 Nol: 1-888-467-2378 • • E-MAIL - . P.O. Box 305191 . ADDRESS: Certificates @willis.cam Nashville, TN 372305191 USA _ INSURER(S)AFFORDING-COVERAGE NAIL A' . INSURER A: XL Insurance America Inc 24554 • INSURED Barron Sports Surfaces, Inc. INSURER B; Travelers Property Casualty Company of Ame 25674 19600 ew 129th Avs., suite A INSURER C( Travelers Indemnity Company of America 25666 Tualatin, OR 97062 USA - Charter Oak Fire Insurance Company 25615 • - INSURER D:. INSURER E: _ • .INSURER F.: COVERAGES CERTIFICATE NUMBER:W11157694 REVISION NUMBER: INDICATED.C TED.CERTIFY NOTWITHSTANDING.ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLWHICH 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 'AZIDL SUen LIR TYPE OF INSURANCE NW WVD POLICY NUMBER MOLICVEFF MoD/EXP • X COMMERCIAL GENERALLIABILRY (MMIDOIYYYY) (MMIOD/YYYYI LIMITS EACH OCCURRENCE •$ 1,.000,000 CLAIMS-MADE X OCCUR -OAMAGESt RENTED A PREMISES(Ea occurmgel $ 500,000 MED EXP(Any one person) $ 10,000 II500010327LI19A 05/01/2019' 05/01/202(1 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY J JEOT OTHER: LOC — • PRODUCTS-COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO • _LEA map14gn0 $ 2,000/000 e OWNED BODILY INJURY(Per•perscn) $ I •SCHEDULED TJ-CAP-8231$312A-TIL-3B 09/28/201809/28/2019 BODILY INJURY(PeraccWentl $ AUTOS ONLY AUTOS ' HIRED C nr���y nNIOTN.OWnNUIEvD X<Urnea qi oC X C,e11-DLH'$10oa JE c de DAMAGE $ UMBRELLALIAE OCCUR EXCESS DAe EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ I DED RETENTIONS - - WORKERS COMPENSATION $ AND EMPLOYERS'DABILITY V/N X I STATUTE i I ERH • C ANYPROPRIETORIPARTNER/EXECUTIVE 1,000,000 OFFICER:MEMBEREXCLUDED? No N/A TC2RUB-823x310-6-18 09/28/2018 09/28/2019 E.L.EACHACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA'EMPLDYEE $ 1,000,000 It yes.describe antler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 D Workers Compensation a TROUB-823x311-8-18 '09/28/2018 09/28/2019 E.L. Each Accident '81,OOOy 000 • Employer's Liability E.L. Disease-Pal Lot $1,000,000 Work Comp,- Per Statute E.L. Disease-Mach m@$1,oe 0,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) • WC Policies: • Policy 8TC2HUB-823x3106-18- covers all other states, Policy HTROUB-823K3118-18 - covers AZ Jilt,OR,WI only. Project Name and Description: Supply a Install Synthetic Tennis Court Surfacing at Heiman Park in Ashland, Oregon. BSS Joblt 1609-023. •CERTIFICATE.HOLDER CANCELLATION , • SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE:POLICY PROVISIONS. City of Ashland, Oregon Ashland Parke 'and Recreation Commission AUTHOR¢EDREPgESENTATIVE 340 S. Pioneer Street 4../.,144, Ashland, OR 97520 ,\rare • - ' ' ©1988-2016 ACORD CORPORATION, All rights reserved. ACORD 25•(2016/03) The ACORD name and logo are.reglstered marks ofACORD- ' SR m: 17907897' eATCH: 1179487 4of5 7790 • • • • • - C r . t • - _ ' .. .. ,.- _ , • • 4 r , • r r • • • WILLIS TOWERS WATSON 26 CENTURY BLVD. 6TH FL NASHVILLE, TN 37214 7790 2 MB 0.425 111111II1IIInIIIIIIIIIIIIIi 11111IIIIIIII1iluIIIIn1'IIIIIIIIIII CITY OF ASHLAND, OREGON 7790 340 S PIONEER ST ASHLAND PARKS AND RECREATION COMMISSION ASHLAND, OR 97520-2729 ****NOTICE**** In order to expedite distribution of certificates to Certificate Holders, we would like to begin using electronic distribution for future issuances.Also, we would like to remove any certificates that are no longer needed. If you would like to receive electronic copies in the future or no longer require a certificate for this Insured, please note as such below. Please complete this form and submit with a copy of your current certificate to the contact information below: Do y ou wish to receive renewal certificates: Ws F ] No [ Reguire_a_hard copy be mailed : No [ 7 Email Address or Fax Number: SR ID: 17907897 If you require additional information or have further questions, please feel free to contact: Willis Towers Watson Global Certificate Center Email: EDPCERTS @willistowerswatson.com Fax: 888-467-2378 Phone: 877-945-7378 Please note that it is your responsibility to provide up-to-date contact information to assure correct distribution of any future renewal certificates.