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HomeMy WebLinkAboutInsurance Certificate: Humphries Family Enterprises A~~ ® F DATE (MM/DWYYYY) CERTIFICATE OF LIABILITY INSURANCE 081122019 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 ri Ms to the certificate holder in lieu of such endorsements . PRODUCER CONTACT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY "OE HOME OFFICE: P.O. BOX 328 1A CNNo Ext : 888-333-4949 a/c No : 507-446-4664 OWATONNA, MN 55060 E-MAIL ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 339-397-2 INSURER B: FEDERATED SERVICE INSURANCE COMPANY 28304 HUMPHRIES FAMILY ENTERPRISES INC, WEST COAST APPLIANCE INSURER C: 6439 CRATER LAKE HWY CENTRAL POINT, OR 97502-8405 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 45 REVISION NUMBER: 0 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. INSR1 II TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR' IN SR WVD MM/D DIYYYV MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE T RENTED CLAIMS-MADE FXJ OCCUR PREMISES Ea occurrence $100'000 MED EXP (Any one person) EXCLUDED B Y N 9284866 03/0112019 03/01/2020 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑ JE. LOC PRODUCTS - COMP/OP AGO $2,000,ODO PRO- OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY 'SCHEDULED B autos N N 9284866 03/01/2019 03/01/2020 BODILY INJURY (Per accident) H NON-OWNED PROPERTY DAMAGE HIRED AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 B EXCESS LIAB CLAIMS-MADE N N 9284867 03101/2019 03/0112020 AGGREGATE $2,000,000 LIED RETENTION WORKERS COMPENSATION X PER STATUTE OTH- AND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 A OFFICER/MEMBER EXCLUDED? 7111A N 9334540 10/0112019 10/01/2020 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under E.L DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addibnnal Remar" Schedule, may be attached it more space is required) CITY OF ASHLAND IS ADDITIONAL INSURED ON GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 339-397-2 450 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-2014 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v I A ~ O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9284866 COMMERCIAL GENERAL LIABILITY CG 20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations: Location(s) Of Covered Operations CITY OF ASHLAND ANY COVERAGE PROVIDED BY THIS 90 N MOUNTAIN AVE ENDORSEMENT APPLIES ONLY WHILE HUMPHRIES ASHLAND OR 97520 FAMILY ENTERPRISES INC IS SERVICING, INSTALLING, OR DELIVERING APPLIANCES (WHILE IN THEIR CARE, CUSTODY, OR CONTROL) TO OR FOR THE ADDITIONAL INSURED/CERTHOLDER. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage" occurring after: injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted by intended use by any person or organization law; and other than another contractor or subcontractor engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. HUMPHRIES FAMILY ENTERPRISES INC 6439 CRATER LAKE HWY CENTRAL POINT OR 97502 © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 Policy Number: 9284866 Transaction Effective Date: 03-01-2019 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or I I Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: 9284866 Transaction Effective Date: 03-01-2019 BWNDHBS 339-397-2 45 XWXW0021 XXXXXXX5# BD001-09 - 0290 CITY OF ASHLAND 90 N MOUNTAIN AVE ASHLAND OR 97520-2014