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HomeMy WebLinkAboutInsurance Certificate: JviationACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/019 Y) 12/zo/2o 1 s 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 Leigh Pullen NAME: Moody Insurance Agency, Inc. A No Ext : (303) 824-6600 aC, No): (303) 370-0118 E-MAIL leigh.pullen@moodyins.com ADDRESS: 8055 East Tufts Avenue INSURER(S) AFFORDING COVERAGE NAIC # Suite 1000 INSURERA: Travelers Indemnity of America 25666 Denver CO 80237 INSURED INSURER B: Travelers Indemnity Company 25658 INSURER C : Lexington Insurance Co 19437 JVlatlon, Inc. INSURER D : 900 S. Broadway INSURER E : Suite 350 INSURER F : Denver CO 80209 COVERAGES CERTIFICATE NUMBER: 20/21 Master 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 LTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 1,000,000 $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A 68031<605697 01/01/2020 01/01/2021 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY PRO ❑ LOC JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY HAUTOS ONLY BA31<607433 01/01/2020 01/01/2021 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 9,000,000 B EXCESS LIAB CLAIMS -MADE CUP31<612467 01/01/2020 01/01/2021 AGGREGATE $ 9,000,000 DED I X1 RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED. (Mandatory in NH) N/A UB3K609703 01/01/2020 01/01/2021 X STATUTE ORH E.L. EACHACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below Each Claim Limit 5,000,000 C Primary Professional 031711172 01/01/2020 01/01/2021 Aggregate Limit 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon, and its elected officials, officers and employees are included as Additional Insureds on the General, Automobile and Umbrella Liability Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. RFRTIFICATG WrIl IIFR CANCFI 1 ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 mow @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ACORU� ADDITIONAL REMARKS SCHEDULE Page of AGENCY Moody Insurance Agency, Inc. NAMED INSURED Jviation, Inc. POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes Coverage Lines: Aviation Insurance Policy/Unmanned Aircraft Policy Number: 9008387. Policy Effective Dates: 01/01/2020- 01/01/2021. Insurer: American Alternative Insurance Corp. Limits of Insurance: Each Occurrence Limit $3,000,000. Passenger War Liability Included. Medical Limit $5,000. Pollution Liability Policy: Policy Number: 031711172 Policy Effective Dates: 01/01/2020 — 01/01/2021 Insurer: Lexington Insurance Co. Pollution Liability Limit: $5.000,000 Each Pollution Condition Cyber Liability Policy: Policy Number: EVOPNZ490793 Policy Effective Dates: 01/01/2020 — 01/01/2021 Insurer: Evolve MGA Cyber Liability Limit: $1,000,000 Deductible: $10,000 General Liability CG D3 81 09 15 - Blanket Additional Insured Status When Required by Written Contract CG D3 81 09 15 — Blanket Waiver of Subrogation Status When Required by Written Contract CG D3 79 01 16 -Architects, Engineers and Surveyors Coverage Xtended Endorsement - Blanket Additional Insured, Blanket Waiver of Subrogation CG D4 69 07 14 - Per Project and Location Aggregate Limit Drone Liability UASA121 10/18Additional Insured Endorsement Automobile Liability CA T420 0215 - Blanket Additional Insured & Waiver of Subrogation Umbrella Liability UM 04 88 07 08 — Blanket Waiver of Subrogation Status When Required by Written Contract Workers Compensation WC 00 03 13 00 001 Form Attached Includes: Blanket Waiver of Subrogation status applies when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, please send your request with the email address to certreauest(a)moodvins.com. © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds 35 S 400 W, LLC: Owns the building in Saint George, Additional Named Insured & Noble - A Jviation Company Additional Named Insured & Noble, Inc. lJ3Aviation Consultants, Inc. Additional Named Insured Additional Named Insured OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC