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HomeMy WebLinkAboutInsurance Certificate: Owen Equipment Holdings, kw o' V CERTIFICATE OF GARAGE INSURANCE DATE9M20 9/YYYY) 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 Sentry Insurance 1800 North Point Dive CONTACT Sentry Customer Service NAME: PHONE 800-473-6879 FAX 800-5147191 A/C, No Ext : A/C No EMAIL ADDRESS: bu5ine5sproducts directdsentty.com Stevens Point, W1$4481 INSURER(S) AFFORDING COVERAGE NAIC X INSURER A: Sentry Select Insurance Company 21180 INSURED INSURER B : Owen Equipment Holdings Corp 4201 NE 66th Ave Ste 105 INSURER C : INSURER D : Vancouver, WA 98661-3078 INSURER E : INSURER F : COVERAGES PROD / CUSTOMER ID: CERTIFICATE p: 1457626 REVISION C 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 ADDL INSRD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GARAGE LIABILITY H HIRED AUTOS ANY AUTO ONLY X NON -OWNED OWNED AUTOS USED AUTOS ONLY IN GARAGE BUSINESS X A0120217004 01/01/2019 01/01/2020 AUTO ONLY (Ea accident) $ 500,000 OTHER THAN AUTO ONLY EA ACCIDENT $ 500,000 AGGREGATE $ 2,500,000 A GARAGE KEEPERS LIABILITY LEGAL LIABILITY DIRECT BASIS Ix PRIMARY EXCESS X A0120217004 01/01/2019 01/01/2020 X COMP / LOG OTC SPECIFIED LOG PERILS 1 $ 1,000,000 $ X COLLISION LOG LOG 1 $1,000,000 $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- LOG JECT OTHER GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ $ A X UMBRELLALIABN X EXCESS LIAR OCCUR CLAIMS -MADE A0120217009 01/01/2019 01/01/2020 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 30,000,000 DIED I RETENTION S PRODUCTS - COMP/OP AGG $ 30,000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y / N (Mandatory in NH) ❑ If yes, describe under REMARKS below N / A A0120217001 01/01/2019 01/01/2020 X PERpT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1.000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 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 97520-1814 WITH THE POLICY PROVISIONS. AUTH RIZ ESENTA IV / yr ACORD 30 (2016/03) A0120217 Sentry Select Insurance Company 3 00004 0000000256 19344 0 N Page 1 of 2 © 2010-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 12/09/2019 8A5182DF-E33E-4469-93E5-02BiC3D58323 0027020044353406636797520185020 .�� AGENCY CUSTOMER ID: XV,M6953 AC�RO� LOC It: �•....�"" ADDITIONAL REMARKS SCHEDULE Page of .GENCY NAMED INSURED ameron Scott Oven Equipment Holdings Corp OLICY NUMBER 0120217004 ;ARRIER NAIC CODE entry Select Insurance Company 21180 EFFECTIVE DATE: 01/01/2019 DDITIONAL 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 (including products/completed operations). Garagekeepers Liability Location # State Basis Collision Limit Comp/OTC/Specified Perils Limit 2 UT Direct Coverage (Primary) $ 31250,000 $ 3,250,000 3 CA Direct Coverage (Primary) $ 1,0007000 $ 17000,000 4 V,A Direct Coverage (Primary) $ 1,000,000 $ 1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. A0120217 The ACORD name and logo are registered marks of ACORD 12/09/2019 Sentry Select Insurance Company 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. Name of Person or Organization: City of Ashland Start Date of Show: Event Name: Event Location: SCHEDULE End Date of Show: (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 D. Who Is An Insured is amended by the addition of the following: The following are "insureds" for "auto dealer operations"; The person or organization listed in the Schedule above, but only with respect to liability arising out of your "auto dealer operations" or premises owned by or rented to you. All other terms and provisions of the policy remain unchanged. Change effective 11/25/2019 CA 88 04 10 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0120217 with its permission. 1210912019 Sentry Select Insurance Company 5 00004 0000000256 19344 0 N 81OF45FE-4160-41ED-875E-74DAMB6463 0027020044353406650497520185020 IL70580214 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. Change effective 11/25/2019 IL 70 58 02 14 Page 1 of 1 A0120217 12/09/2019 Sentry Select Insurance Company 7 00004 0000000256 19344 0 N B10F45FE-4160-41ED-675E-74DAMB6463 0027020044353406650497520185020