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HomeMy WebLinkAboutInsurance Certificate: Owen Equipment Holdings (2)A� �® CERTIFICATE OF GARAGE INSURANCE DAT21OW20 D/YYY1) v6326,9 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(es) 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 Pdrt Drive CONTACT Sentry Customer Service NAME: aC N . 800-4]3-6879 FAX C No: 800-514-7191 Stevens Point, WI 54481 EMAIL busine raduds_dved@seniry.can ADDRESS: ssP INSURER(S) AFFORDING COVERAGE NAIC q INSURER A: Sercy Select Insurance Company 21180 INSURED INSURER B : Owen Equipment Holdings Carp PO Box 30959 INSURER C: INSURER O: Partland, OR 972U INSURER E: INSURER F: COVFRAGFS PROD/CUSTOMER ID: CERTIFICATE1f: 1457626 REVISION N: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 GERTIFlCATE 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSRD SUBR WVD POLICYNUMBER POLICY EFF (MM/DD/YYYY) POLICYEXP (MM1DD/YYY11 LIMITS A GARAGE LIABILITY I HIRED AUTOS ANY AUTO ONLY Ilu—II X OWNED NON -OWNED ED AUTOS US AUTOS ONLY IN BUSINESS X A0120217004 01/01/2020 01/01/2021 AUTO ONLY (Ea acudem) $ 500,000 OTHERTHAN ONLY EA ACCIDENT $500,000 AGGREGATE $ 2,500,000 A GARAGE KEEPERS LIABILITY LEGAL LIABILITY X DIRECT BASIS X PRIMARY EXCESS X A0120217004 01/01/2020 01/01/2021 X OTCP / LOC SPECIFIEDLOC PERILS 1 $1,000.000 g X COLLISION LOC LOC 1 $1,000,000 $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE❑ OCCUR EACH OCCURRENCE $ PREMISE RE"-MEDence $ MED EXP (rmy cna penscn) $ PERSONAL& ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑SECT ❑ LOC OTHER GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGO $ $ A X UMBRELLA LIAR X EXCESS LIAR X OCCUR CLAIMS -MADE A0120217009 01/01/2020 01/01/2021 EACH OCCURRENCE $ 10.000.000 AGGREGATE $ 30,000,000 DIED I I RETENTION$ PRODUCTS-COMP/OP AGG $30.000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEIVEXECUTME OFFICER/MEMSEREXCLUDED? Y/N (Mandatory in NH) ❑ 0 yes, describe under REMARKS below N/A A0120217001 01/01/2020 W101/2021 T}� X PER �R - STATUTE E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 EL DISEASE- POLICY LIMIT $ 1,000,000 REMARKS (ACORD 101, Additional Remarks Schedule, may be atached if more space is required) Referto 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. AU RIZED UMESFNTA ACORD 30 (2016/03) A0120217 Sentry Select Insurance Company 3 00004 0000000318 19338 0 N Page 1 of 2 © 2010-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 12103/2019 BDI B94aA-51 FO S8 9A01-34A3880AC4EA 00270200443533136700975201&5020 AGENCY CUSTOMER ID: xl000aceass ACORO® LOG #: ADDITIONAL REMARKS SCHEDULE Page P of E AGENCY NAMED INSURED Cameron Soot Owan Equipment Holdings Corp POLICY NUMBER A0120T 70M CARRIER NAIC CODE Sentry Select Insurance Company 21180 EFFECTIVE DAIS 01/01/2020 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, 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 LiabilityCincluding products/completed operations). Garagekeepers Liability Location # State Basis Collision Limit Comp/OTC/Specified Perils Limit 2 LIT Direct Coverage (Primary) $ 3,250,000 $ 3,250,000 3 CA Direct Coverage (Primary) $ 1,000,000 $ 1,000,000 4 WA Direct Coverage (Primary) $ 1,000,000 $ 1,000,000 ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. A0120217 The ACORD name and logo are registered marks of ACORD 12/03/2019 Sentry Select Insurance Company COMMERCIAL AUTO CA 88 04 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modes insurance provided underthe 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. CA 88 0410 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0120217 with its permission. 12/03/2019 Sentry Select Insurance Company 5 00004 0000000316 19338 0 N 2A5B599G7a23-42A6-9349-B05BBB37f729 0027020044353313468497520185020 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 persons) 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 A0120217 Sentry Select Insurance Company 7 00004 0000000318 19338 0 N 2A5B599G7a23-42A6-9349-13OSB8B37F729 002702004 3313468497520185020 Page 1 of 1 12/03/2019