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HomeMy WebLinkAboutInsurance Certificate: TC ChevroletA41061Z & CERTIFICATE OF LIABILITY INSURANCE DAT01/,/0Sl205/20vvvv' 20 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER PA cNNo E ct : 888 333 4949 n/c No : 507-446 4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 276-176-5 INSURER B: TC CHEVROLET INC INSURER C: PO BOX 249 INSURER D: ASHLAND, OR 97520-0249 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1 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. INSR LTR TYPE OF INSURANCE DL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYV POLICY EXP MMIDDIYYYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $500,000 CLAIMS -MADE FXI OCCUR E TO RENTED PREMISES Eaocalm— $100,000 MED EXP (Any one person) $5,000 A Y N 9918174 03/01/2020 0'i. /01/2021 PERSONAL 6 ADV INJURY $500,000 GEN'L %f AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑JECT ❑ LOC GENERAL AGGREGATE $1,000,000 PRODUCTS - COMP/OP AGO $1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciden BODILY INJURY (Per person) ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PDAMAGE PROPERTY a X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $15,000,000 A EXCESS LIAB CLAIMS -MADE N N 9918175 03/01/2020 03/01/2021 AGGREGATE DIED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE PER STATUTE OTH- I ER E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) N I A E.L. DISEASE - EA EMPLOYEE It yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT AUTO DEALER LIABILITY N N 9918174 03/01/2020 03/01/2021 AUTO LIAB - EA ACCIDENT $500,000 A GENERAL LIABILITY • EACH ACCIDENT $500,000 - AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Shcedule, may be ethNed it more space is required) CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 276-176-5 CITY OF ASHLAND 20 E MAIN ST ASHLAND, OR 97520-1814 10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2018M) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9918174 COMMERCIAL GENERAL LIABILITY CG 20 24 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS OR OTHER INTERESTS FROM WHOM LAND HAS BEEN LEASED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises Name Of Person(s) Or Organization(s) (Part Leased To You) CITY OF ASHLAND 403 DEAD INDIAN RD, ASHLAND, OR 20 E MAIN ST ASHLAND OR 97520 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you and shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to lease that land; DESCRIPTION OF INTEREST IF APPLICABLE: Insured: TC CHEVROLET INC PO BOX 249 ASHLAND OR 97520 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 24 04 13 Policy Number: 9918174 Transaction Effective Date: 03-01-2020