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HomeMy WebLinkAboutInsurance Certificate: John's Tub repair, LLC DBA West Coast Tub Repair DATE(MMIDD/YYdY) A• O - CERTIFICATE OF LIABILITY INSURANCE E(MMIDD/Y 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). CONTACT Sierra Shore PRODUCER NAME: Century Insurance Group,LLC PHONE Ext): (541)382-4211 FAX No): (541)382-7468- 320 SW Upper Terrace Dr. Aj T SS: Sierra@centuryins.com Suite 104 . INSURER(S)AFFORDING CovERAGE NAICN • Bend OR 97702wsURERA: American Hallmark In.Co.ofTX INSURED - INSURER B: SAIF 36196 . John's Tub Repair,LLC,DBA:West Coast Tub Repair,Central OR INSURER C: 22875 Highway 20 INSURER D: • INSURER E: -- _-_ Bend_ - _ _ - ._ __ _ -___-_ .— _OR 97701 INSURERF: • COVERAGES CERTIFICATE NUMBER: MASTER 22/23 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER • (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 -DAMAGE TO RENTED 100,000 CLAIMS-MADE n OCCUR - PREMISES(Ea occurrence) -$ - MED EXP(Any one person) $ 5,000 A 44CL496047 12/15/2022, 1'2/15/2023 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 PRO- 1 I LOC PRODUCTS=COMP/OPAGG $ 2,000,000 OTHER:THICY JECT I f Employment Practices $ 100,000- AUTOMOBILE LIABILITY GOMBFNED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ .• OWNED SCHEDULED BODILY INJURY(Per accident) $ - AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ $ . X UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ 1,000,000- A EXCESS LIAB CLAIMS-MADE 44CL496047 12/15/2022 12/15/2023 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y/N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 878721 01/01/2023 01/01/2024 E.L.EACH ACCIDENT $ 1,000,000 FFICERin ER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ ----ifyes,describeunder - _- - - ---- --- -_— --_ _--_- - ._ . -- -1;000;000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT. $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon,its officers,agents and employees is named as an additional insured with respects to General Liability. . . CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,'NOTICE WILL BE DELIVERED IN The City of Ashland,Oregon ACCORDANCEWITH THE POLICY PROVISIONS. 51 Winburn Way AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. . . ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD