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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group Inc ACQRt7• CERTIFI.CATE O.F LIABILITY INSURANCE DATE(MMIDDrY.YYY) 5/4/2021 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'termsand conditIons of the policy,.certain policies may require-an endorsement. A statement on this'certlficate:does not confer rights,to the Certificate holder in:Ileu;.of.such endorsement(s). . .. .. . .. . . . , PRODUCER CONTACT' Arthur J.Gallagher&Co. PHONECert Requests; FAX lnsGrance'Brokers of CA, Inc. License#0726293 ' '(A/C.No.'Ext): -.- (A/C,No): E•MAIC _ _. 505 N. Brand Boulevard, Suite600 ADDRESS:, certrequestsa ajg,com Glendale CA 91203 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Zurich Amerlcan'insurance Company 16535 INSURED TRISINS-03 INSURER B:Great American EFTS Insurance Company 37532 TR100 Ocea Insurance Group,Inc: '7 INSURER C:American.Zurich.Insurance Company 40142 100 Oceangate Avenue, Suite 700 'Long Beach, CA 90802 ' : INSURER D.:XL SpecialtyInsurance Company 37885 INSURERE:Endurance'American Specialty Ins Co 4171'8 'INSURER F: , COVERAGES CERTIFICATE'NUMBER:.719193363( 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 SUBR POLICY EFF POLICY EXP " LTR TYPE OF INSURANCE INSD WVD .POUCY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) `LIMITS A X COMMERCIAL GENERAL LIABILITY' Y 'CPO-5543602-08 1/1/2021 1/112022 EACH OCCURRENCE $1;000,000 AMAGENTED CLAIMS-MADE' X OCCUR PREM SES(Ea ocOUr ence) $;1';000;000 • MED.EXP:(Anyone person' $1.0,000 X' ContrecUal Lleb PERSONAL&',ADV INJURY $•1,000,000 — GEN',L,AGGREGATE LIMIT APPLIES'PER: GENERAL AGGREGATE $.2',000,000 POLICY jEGT PRO X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILEUABILITY Y CP0=5543602708 1/1/2021 1/1/2022 Ea aB dED'SINGLE LIMIT $1,000;000 X ANY AUTO BOOILYINJURY(Per person) $ OWNED SCHEDULED ' BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS _ X HIREDTOS ONLY V. NON•OWNESONLY D PROPERTY DAMAGE $, AUAUTO (Par accident) Comp.&Call Ded. $500 C X UMBRELLA LIAB X .00CUR AUG-354347E08 1/1/2021 1:/1/2022, EACH OCCURRENCE _ $4,000,000 EXCESS LI(AB CLAIMS-MADE AGGREGATE $4,000,000' . DED I,RETENTION$ ._. . $. WORKERS COMPENSATION PER .DTH= AND EMPLOYERS'LIABILITYY/.N STATUTE ER ANYPROPRIETOR/PARTNERIEXECUTIVE _ E.L.EACH ACCIDENT' $ OFFICERIMEMBEREXCLUDED? n'.Ni A (Mandatory In NH) E.L.DISEASE--EA EMPLOYEE $ II.yes,describe under.' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY.LIMIT '$' D Crime ; 'ELU173109-21 1131/2021 1''31/2022 ' Aggregate $3,000,000 B Errors&Omissions TER 2861129 1/31/2021 1/3172022 Aggregate $3,000,000 E Cyber 'PRV30003483200: 1/31/2021 1/$172022' Aggregate $2,000;000 DESCRIPTION OF OPERATIONS./LOCATIONS/VEHICLES(ACORD 101,Addlllonai Remarks Schedule may be:attached If more space,is required) City of-Ashland is named'additionalinsured'under General Liability and Automobile:Liability as respects•their interestin the operations of the Named Insured. CERTIFICATE HOLDER .CANCELLATION. , SHOULD ANYÔF THE ABOVE DESCRIBED POLICIES'BECANCELLED BEFORE THE EXPIRATION DIME THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE•WITH.1'HE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland OR 97520. AUTHORIZED REPRESENTA1WVE USA ©1986-2015 ACORD CORPORATION. 'All rights:reserved: ACORD 25(2016/03) The ACORD name and logo ereregistered marks of ACORD 2•of 5 6747 a. Your "volunteer workers" only while performing. duties related to the conduct of your business, or your "employees", other than either your"executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers(if you area limited liability company), but only for acts within the scope of theiremployment by :you or while ;performing duties related to the conduct of your business. However, none of these"employees"or 'Volunteer workers"are insureds for: (1) 'Bodily injury" or"personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture),,to your members(if you are a limited liability company), to a co-"employee"while in the course of his or her employment or performingduties related to the conduct of your business, or to,your other"volunteer workers"while performing duties related to the conduct of your business; (b)' To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someoneelse who must pay damages because of the injury described in Paragraphs(1)(a). or(b)above; or (d) Arising out of his or her providing or failing to,provide professional health care services.. However:. Paragraphs (1)(a) and (1)(d) do not apply to your'"employees" or"volunteer workers",.who are not employed by you or volunteering for you as health care professionals, for"bodily injury"arising out of"Good.Samaritan Acts"while the"employee"or'Volunteer worker" is performing duties related to the conduct of your business. "Good Samaritan Acts" means any assistance of .a::medical nature rendered or provided in an emergency situation for which no remuneration is demanded or received. Paragraphs (1)(a),,(b) and (c) do not apply to any "employee designated as a supervisor or higher.in rank, with respect to' 'bodily injury" to. co-"employees". As used in this. provision, "employees" designated as a supervisor or higher in rank means only"employees" who are authorized by you to exercise direct or indirect supervision or control over"employees" or'Volunteer workers"and:the manner in which work is performed. e)'.MIMED rise lr " ' c roni 1l3G` l ila CO :':t, reo omen a oroaniza ion.. . .a , ' ,�9r o' + n amenoeo,: o inclnCl:tee 00 0 eases o - - a o o a _ o. o o . _ �Q ° o " 1��� �1� ma a e,t :;reoul;eo aa_flEE aonitroa : Sklreo,, QOM-0o to/ u "oe awl en eon rac ; w. then ear -men ; t MQ'on :resoee . io 'lao+itl arts! a at arVattiP ow ers 10:+;maintenance cg reoalr@,w..0 part G(ft: e int, •;,i1 6a.reserveo;,;il a cl IVe.A r, occuoanc M10 son v aanizaIa r;MCCAW.tenan tresses o.,_-ever, a 'Ins ran•ea!oroea Jo suc'i -o oitiona ;insured::• r0 gvi,a0 o 'eso`a rmtteo i 1 I ' '� oroaoer� ilftsvaDi reouireo o J..o ita„MContract.o 1_aor -m nt a:;} arovie r .sUc ao of #ona-insure?;, o C ` "_nos.'iitt , oersotl o'c.a aaniza Ion cease—SA) emises o Ado; reS zetioMt;insurance E 080._tquaterattiona reos il„MirMenoorse -tlt Woo to eesi 0. 0" e on to Ir•t'1tTSQ nsurance;• glitt-Vt)iggiiid'pi—CS L L Iii -o o itio na I I J lt`3flnlga- c untt •nsura''ce:` "eait-,a a Gant ac rate'!" aor'eems ", reeren uooar-arao :ea aoov e o o.Isementga A`w�a�iYaa e Una he a)- !Cabe Ne sat nst,►rance s o 'n.101M Dec rations" "aragrao Il`l +°Grease'1a tcao i t s nsr ran e s own 1111 Deem [(moo A-dai onat a Yen.or, {slog: a owing c anoe:'a°ale Alm overage,I; orOVlaeS insua ce,; o o J a .,,0001 ,;til U a M oroo oa: aoejtatista., ora cts-co o et-o,00ertatiOns... aro, 1.1-GL-1330-C CW(04/13) Page 2o 12 Includes'copyrighted material of Insurance Services Office,Inc.,with its permission. 3'of 5 6747 . action rt o S ' nsur•• is arnenses to inc use as.an,a••itiona insures, any person or organization g, r gip! `Tcontract or Written.. agreerment •trhiorr to asst t name as an additional insured buto l with-essect to "bodil or ''•ro•er 'enlace 'arising ou ayour-prosuc s' w 'ic are dig-rib-Mel ri: u e• or so •' In e resu>.r course o e v-n•or`s usiness. , owi Bever, the insurance afforded to such vendor: 'a in y app les b le ex en. permitte.• sy aw;an. •: j:CR -nfit-be-broader Wan-that w"h'ic1T`you are required •y f e wri encon ract or wri ten agreement o •rovi•e ,(tor such vendor.)- t it respect o t a insurance af;or tcit ese von ors,tie following-a it'ion usin p 3y �"i` "i`nsura:nee afforcle von or oes no apply toy El) (" o•i injury _or property same is obligated to iDayt damages by reason of the), iassumptionot.iabilit in a contract or agreement. rhis exclusion does not apply to'ifabijit";for dama•es t at the vendor would have he a sense of"the contractor agreement }; (Any express warrant unauthorize. • ou. •<{M (Any physical or chemical change in the product made intentionally_by the vendor;),' (Repackaging, except when-unpacked solely tor the purpose of inspection,,demonstration, testing, or) t:a substi ution o_par sun er ins ructions from filifffeturer,an, en repac .ge•.:in` ie orifi ni af) (container-„) RR (Any failure to make such inspections,adjustments tests or servicing as the vendor has as reed to make Lor normail undertakes to make in t e usua course olbusiness in in connec iot n Wii ii the istrf•ution or sa ef`of�he pia uc s;;; . _ {61 (Demonstration, installation, servicing Or repair operations, except such operations performed at the) ivendor.'s premises in connection with the sale of the product;) ( ) {productsution whir ,a ter is ri ors a by o ave l�en`laEe a or re ete or use as a con auier (part ar ingredien a any other thing'or sub-is ahnce by or cf"r l- vendor'or) dl Gorily in"ur'"-Er' •ro•er deMa•e'' arisins out of-The sole he li enee o he vendor for its awn acts or'' omissions or ose 4 its employees or anyone a se acttt ct on its seha . owever, is xiuion does),. riot app yrai ((a}The excep ions containedin Subparagraphs: --07-)x.; Such inspections,adjustments; tests or servicing_as _theyenda__r has agreed to make or norj !i un.erta es to ma e in e usua course orbusiness, in connection with;the dlstrib`ution or sae a, {the:products.,), ,T is insurance oes not ass! to an insured •erson or or.anization from whom ou have ace uired such , ,products;or any ingredient,part or container,entering,into,accompanying or containing suc pros ucts. ,C) is insuranc oes nota �` ply ,o any of�+ciur productsT'tor w Ic coverage s excu•e•_un.er t is overage 'art i ; ressect o t e insurance oroe.'to - e ven•or . ...unser Is `arasra• a o owing is to ectip (—Limits Of Insurance) ti( a mos,_Wewi pay on s: o t a van.or is aamount'.of Insurance) . 0squired by the written contract or written-agreement referenced- in SubparagraphEA., above-(of this) -(endorsee entj; or) .¢Avaita ,e wider the app ica leTimits o nsurance s own in e sec orations 'w is ever tseS$. (, is `aragrap, ,s a not increase t e app cable_ Limits of Insurance Shown in the Declarations. {Atiditionafinsured�-A na ors, Lessors or overnme UEn U-GL-1330-C CW(04/13) Page'3,of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 4'or 5 6747 •(1)- ecti-on 11---WfiTis An insured is amended to include as an insured anKserson or organization W.RTE-1-1. , manaser -ssor or_governrnen a en tyw o you are require. ta at,. as an as•itiona insure. onti.seoic unser written contract, written agreement or peri1tIhrecttQjiabjjjtyjbodlIInu propertyll • samage'or 'personal an. as ver ism. mu caused in w o e or in ear • : Cvirous—'-iFi oiFOritiBirs;61) ,,K) le acts or omissions o t ose acting on your be ail resu ing sirecty rom; C) Os-rations serformed b ou or on our behalf for which The state or solitical s bdivision has issued a' .g) * ners is maintenance ()eau san or use of s remises • 011: or ,Fintenance, operation or use sy you a equipment ease. a you sy suc person or organize io r(Frowe-vt7,1h-FFS7tiranc Ors es 0 sue •as,itigna insures: II) Only applies.ta the extentpermitted by law.and 4), bbr wFIEfiT wri en contract or writ agreement toprovide); lb?a-L76FRa.61-tkiriarinstTreT) • C2. -1 rii-S'crcv.islop does net apply)) 1(3 (Un ess t e written centre or written aoreement as been executed, or thesermit has been issued srior to, •.ffie"bodily irritaLL,"pLepgAi damage" or offense that caused "personal.and advertisingin"m2_;)' o any person or organization Inc v.-9 as an insur-. uncre-TPaTalif55WW-iir -chart 0 a_ n nsure `'. 0, a any essor o equipmen e occurrence' or eprise dRe-§15Tece after the equipment lease expires;) '(1) Owners or athennieresis from wTham landhas been leased °Tr)! q-s c!riorsof premises, if:)° (17) e occurrence or a ense ta<es • ace a ter he ex.iration of the'raise or Olt cease to be a tenant in (that premises Pr-The "bodry injury ,, 'property damaq&,pr persorsin ifiFT-"eases out Of the Straft:ii.a reiterations, new construction or,dernalieratiorisycefft arrnes sy or on • a a te manager o • . . lessor; or): £ a premises are exc uses unser t is overage Frail-1 cl); respect tot e insurance a onset, tot e additional insures s unser is "eras ras t e o owls is asses to, len - nuts_Of insurance ! he most we will pay on behalf pt the additional insured is the amount of insurance:), • t e wri -n con rac or written a reemen re erence. in usparagrap . . a.OVe o t is endersetrpntli or) • • . . (b. ye,aele unser t a app ices e Inv a -InSurance howThiFetreciarations,) , '(whichever is less. ? .•. . • is -araqrap .s a not increase t e app'caste 'nits a nsurance$ own in t a ftsclarations,), G. Damage to Premises Rented or Occupied by You • 1. The last paragraph under Paragraph 2: Exclusions of Section I - Coverage-A - Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n.. do not apply to damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Damage To Premises Rented To You Limit of Insurance applies to this coverage as described in Section III -Limits Of Insurance, 2. Paragraph 6. of Section III-Limits Of Insurance is replaced by the following:. U-GL-1330-C CW(04/13) • Page 4 of 12 Includes copyrighted material 9f Insurance Services Office,Inc"With its permission, s•of 5 6747 Arthur J.Gallagher&Co. Insurance Brokers of CA., Inc. 505 N. Brand Boulevard, Suite 600 Glendale, CA 91203 • 6747 2 MB 0.44.7 6747 1111111111111111111111111"11111niiIIuIIIuIIIIIIiIIIIIIIIuhIuIi CITY OF ASHLAND • 90 N MOUNTAIN AVE ASHLAND, OR 97520-2014 We are providing you with a Certificate of Insurance confirming our client's coverage. Want toget certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client'? Please contact us at ' COI.UpdateMyEmail@AJG.com and provide the.following'.information for.processing: 1. Confirmation that a.certificate of insurance'is no longer required;or 2. E-mail address to sendfuture certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code foundin the Insured section on the enclosed certificate.An example of this code is XXXXXX-01 4. This Certificate Number: 719193363 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https://www.ajg.com/us/privacy-policy/. l'of 5 6747