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HomeMy WebLinkAboutInsurance Certificate: General Info. Solutions LLC /...1 ® DATE(MM/DD/YYYY) A��'' CERTIFICATE OF LIABILITY INSURANCE 06/01/2021 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 m 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). c PRODUCER CONTACT NAME: Aon Risk Insurance Services West, Inc. PHONEFAX '- Los Angeles CA office (A/C.No.Ext): (866) 283-7122 (AIC.No.): (800) 363-0105 707 Wilshire Boulevard E-MAIL 0 Suite 2600 ADDRESS: Los Angeles CA 90017-0460 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AIG Specialty Insurance Company 26883 General Information Solutions LLC INSURER B: Transportation Insurance Co. 20494 917 Chapin Road Chapin SC 29036 USA INSURER C: Valley Forge Insurance Co 20508 " INSURER D: American Casualty Co. of Reading PA 20427 INSURER E: The Continental Insurance Company 35289 INSURER F: f., COVERAGES CERTIFICATE NUMBER:570087537023 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. Limits shown are as requested INSR ADDL SUBR - POLICY bFF POLICY bXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYY LIMITS B X COMMERCIAL GENERAL LIABILITY 6083326918 06/01/1021 06/01/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) — MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 R GEN-'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000 X�POLICY CT n LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: cocp cp B AUTOMOBILE LIABILITY 6083145026 06/01/2021 06/01/2022 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) „ ANY AUTO BODILY INJURY(Per person) 0 _ Z OWNED• —SCHEDULED BODILY INJURY(Per accident) C) AUTOS ONLY AUTOS TO PROPERTY DAMAGE X HIREDAUTOS x NON-OWNED 0 ONLY AUTOS ONLY (Per accident) F. t: E X UMBRELLA LIAB X OCCUR 6076599220 06/01/2021 06/01/2022 EACH OCCURRENCE $5,000,000 V — —EXCESS LIAB CLAIMS-MADE SIR applies per policy"terns & conditions AGGREGATE $5,000,000 DED X RETENTION C WORKERS COMPENSATION AND 6083189639 06/01/2021 06/01/2022X PER STATUTE 0TH- EMPLOYERS'LIABILITY Y/N (AOS) ER ANY PROPRIETOR!PARTNER!EXECUTIVE E.L.EACH ACCIDENT $1,000,000 0 OFFICER/MEMBEREXCLUDED? � N/A 6083236037 06/01/2021 06/01/2022 (Mandatory ip NH) (CA) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A E&O-PL-Primary 022112227 10/31/2020 10/31/2021 Sublimit $10,000,000 SIR applies per policy terns & conditions 2 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) certificate holder is included as Additional Insured in accordance with the policy provisions of the General Liability policy. `s E E ti- z�: CERTIFICATE HOLDER CANCELLATION 110.3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE s POLICY PROVISIONS. +��.,,�, City of Ashland AUTHORIZED REPRESENTATIVE pyZ+, Attn: Kariann Olson MI- FF�+�** Purchasing Representative y� 90 N. MOUnta75 an �� �niata Yesu a N/ }� Ashland OR 975200 USA u5A III ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD o DATE(MM/DD/YYYY)® CERTIFICATE OF LIABILITY INSURANCE 06/01/2021 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 d 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). c PRODUCER CONTACTxi NAME: Aon Risk Insurance Services west, Inc. PHONE (866) FAX L. Los Angeles cA office (A/C.No.Ext); 283-7122 (A/C.No.): (800) 363-0105 '00 707 wilshire Boulevard E-MAIL suite 2600 ADDRESS: _ Los Angeles CA 90017-0460 USA INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: AIG Specialty insurance Company 26883 Hi reRight,. LLC INSURER B: Transportation Insurance Co. 20494 3349 Michelson Drive, suite 150 Irvine CA 92612 USA INSURER C: valley Forge Insurance Co 20508 INSURER D: American Casualty Co. of Reading PA 20427 INSURER E; The Continental Insurance Company 35289 INSURER F: ,yyp COVERAGES CERTIFICATE NUMBER:570087537099 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 SY PAID CLAIMS. Limits shown are as requested INSR - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ((MM/DD/YYyV) IMM/DD/Yr/Y) LIMITS • B X COMMERCIAL GENERAL LIABILITY 6083326918 06/01/2021''06/01/2022 EACH OCCURRENCE $1,000,000 DAMAGE 10 RENThD CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 . ° GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 M X POLICY I I JE11 LOC PRODUCTS•COMP/OP AGG $2,000,000 co OTHER: 0 B 6083145026 06/01/2021 06/01/2022 COMBINED SINGLE LIMIT tO AUTOMOBILE LIABILITY $1,000,000 (Ea accident) ANY AUTO - BODILY INJURY(Per person) C Z —OWNED — SCHEDULED BODILY INJURY(Per accident) a) AUTOS ONLY AUTOS X HIRED AUTOS x NON-OWNED PROPERTY DAMAGE V —ONLY —AUTOS ONLY (Per accident) t= E X- UMBRELLALIAB X OCCUR 6076599220 06/01/2021'06/01/2022 EACH OCCURRENCE $5,000,000 C) EXCESS LIAB J CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 C ' WORKERS COMPENSATION AND - 6083189639 06/01/2021 06/01/2022 x PER STATUTE 0TH- - ' EMPLOYERS'LIABILITY Y/N AOS ER D (tI YF ICER/MEMBER/EXCRUDED?EXECUTIVE N N/A 6083236037 06/01/202106/01/2022 E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) CA E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $1,000,000.— A E&O-PL-Primary 022112227 10/31/2020 10/31/2021 Sublimit $10,000,000 SIR applies per policy terns & conditions MI DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional.Remarks Schedule,may be attached If more space is required) +¢ Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability policy. "Z. E" a CERTIFICATE HOLDER CANCELLATION N 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEco EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE m POLICY PROVISIONS. g :?: City of Ashland AUTHORIZED REPRESENTATIVE re o Attn: Kariann Olson �'' Purchasing. Representative `J „ 90 N. Mountain Avenue J �i ill: 8 er 0 Ashland OR 97520 USA Pt 9ZG1[Gtanew Yet. G CdC`✓ w, 1m I II 01988.2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire,IL 60069 MDG2021 00001628 01 111111IIIi11111.111111n.11111h111'iii'iillii11111I'I'yIIIiiII DiCity of Ashland Attn: Kariann Olson Purchasing Representative 90 N. Mountain Avenue Ashland OR 97520 Lag I.,�,'•y i