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HomeMy WebLinkAboutInsurance Certificate: General Information Solutions LLC �-...41, ® �` o DATE(MM/OD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11„2/2021 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 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 Aon Risk Insurance Services West, Inc. PHONE FAX .- Los Angeles CA Office (A/C.No.Ext): (866) 263-7122 (NC.No.): (800) 363-0105 z 707 wi 1 shi re Boulevard EMAIL Suite 2600 ADDRESS: S Los Angeles CA 90017-0460 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED '• INSURER A: Transportation Insurance Co. 20494 General Information Solutions LLC INSURER B: Valley Forge Insurance Co 20508 917 Chapin Road Chapin SC 29036 USA INSURER C: American Casualty Co. of Reading PA 20427 INSURER D: The Continental Insurance Company 35289 INSURER 6: National Fire & Marine Ins Co 20079 INSURER F: ik COVERAGES CERTIFICATE NUMBER:570090299364 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 SUER POLICY EH- POLICY bXP LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MM/DD/YYY ((MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY 6083326918 06/01/2021 66/01/202 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 $1,000,065 w GGEEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 rn �c I POLICY r--1�E�T Ell LOC PRODUCTS-COMP/OP AGG $2,000,000 -—II OTHER: 0 A AUTOMOBILE LIABILITY 6083145026 06/01/2021 06/01/2022 COMBINED SINGLE LIMIT $1,000,000 v) (Ea accident) , ANY BODILY INJURY(Per person) 0 — z OWNED —1 SCHEDULED BODILY INJURY(Per accident) of AUTOS AUTOS ONLY • X HIRED AUTOS x PROPERTY DAMAGE NON-OWNED cd —ONLY ^AUTOS ONLY (Per accident) C.) t ` cu D X UMBRELLA LIAB X OCCUR 6076599220 06/01/202106/01/2022 EACH OCCURRENCE $5,000,000 0 SIR applies per policy terns & conditions AGGREGATE $5,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTION B WORKERS COMPENSATION AND 6083189639 06/01/2021 06/01/2022 X PER STATUTE 0TH- EMPLOYERS'LIABILITY Y/N (AOS) ER C �CERRPMEMBOER/EXCL PARTNER/EXECUTIVE n N/A 6083236037 06/01/2021 06/01/2022 E'L,EACH ACCIDENT $1,000,000 (Mandatory In NI-I) I I (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-- E E&O-PL-Primary 42EPP31858001 11/15/2021 11/15/2022 Sublimit $5,000,000 -- Cl aims made RAI SIR applies per policy terns & conditions 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. r E -r. n. CERTIFICATE HOLDER CANCELLATION 7r O 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE wdycl o, EXPIRATION DATE THEREOF, NOTICE WILL BE,DELIVERED IN ACCORDANCE WITH THE +J• `2 POLICY PROVISIONS. el 8� .tea •1:3 City of Ashland AUTHORIZED REPRESENTATIVE 82 MAI Attn: Kariann Olson Purchasing Representative [� �i 90 N. Mountain Avenue t i��1tG�et flew c9:4 C��J X✓ M S Ashland OR 97520 USA _ 0 MI ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000077537 LOC#: "a ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Insurance Services West, Inc. General Information Solutions LLC POLICY NUMBER See Certificate Number: 570090299364 CARRIER NAIC CODE See certificate Number: 570090299364 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR POLICY POLICY ADDL SUER POLICY NUMBERLIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) OTHER E Cyber Liability 42EPP31858001 11/15/2021 11/15/2022 Sublimit $5,000,000 Claims made SIR applies per policy terms & conditions ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire,IL 60069 MDG2021 00000339 01 uIIIIIIIIIIuIIIIfuIuII„iiunlgir1i 1111III4lnp1111.1i.mh City of Ashland f;�$ Attn: Kariann Olson Purchasing Representative 90 N. Mountain Avenue Ashland OR 97520 a - a 0 0 rn c 8 0 o 0