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HomeMy WebLinkAboutInsurance Certificate: Tristar Ins. Group P5260025002 •A 0 ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE Y' w 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 :,r. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED , N REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. O IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.. N 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). PRODUCER LIC #63238 1-610-941-7751 NOMTACT - a Keystone Risk Partners,, LLC PHONE, FAX N • EEM.No.Ext): (A/C,No): ? 604 E. Baltimore Pike ADDRESS: ' INSURER(S)AFFORDINGCOVERAGE NAIC# Media, PA 19063 INSURER A:ACE AMER INS CO 22667 INSURED INBURERB:ACE,FIRE UNDERWRITERS INS CO 20702 Tristar Insurance Group INSURERC: - 100 OCeangate 'INSURERD: Suite 840 INSURERE: . Long Beach, CA 90802 , INSURER F: COVERAGES CERTIFICATE NUMBER:'64223613 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. I�7R TYPE OF INSURANCE ADDL SUER ' - POLICY EFF POLICY EXP INSD WVD 'POLICY NUMBER IMMIDD/YYYY) (MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED _ PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY PRO-JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $. AUTOMOBILE LIABILITYCOMBINED 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) • $ UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS•MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION X PER OTH- ' A AND EMPLOYERS'LUIBILITY YIN SCFC68918.87A FL,MA,OK,OR 12/31/21 12/31/22 STATUTE ER B ANYPROPRIETOR/PARTNERIEXECUTIVE Ei SCP"C68918911 (WI) 12/31/21 12/31/22 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? NIA A (MandatorylnNH) • WLR C68918832 (AOS) 12/31/21 12/31/22 E,L,DISEASE-EA EMPLOYEE $ 1,000,000 If yes,desedbe under DESCRIPTION OF.OPERATIONS below ' E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION • • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE 'THEREOF, NOTICE WILL, BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, ATTN: Rani Olson, Purchasing Rep 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE �/� • Ashland, OR 97520 (; t 1, rj 0 ' I USA ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD , ' ijarvis 64223613 P5260028002 Keystone Risk Partners,LLC • 604 E.Baltimore Pike Media,PA 19063 • 202201033306 - w Electronic Service Requested N EBIX BPS o ALL FOR AADC 975 • 27995 0.5234 AB 0.458 �'I'll'I'III'I'I�Ill�d�l��l�l�llull�nll�lll�l�n"�'II��IJ�Ir • o City of Ashland 196 N 90 N MOUNTAIN AVE ASHLAND, OR 97520-2014 This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed - on the notice of cancellation/reinstatement.- To find out how you can send and receive all of your certificates of insurance- either by email, high speed fax or standard mail, email customercare@confirmnet.com • - or visit our website at' www.confirmnet.com- cc: • • • • • • • • • The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. • • • Certificate Delivery by CertificatesNow-www.ConfirmNet.com-877.669.8600