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HomeMy WebLinkAboutInsurance Certificate: Owen Equipment Holdings Corp. Acc,RD® CERTIFICATE OF GARAGE INSURANCE DA 12/9/2021/ rn 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). PRODUCER CONTACT Sentry Customer Service Sentry Insurance NH�A.{ME: 1800 North Point Drive (A/C No,Ext): 800-473-6879 FAX No):800-514-7191 Stevens Point,WI 54481 EMAIL businessproducts_directesentry.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 8 INSURER A:Sentry Select Insurance Company 21180 INSURED INSURER B: Owen Equipment Holdings Corp 4201 NE 66th Ave Ste 105 INSURER C: Vancouver,WA 98661-3078 INSURER D: INSURER E: INSURER F: COVERAGES PROD/CUSTOMER ID: CERTIFICATE if: 2399666 REVISION It: 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. INSRr TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MM/DD/YYYY) (MM/DD/YYYY) _ GARAGE LIABILITY HIRED AUTOS AUTO ONLY(Ea accident) $500,000 X ANY AUTO —ONLY — A NON-OWNED X A0186985001 11/09/2021 11/09/2022 EA ACCIDENT OWNED —AUTOS USED OTHER THAN $500,000 AUTOS ONLY IN GARAGE BUSINESS AUTO ONLY AGGREGATE $2,500,000 GARAGE KEEPERS LIABILITYCOMP/ X OTC LOC 1 $1,000,000 — LEGAL LIABILITY SPECIFIED LOC SS $ A DIRECT BASIS X A0186985001 11/09/2021 11/09/2022 • X COLLISION LOC 1 $1,000,000 PRIMARY n EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ — MED EXP(Any one person) $ — PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- E LOC PRODUCTS-COMP/OP AGG $ I I JECT OTHER $ ' X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 A X EXCESS LIAB CLAIMS-MADE A0186985008 11/09/2021 11/09/2022 AGGREGATE $30,000,000 DED RETENTION$ PRODUCTS-COMP/OP AGG $30,000,000 WORKERS COMPENSATION X PER —J N- AND EMPLOYERS'LIABILITY — STATUTE - ANY PROPRIETOR/PARTNER/EXECUTIVE N/A A0186985007 11/09/2021 11/09/2022 E.L.EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? Y/N (Mandatory In NH) ❑ E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under REMARKS below E.L.DISEASE-POLICY LIMIT $1,000,000 REMARKS(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Refer to attached CERTIFICATE HOLDER _CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E Main St THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE Ashland,OR 97520-1814 WITH THE POLICY PROVISIONS. AUTRIFT Z�EjyBEGANTAJIV / ACORD 30(2016/03) Page 1 of 2 ©2010-2!0/15 ACORD CORPORATION.All rights reserved. A0186985 Sentry Select Insurance Company The ACORD name and logo are registered marks of ACORD 12/09/2021 I ^'' 3 00004 0000000700 21343 N A 0 882CE860-361B-461E-8B8D-827289558E40 0027020044363394900097520184920, • • �.•� AGENCY CUSTOMER ID:)00000(6853 ACCAD® ADDITIONAL REMARKS SCHEDULE Page ? of 2 AGENCY NAMED INSURED Cameron Scott Owen Equipment Holdings Corp POLICY NUMBER A0186985001 CARRIER NAIC CODE Sentry Select Insurance Company 21180 EFFECTIVE DATE: 11/09/2021 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Gara.e Insurance Auto Dealers The City of Ashland, Oregon, its Officers, Agents and Employees are named as Additional Insured on a Primary and Non-Contributory basis. General Liability is included within the Garage Liability(including products/completed operations). Garagekeepers Liability Location# State Basis Collision Limit Comp/OTC/Specified Perils Limit 2 UT Natural Disasters Legal $ 3,250,000 $ 3,250,000 Liability 3 CA Natural Disasters Legal $ 1,000,000 $ 1,000,000 Liability • 4 WA Natural Disasters Legal $ 1,000,000 $ 1,000,000 Liability • • • • ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. A0186985 The ACORD name and logo are registered marks of ACORD 12/09/2021 Sentry Select Insurance Company COMMERCIAL AUTO CA 88 04 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name of Person or Organization: City of Ashland Start Date of Show: End Date of Show: Event Name: Event Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - General Liability Coverages, Paragraph The person or organization listed in the Schedule D.Who Is An Insured is amended by the addition of above, but only with respect to liability arising out of the following: your "auto dealer operations" or premises owned by The following are "insureds" for "auto dealer or rented to you. operations"; All other terms and provisions of the policy remain unchanged. CA 88 04 10 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0186985 with its permission. 12/09/2021 Sentry Select Insurance Company 5 00004 0000000700 21343 N A 0 E8397332-EC46-432D-98F6-309888A3D4BB 0027020044363394870997520184920 IL 70 58 0214 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s)or organization(s)shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s) or Organization(s) including mailing address: City of Ashland 20 E Main St Ashland,OR 97520-1814 All other terms and conditions of this policy remain unchanged. 1L 70 58 0214 Page 1 of 1 A0186985 Sentry Select Insurance Company 12/09/2021 • 7 00004 0000000700 21343 N A 0 E8397332-EC46-4320-98F6-309898A3D4B8 0027020044363394870997520184920 Dealer Operations Sentry Select Insurance Company 4400 E 53rd St Davenport, IA 52807 0000000700 City of Ashland 20 E Main St Ashland, OR 97520-1849 liii11111I11111111111111'IIIullIlilulil11111111111lin111111'nil • 1 00004 0000000700 21343 N A 0 5E375730-1007-465D-AE84-0498C0979F33 0027020044363394921097520184920 Dealer Operations Sentry Select Insurance Company 4400E 53rd St Davenport,IA 52807 0000000700 fry';;i1 City of Ashland 20 E Main St Ashland, OR 97520-1849 111111IllIIiiI1111111I11111111111111111111III111111Iniilllil'nil