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HomeMy WebLinkAboutInsurance Certificate: Trish Dorr • AA. CE °AE(MM "' 203 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 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 NAME CT FLIP Program Support - .Veracity Insurance Solutions,LLC. lAIC PHONE EMI:(844)5205992 I(ac,Nol: 260 South 2500 West,Suite 303 E-MAIL info fli ro ram.com ADDRESS: @ P 9 ' Pleasant Grove• ' UT' 84062 • INSURER(,AFFORDING COVERAGE NAICO INSURER A:. Great American Alliance Insurance Co. 26832 •INSUREDINSURER B: ' • . • Trish Dorr . INSURER C: 738 S Mountain Ave . INSURER o: • Ashland OR 97520 INSURERS: INSURER F: ' COVERAGES ' CERTIFICATE NUMBER: ' '. 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 TYPE OF INSURANCE NSR AWL WVD POLICY NUMBER BR POLICY POLICY EXP LIMITS (MOLIC/YEFF (POLIC YEXP GENERAL LIABILITY . . - EACH OCCURRENCE $ 1,000,000 • . . • X COMMERCIAL GENERAL LIABILITY rX r PRREMSES(En occur $ 300,000 CLAIMS-MADE I X,OCCUR FT; I___-I MED EXP(Any one person) $ 5,000 A • PLE864748-F201284. 06/28/2023 06/28/2024 PERSONAL&ADV INJURY $ 1,000,000 . • GENERAL AGGREGATE- S 2,000,000 ' GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s 2,000,000 POLICY I it jPa J]LOC ANIMAL BAILEE S AUTOMOBILE UABILTTY • �j Er COMBINED SINGLE LIMIT ' (EaaaideniJ S ANY AUTO BODILY INJURY person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S ' AUTOS .. HIRED I NON-OWNED PROPERTY DAMAGE S _AUTOS (Per accident) S UMBRELLA UAB _OCCUR [ 1J EACH OCCURRENCE S • EXCESS LIAB CLAIMS-MADE e—•. • • AGGREGATE $ ' mm DED I ' I RETENTIONS 7U �O 5 WORKERS COMPENSATION ,I TOMTITS I;,_;,L_ NIS AND EMPLOYERS'LIABILITY — ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N k E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? I—I N/A i . (Mandatory In NH) • E.L.DISEASE-EA EMPLOYEE$ • I/yes,describe under • DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S . ' C� , DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured-Designated Person or Organization(CG 20 26 Ed.04 13) • • CERTIFICATE HOLDER CANCELLATION . ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • City of Ashland • ACCORDANCE WITH THE POLICY PROVISIONS. ' 51 Winbum Way - Ashland,OR 97520 • , AUTHORIZED REPRESENTATIVE //�//�7_ p I �' • ©1988-2014 ACORD CORPORATION. All rights reserved. • . ACORD 25(2014/01) The ACORD name and logo.are registered marks of ACORD INS025(201401) • • PLE864748-F201284 • CG 20 26(Ed.04 13) • THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE PART • .Schedule • Name of Additional Insured Person(s)or Organization(s): City of Ashland • Information required to complete this Schedule,if not shown above,will be shown in the Declarations. • A. , SECTION II-WHO IS AN INSURED is amended to include as an Additional Insured the person(s)or organization(s)shown in the Schedule,but only with respect to liability for"bodily injury,""property damage"or • • "personal and advertising injury"caused,in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf: 1.in the performance of your ongoing operations;or 2.in connection with your premises owned by or rented to you. However: 1.the insurance afforded to such additional insured only applies to the extent permitted by law;and 2.if coverage provided to the Additional Insured is required by a contract or agreement,the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to • provide for such additional insured. . • • B•. With respect to the insurance afforded to these Additional Insureds,the following is added to SECTION III— LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement,the most we will pay on behalf of the Additional Insured is the amount of insurance: • 1.required by the contract or agreement;or 2.available under the applicable Limits of Insurance shown in the Declarations; • whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. • Copyright,ISO Properties,Inc.,2012 • ' CG 20 26(Ed.04/13)PRO Page 1 of 1 C . • • • •