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HomeMy WebLinkAboutInsurance Certificate: John's Tub Repair, LLC dba West Coast Tub Repair " ® A��D DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/16/2020 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 Sierra Shore NAME: Century Insurance Group,LLC (A/CNNo,Ext): (541)382-4211 FAX No): (541)382-7468 572 SW Bluff Dr. E-MAIL ADDRESS: Sierra@centuryins.com Suite 100 • INSURER(S)AFFORDING COVERAGE NAIC# Bend OR 97702 INSURERA: American Hallmark In.Co.of TX INSURED - INSURER B: SAIF John's Tub Repair,LLC INSURER C: DBA:West Coast Tub Repair,Central OR Division INSURER D: 22875 Highway 20 INSURER E: ' -Bend - - — OR. 97701 .---- INSURER F:---- -- COVERAGES CERTIFICATE NUMBER: 20/21 Master 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 A SPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE • ISW D VD POLICY NUMBER LIMITS (MM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 DAMAGE r0 RENTED 100,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A 44CL496047-02/000 12/15/2020 12/15/2021 PERSONAL BADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n Ta n LOG PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employment Practices $ 100,000 AUTOMOBILE.LIABILITY GOM9FNED 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 PTATUTE ETH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 B N/A 878721 01/01/2020 01/01/2021 000000 OFFICER/MEMBER EXCLUDED? 1,000,000 –_ (Mandatory_ir.-NH)=_- - __- ____— __ _____ - . _ - . --- . __ _= — E,L_DISEASE-EA EMPLOYEE_._$_ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) The City of Ashland,Oregon,its officers,agents and employees is named as an additional insured with respects to General Liability. CERTIFICATE HOLDER . CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Ashland,Oregon ACCORDANCE WITH THE POLICY PROVISIONS. 51 Winburn Way AUTHORIZED REPRESENTATIVE Ashland OR 97520 I I I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD