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HomeMy WebLinkAboutInsurance Certificate: John's Tub Repair LLC dba West Coast Tub Repair 7 ® DATE(MM/DD/YYl/Y) •4` o CERTIFICATE OF LIABILITY INSURANCE 12/15/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS- CERTIFICATE HISCERTIFICATE 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 hale 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). PRODUCERNAME:CNTACT Sierra Shore Century Insurance Group,LLC • PvCNNo.Ext): (541)382-4211 (AIC,No): (541)382-7468 572 SW Bluff Dr. E-MAIL Sierra@centuryins.com ADDRESS: Suite 100 INSURER(S)AFFORDING COVERAGE NAIC# Bend OR 97702INSURERA: American Hallmark In.Co.of TX INSURED INSURER B: SAIF , • John's Tub Repair,LLC,DBA:West Coast Tub Repair,Central OR INSURER C: 22875 Highway 20 INSURER D: 1 INSURER E: i - - -- - Behd — — — ---OR-97-701------ INSURER F: -- _.- — - COVERAGES CERTIFICATE NUMBER: Master 21/22 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. NOTVVITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VVITH 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 ADDL SUBR POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM!DD!YYYY) LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,DAMA000 . CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 100,000 :MED EXP(Any one person) $ 5,000 A - 44CL496047-. 12/15/2020 12/15/2021 , PERSONAL INJURY $ 1,000,000 GEN''LAGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 2,000,000 riPRO [1 LOC OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JEC7 Employment Practices $ 100,000 AUTOMOBILE LIABILITY - ' G(3MEINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILYINJURY(Perperson) $ . — 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 LIAR I CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 00 STATUTE ER AND EMPLOYERS'LIABILITY -YIN , ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? N/A 878721 . 01/01/2021 01/01/2022 S--- a - - - __ -__ _ 1,000,000 (Ma�atory'in NH) -- ---- -_- -- _ E.L.DISEASE-EA EMPLOYEE $ If yes,describe under ---1;000,000 DESCRIPTION OF OPERATIONS below E.L.DIS-EASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 1 The City of Ashland,Oregon,its officers,agents and employees is named as an additional insured with respects to General Liability. CERTIFICATE HOLDER CANCELLATION • 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 VVay • • . AUTHORIZED REPRESENTATIVE Ashland OR 97520 - • • 1 . , — ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,