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HomeMy WebLinkAboutInsurance Certificate: RCI Finishes LLC Al CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/08/2020 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 ,Debbie D Reed _ NE Insurance Marketplace,Inc. (A/C No,Ext): I (541)779-0177 FA 41)779-0177 (541)772-8235 1998 Sky Park Dr E-MAIL ADDRESS: , debbie@insmarket.com Medford, OR 97501 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: U.S.Specialty Insurance Company INSURED INSURER B: Mutual of Enumclaw 14761 RCI Finishes LLC INSURERC: SAIF Corporation 3181 Old Stage Rd INSURERD: Central Point,OR 97502-9999 INSURERE: I INSURER F: ! COVERAGES CERTIFICATE NUMBER: 00000000-1951534 REVISION NUMBER: 25 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 ADDL SUBR POLICY EFF POLICY EXP W LTR INan VD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y UI9AC117829-00 10/07/2019 10/07/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 ..., ... n _ , " _ . MED EXP(Any one person) $ 5,000 • PERSONAL&ADV INJURY . $ 1,000,000 GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Z000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I OTHER: $ B AUTOMOBILE LIABILITY CPP0019185 10/15/2019 10/1512020 CO aBI id5pNGLE LIMIT $ 1,000,000 • ANY AUTO BODILYINJURY(Perperson) $ OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NONO- D PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS OOWNENLY' (Per accident) _ i $ A UMBRELLA LIAB X OCCUR U19AC117829-00 10/07/2019 10/07/2020 EACH OCCURRENCE $ 1,000,000 X EXCESS UAB CLAIMS-MADE 1 AGGREGATE $ 1,000,000_ DED X RETENTION$ $ . C WORKERS COMPENSATION 970729 07/01/2020 07/01/2021 • STATUTE X 0TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe 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) additional insured as per attached CG2010 0704,HCSO40 06 10 13,CG2037 0704 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. 20 E.Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE/ I ����"""`E. gg (DDR) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by DDR on June 08,2020 at 08:17AM