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HomeMy WebLinkAboutInsurance Certificate: TC Chevrolet Inc ACCPREP DATE DADDD1TT" CERTIFICATE OF LIABILITY INSURANCE 01/13/1/13rzo21 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 FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER N HOME OFFICE:P.O.BOX 328 (A/C,No,Est):888-333-4949 FAX No):507-446-4664 OWATONNA,MN 55060 E-MAIL CLI ENTCONTACTCENTEReFEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# _INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 276-176-5 INSURER B: TC CHEVROLET INC INSURER C: PO BOX 249 ASHLAND,OR 97520-0249 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1 REVISION NUMBER:0 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 SUER PODGY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYYI (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $500,000 CLAIMS-MADE n OCCUR PREMISES(Ea RENTED $100,000 MED EXP(My one person) $5,000 A Y N 9918174 03/01/2021 03/01/2022 PERSONAL&ADV INJURY $500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 X POLICY nJEC7 LOC PRODUCTS-COMP/OP ADO $1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident! ANY AUTO BODILY INJURY(Per person) — OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY(Per accident — HIRED AUTOS ONLY NON•OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident! X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $15,000,000 A EXCESS LIAB CLAIMS-MADE N N 9918175 03/01/2021 03/01/2022 AGGREGATE DED I [RETENTION WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N PER STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE pi E.L.EACH ACCIDENT OFF10ERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT AUTO DEALER LIABILITY N N 9918174 03/01/2021 03/01/2022 AUTO UAB-EA ACCIDENT $500,000 A GENERAL LIABILITY -EACH ACCIDENT $500,000 •AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 276-176-5 1 0 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 ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE G O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9918174 COMMERCIAL GENERAL LIABILITY CG 20 24 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS OR OTHER INTERESTS FROM WHOM LAND HAS BEEN LEASED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Land Name Of Person(s) Or Organization(s) (Part Leased To You) CITY OF ASHLAND 403 DEAD INDIAN RD, ASHLAND, OR 20 E MAIN ST ASHLAND OR 97520 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 2. Structural alterations, new construction or include as an additional insured the person(s) or demolition operations performed by or on organization(s) shown in the Schedule, but only behalf of the person(s) or organization(s) with respect to liability for "bodily injury", shown in the Schedule. "property damage" or "personal and advertising C. With respect to the insurance afforded to these injury" caused, in whole or in part, by you or additional insureds, the following is added to those acting on your behalf in connection with the Section III - Limits Of Insurance: ownership, maintenance or use of that part of the land leased to you and shown in the Schedule. If coverage provided to the additional insured is However required by a contract or agreement, the most we 1. The insurance afforded to such additional will pay on behalf of the additional insured is the insured only applies to the extent permitted by amount of insurance: law; and 1. Required by the contract or agreement; or 2. If coverage provided to the additional insured 2. Available under the applicable limits of is required by a contract or agreement, the insurance; insurance afforded to such additional insured whichever is less. will not be broader than that which you are required by the contract or agreement to This endorsement shall not increase the provide for such additional insured. applicable limits of insurance. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to lease that land; TC CHEVROLET INC PO BOX 249 ASHLAND OR 97520 © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 24 12 19 Policy Number: 9918174 Transaction Effective Date:03-01-2021 276-176-5 1 B W N DH BS BE000-00-0329 XWXW0021 XXXXXXX5## ITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1814