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HomeMy WebLinkAboutInsurance Certificate: Tristar Insurance Group (2) P5260020002 M e i 7e5.4 Q('"`9 �0 DATE(MMIDOIYYYY) ‘mo,....--- �,�`,-/�?� CERTIFICATE OF LIABILITY INSURANCE 12/06/2019 •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 ` u, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE'A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED N REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 0 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. csI 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 LIC #63238 1-610-941-7751 CONTACT rno Keystone Risk Partners, •LLC PHONE FAX VD INC.No.Ext): • I(AIC.No): 7 EMAIL 604 E. Baltimore Pike ADDRESS: - W INSURER(S)AFFORDING COVERAGE NAIC S Media, PA 19063 INSURERA:ACE AMER INS CO 22667 INSURED INSURER O:ACE FIRE UNDERWRITERS INS CO 20702 Tristar Insurance Group INSURER C: 100 Oceangate INSURERD: Suite 700 INSURERE: ' Long Beach, CA 90802 INSURERF: COVERAGES CERTIFICATE NUMBER:57911918 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 ADDL SUER POLICY EFF POLICY EXP LTR _ TYPE OF INSURANCE NOD WVD POLICY NUMBER (MMIDDIYYYY) IMMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE I I OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENt AGGREGATE LJMIT APPLIES PER: GENERAL AGGREGATE $ • POLICY JECT LOC PRODUCTS.COMP/OP AGG_$ OTHER: $ AUTOMOBILE LIABILITY COMBINED 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 I RETENTION$ $ WORKERS COMPENSATION g PER OTH- A WLR C66042790 .(AOS) 12/31/19 12/31/20 STATUTE ER AND EMPLOYERS'LIABILITY B ANYPROPRIETOR/PARTNER/EXECUTIVE nYIN SCF C66924348 (WI) 12/31/19 12/31/20 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? I I' NIA A (Mandatory In NH) SCF 066042832 12/31/19 12/31/20 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ SCF C66042832 includes FL,IA,MA,NJ & OR • DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ' ATTN: Rari Olson, Purchasing Rep 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE • (1.2(2Z?) . Ashland, OR 97520 I USA 1) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ljarvis 57911918 • P5260028002 Keystone Risk Partners,LLC 604 E.Baltimore Pike Media,PA 19063 201912093322 Electronic Service Requested E B I X B P 0 C /� v • o ALL FOR AADC 975 16303 0.5738 AB 0.409 uIliIlll�Iii�Iilu�ll�lllnllulllilnlul�l.11llll�ulll"'III'III `o City of Ashland 67 90 N MOUNTAIN AVE ASHLAND, OR 97520-2014 This document was brought to you byCerti'£icatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed - on the notice of cancellation/reinstatement.- To find out how you can send and receive all of your certificates of insurance- either by email, high speed fax or standard mail, email customercare@confirmnet.com- or visit our website at www.confirmnet.com cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this Information. Certificate Delivery by CertificatesNow-www.ConfirmNet.com-877.669.8600