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HomeMy WebLinkAboutInsurance Certificate: Owen Equipment Holdings Corp. '�Ca® DATE CERTIFICATE OF GARAGE INSURANCE 09/15/2023�YYY) 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 Sentry Customer Service Sentry Insurance PHON 1800 North Point Drive (A/C,No,Ext): 800-473-6879 FAX No):800-514-7191 Stevens Point,WI 54481 EMAIL ADDRESS: businessproducts_directesentry.com • INSURER(S)AFFORDING COVERAGE NAIC P INSURER A:Sentry Select Insurance Company 21180 INSURED INSURERS: Owen Equipment Holdings Corp 4201 NE 66th Ave Ste 105 INSURER C Vancouver,WA 98661-3078 INSURER D: INSURER E: INSURER F: COVERAGES PROD/CUSTOMER ID: CERTIFICATE II: 2399666 REVISION#: 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MM/DD/YYYY) (MM/DD/YYYY) GARAGE LIABILITY HIRED AUTOS AUTO ONLY(Ea accident) S 500,000 X ANY AUTO —ONLY A OWNED AUTOS USED X A0186985001 11/09/2023 11/09/2024 OTHER THAN EAACCIDENT $500,000 ' AUTOS ONLY IN GARAGE BUSINESS AUTO ONLY AGGREGATE Scheduled Autos $2,500,000 GARAGE KEEPERS LIABILITYCOMP/ X OTC LOC 1 $1,000,000 LEGAL LIABILITY SPECIFIED LOC $ A0186985001 11/09/2023 11/09/2024 A DIRECT BASIS X X COLLISION LOC 1 $1,000,000 PRIMARY n EXCESS — LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $500,000 CLAIMS-MADE[] OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $5,000 A0186985001 11/09/2023 11/09/2024 PERSONAL&ADV INJURY $500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,500,000 JEC ' POLICY r l I LOC PRODUCTS-COMP/OP AGG $2,500,000 OTHER I 1 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 A X EXCESS LIAB CLAIMS-MADE A0186985008 11/09/2023 11/09/2024 AGGREGATE $30,000,000 DED RETENTION$ PRODUCTS-COMP/OP AGG $30,000,000 WORKERS COMPENSATIONX PER Ni- AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE N/A A0186985007 11/09/2023 11/09/2024 E.L.EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? Y/N •-- -- - -- -(Mandatory in in NH) ❑ E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under REMARKS below E.L.DISEASE-POLICY LIMIT $1,000,000 Employee Benefits Occurrence Limit $500,000 ' Errors&Omissions Annual Aggregate Limit $1,000,000 A ERRORS&OMISSIONS A0186985005 11/09/2023 11/09/2024 Deductible $1,000 All Other Errors& Occurrence Limit $250,000 Omissions Annual Aggregate Limit $500,000 Deductible $500 REMARKS(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION 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 ACCORDANCE Ashland,OR 97520-1814 WITH THE POLICY PROVISIONS. AUTH RIZ ESE4 v!�NTAJIV e y� ACORD 30(2016/03)• Page 1 of 2 ©2010-2!0/15 ACORD CORPORATION.All rights reserved. ''S A0186985 The ACORD name and logo are registered marks of ACORD Sentry Select Insurance Company 09/15/2023 3 00005 0000000480 23260 N A 0 51B3EF9D-5584-4CD6-876E-F73E82E1FDOE 0027020044371567420697520181420 I ...'"'"."111) AGENCY CUSTOMER ID:m000mss AMMO LOC#: `...--' ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Shaun Retz Owen Equipment Holdings Corp POLICY NUMBER A0186985001 CARRIER NAIC CODE Sentry Select Insurance Company 21180 EFFECTIVE DATE: 11/09/2023 , ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Garage Insurance Auto Dealers The City of Ashland, Oregon, its Officers, Agents and Employees are named as Additional Insured on a Primary and Non-Contributory basis. General Liability is included within the Garage Liability(including products/completed operations). Garagekeepers Liability Location# State Basis Collision Limit Comp/OTC/Specified Perils Limit 2 UT Natural Disasters Legal $ 3,250,000 $ 3,250,000 Liability 3 CA Natural Disasters Legal $ 1,000,000 $ 1,000,000 Liability 4 WA Natural Disasters Legal $ 1,000,000 , $ 1,000,000 Liability 10 WA Natural Disasters Legal $ 1,000,000 $ 1,000,000 Liability Errors and Omissions Liability Coverage: Policy Number:A0186985005 Effective date: 11/09/2023 Expiration Date: 11/09/2024 Per Occurrence Limit:$250,000 General Aggregate Limit:$500,000 Truth-In-Lending and Truth-In-Leasing Odometer Hour Meter and Prior Damage Disclosure Errors and Omissions Dealership Insurance Agents' Errors and Omissions Title Errors and Omissions • • ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. A0186985 The ACORD name and logo are registered marks of ACORD 09/15/2023 Sentty Select Insurance Company CCORD S DATE CERTIFICATE OF GARAGE INSURANCE 9/5/ /YYYY) 2023 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 Sentry Customer Service Sentry Insurance NAME: 1800 North Point Drive (A/C,No, Ext): 800-473-6879 FAX No):800-5147191 Stevens Point,WI 54481 EMAIL ADDRESS: businessproducts_directOsentry.com INSURER(S)AFFORDING COVERAGE NAIC If INSURER A:Sentry Select Insurance Company 21180 INSURED INSURER B: Owen Equipment Holdings Corp INSURER C 4201 NE 66th Ave Ste 105 Vancouver,WA 98661-3076 INSURER D: INSURER E: . INSURER F: • COVERAGES PROD/CUSTOMER ID: CERTIFICATE II: 2399666 REVISION#: 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MM/DD/YYYY) (MM/DD/YYYY) GARAGE LIABILITY HIRED AUTOS AUTO ONLY(Ea accident) $ ANY AUTO ONLY NON-OWNED EA OWNED AUTOS USED OTHER THAN ACCIDENT $ AUTOS ONLY IN GARAGE BUSINESS AUTO ONLY AGGREGATE Scheduled Autos $ GARAGE KEEPERS LIABILITY _ OTC P / LOC $ LEGAL LIABILITY SPECIFIED LOC $ ILS DIRECT BASIS _ COLLISION_ LOC $ _ PRIMARY n EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE n OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ POLICY n PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER ATUTE ER p7� AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/IXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y/N (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYEE $ If yes,describe under REMARKS below E.L.DISEASE-POLICY LIMIT $ Cyber Liability arid N/A A0186985009 11/09/2023 11/09/2024 Policy Aggregate Limit of Liability $100,000 A Data Breach Response Retention $2,500 REMARKS(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 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 ACCORDANCE Ashland,OR 97520-1814 WITH THE POLICY PROVISIONS. AUT RIZ ESENT/71.77/ rile ;� ACORD 30(2016/03) Page 1 of 2 ©2010-2015 ACORD CORPORATION.All rights reserved. ` A0186985 The ACORD name and logo are registered marks of ACORD 09/15/2023 _xi Sentry Select Insurance Company 5 ' 00005 0000000480 23260 N A 0 1D5746AE-OAEE-454C-8FD0-92824E9598FA 0027020044371567460997520181420 �•� AGENCY CUSTOMER ID:)00000(6186 fICORD® ADDITIONAL REMARKS SCHEDULE Page ? of ? AGENCY NAMED INSURED Shaun Retz Owen Equipment Holdings Corp POLICY NUMBER • CARRIER NAIC CODE Sentry Select Insurance Company 21180 EFFECTIVE DATE: 11/09/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Garage Insurance • • • ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. A0186985 The ACORD name and logo are registered marks of ACORD 09/15/2023 Sentry Select Insurance Company COMMERCIAL AUTO CA 88 04 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name of Person or Organization: City of Ashland Start Date of Show: End Date of Show: - Event Name: Event Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - General Liability Coverages, Paragraph The person or organization listed in the Schedule D.Who Is An Insured is amended by the addition of above, but only with respect to liability arising out of the following: your "auto dealer operations" or premises owned by The following are "insureds" for "auto dealer or rented to you. operations"; All other terms and provisions of the policy remain unchanged. CA 88 04 10 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0186985 with its permission. 09/15/2023 aSentry Select Insurance Company 7 00005 0000000480 23260 N A 0 770C3443-D8E1-46F2-87FB-82873F5B4D6F 0027020044371567577797520181420 IL 70 58 0214 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s)or organization(s)shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s)or Organization(s) including mailing address: City of Ashland , 20 E Main St Ashland,OR 97520-1814 All other terms and conditions of this policy remain unchanged. iIL70580214 Page of 1 A0186985 09/15/2023 Sentry Select Insurance Company 9 00005 0000000480 23260 N A 0 77003443-D8E1-46F2-87FB-B2B73F5B406F 0027020044371567577797520181420 Dealer Sentry Select Insurance Company 4400E 53rd St Davenport,IA 52807 • 0000000480 City of Ashland 20 E Main St Ashland, OR 97520-1 81 4 mllluippl"11'1II11111111111111111111i111II'Iimllillill N.k; 1 00005 0000000480 23260 N A 0 BA4AF71G9806-4E30-9E14-D28B2D75925E 0027020044371567586397520181420 Dealer Sentry Select Insurance Company 4400 E 53rd St Davenport,IA 52807 • 0000000480 • City of Ashland 20 E Main St Ashland, OR 97520-1814 II"IIuIIIi1IIIIIIIIII111111IIiiiiHIPliuiiIlIllIII l