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HomeMy WebLinkAboutInsurance Certificate: Humphries Family Enterprises dba West Coast Applicance E(MIWEIDNYYY) r4CERTIFICATE OF LIABILITY INSURANCE �"0 01272021 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 NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 (A/C,No,Ext):888-333-4949 FAX No):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER((FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 339-397-2 INSURER B:FEDERATED SERVICE INSURANCE COMPANY 28304 HUMPHRIES FAMILY ENTERPRISES INC,WEST COAST APPLIANCE INSURER C: 6439 CRATER LAKE HWY CENTRAL POINT,OR 97502-8405 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:45 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 POLICY EXP LTR TYPE OF INSURANCE `INSR SWVD POLICY NUMBER (MM DID VYCY I YI (MMIDDIVYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE n OCCUR PREMISES(Ea RENTED eccurrrence) $100,000 MED EXP(Any one person) EXCLUDED B Y N 9284866 03/01/2021 03/01/2022 PERSONALE ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- �OTHER:pOLICY )ECT LOC PRODUCTS-COMP/OP A00 $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) —OWNED AUTOS ONLY SCHEDULED B AUTOS N N 9284866 03/01/2021 03/01/2022 BODILY INJURY(Per accident) _ HIRED AUTOS ONLY AUT-OWNED • PROPERTY DAMAGE _AUTOS ONLY (Per accident) I X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $2,000,000 B EXCESS LIAB CLAIMS-MADE N N 9284867 03/01/2021 03/01/2022 AGGREGATE $2,000,000 DED I I RETENTION WORKERS COMPENSATION X PER STATUTE CER AND EMPLOYERS'LIABILITY Y/N ' ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500,000 , A OFFICER/MEMBER EXCLUDED? N I A N 9334540 10/01/2020 10/01/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached if more space is required) CITY OF ASHLAND IS ADDITIONAL INSURED ON GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 339-397-2 45 0 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-2014 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9284866 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations CITY OF ASHLAND ANY COVERAGE PROVIDED BY THIS 90 N MOUNTAIN AVE ENDORSEMENT APPLIES ONLY WHILE HUMPHRIES ASHLAND OR 97520 FAMILY ENTERPRISES INC IS SERVICING, INSTALLING, OR DELIVERING APPLIANCES (WHILE IN THEIR CARE, CUSTODY, OR CONTROL)TO OR FOR THE ADDITIONAL INSURED/CERTHOLDER. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage" occurring after: injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs)to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been completed; or designated above. However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. HUMPHRIES FAMILY ENTERPRISES INC 6439 CRATER LAKE HWY CENTRAL POINT OR 97502 © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 10 12 19 Policy Number: 9284866 Transaction Effective Date:03-01-2021 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 Policy Number: 9284866 Transaction Effective Date:03-01-2021 339-397-2 45 PW N D H BS BS000-04-0382 WXW0021 XXXXXXX5## Y OF ASHLAND 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 • . - __� LL ti