Loading...
HomeMy WebLinkAboutInsurance Cancellation: Owen Equipment Holdings CorpIL70580214 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. IL 70 58 02 14 i A0186985 Sentry Select Insurance Company ' 9 00005 0000000736 24035 N A 0 FFED695D-E68C-4266-9138-06DCB60C9CDE 0027020044373689711097520181420 Page 1 of 1 02/02/2024 ACOR& CERTIFICATE OF GARAGE INSURANCE ATE (MM/DD/YYYY) 02/02/2024 r 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 endorsements . PRODUCER Sentry Insurance 1800 North Point Drive CONTACT Sentry Customer Service NAME: aC No Ex ; 800-473-6879 AIC No): 800-514-7191 Stevens Point, WI54481 EMAIL ADDRESS: businessproducts_directdsentry.com INSURER(S) AFFORDING COVERAGE NAIC H INSURER A; Sentry Select Insurance Company 21160 INSURED INSURER B : Owen Equipment Holdings Corp 4201 NE 66th Ave Ste 105 INSURER C : INSURER D : Vancouver, WA 98661-3078 INSURER E : INSURER F : COVERAGES PROD / CUSTOMER ID: CERTIFICATE N: 2399666 REVISION f): 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 LTR TYPE OF INSURANCE ADDL INSRD SUBR WVD POLICY NUMBER POLICY EFF (MM/DDYYY) /Y POLICY EXP (MM/DD/YYY`n LIMITS GARAGE LIABILITY HIRED AUTOS AUTO ONLY (Ea accident) $ ANY AUTO ONLY NON -OWNED OWNED AUTOS USED OTHER THAN EA ACCIDENT $ AUTOS ONLY IN GARAGE BUSINESS Scheduled Autos AUTO ONLY AGGREGATE $ GARAGE KEEPERS LIABILITY COMP / OTC LOC $ LEGAL LIABILITY SPECIFIED LOC $ COLLISION LOC $ DIRECT BASIS PRIMARY EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? Y / N E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) ❑ If yes, describe under E.L. DISEASE - POLICY LIMIT $ REMARKS below Cyber Liability and 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 Ashland, OR 97520-1814 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT IZ ESENTAqvv ,w r A.- / ACORD 30 (2016/03) A0186985 Sentry Select Insurance Company 3 00005 0000000736 24035 N A 0 Page 1 of 2 m 2010-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 02/02/2024 836E8238-DB2E-453F-892C-DFEFBFDCEBD2 0027020044373689709997520181420 AGENCY CUSTOMER ID: b000IX61e6 ACOR" LOC #: — ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Kameron Lajoie NAMEDINSURED Owen Equipment Holdings Corp POLICY NUMBER CARRIER Sentry Select Insurance Company NAIC CODE 21180 EFFECTIVE DATE: 11/09/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate Of Gara a Insurance ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. A0186985 The ACORD name and logo are registered marks of ACORD 02/02/2024 Sentry Select Insurance Company ACORD® L....� CERTIFICATE OF GARAGE INSURANCE ATE (MM/DD/YYYY) 02/02/2024 r 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 endorsements . PRODUCER Sentry Insurance 1800 North Point Drive CONTACT Sentry Customer Service NAME: A/CNNo Ex : 800-473-6879 1 FAA1XC No: 800-514-7191 Stevens Point, WI54481 EMAIL ADDRESS: businessproducts_direct@sentry.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Sentry Select Insurance Company 21180 INSURED INSURER B : Owen Equipment Holdings Corp 4201 NE 66th Ave Ste 105 INSURER C : INSURER D : Vancouver, WA 98661-3078 INSURER E : INSURER F : COVERAGES PROD / CUSTOMER ID: CERTIFICATE #: 2399666 REVISION N: 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 LTR TYPE OF INSURANCE ADDL INSRD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYY1/) LIMITS GARAGE LIABILITY HIRED AUTOS AUTO ONLY (Ea accident) $ 500,000 A ANY AUTO ONLY NON-OWNED OWNED AUTOS USED X A0186985001 11/09/2023 11/09/2024 OTHER THAN EA ACCIDENT $ 500,000 AUTOS ONLY IN GARAGE BUSINESS Scheduled Autos I AUTO ONLY AGGREGATE $ 2,500,000 GARAGE KEEPERS LIABILITY X CAMP / LOC OTC 1 $ 1,000,000 A LEGAL LIABILITY DIRECT BASIS X A0186985001 11/09/2023 11/09/2024 SPECIFIED LOC PERILS $ X COLLISION LOC 1 $ 1,000,000 PRIMARY EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS -MADE OCCUR PREMISES Ea oocccu rence $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 500,000 A0186985001 11/09/2023 11/09/2024 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,500,000 POLICY ❑ PRO- El PRO- JECT PRODUCTS - COMP/OP AGG $ 2,500,000 $ OTHER 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 I I RETENTION $ PRODUCTS - COMP/OP AGGp7}{ $ 30,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X PER ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N / A A0186985007 11/09/2023 11/09/2024 A OFFICER/MEMBER EXCLUDED? Y / N E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) ❑ If yes, describe under E.L. DISEASE- POLICY LIMIT $ 1,000,000 REMARKS below 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. AUT RIZ ESENTA IV ACORD 30 (2016/03) A0186985 Sentry Select Insurance Company 5 00005 0000000736 24035 N A 0 Page 1 of 2 © 2010-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 02/02/2024 7CF29F13-1197-46 DC-8E64-6 FEF5889 DB19 0027020044373689711397520181420 AGENCY CUSTOMER ID: X)00=6186 LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Kameron Lajoie NAMED INSURED Owen Equipment Holdings Corp POLICY NUMBER A0186985001 CARRIER Sentry Select Insurance Company NAIC CODE 21180 EFFECTIVE DATE: 11/09/2023 \DDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 30 FORM TITLE: Certificate 0f Gara a 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) m 2008 ACORD CORPORATION. All rights reserved. A0186985 The ACORD name and logo are registered marks of ACORD 02/02/2024 Sentry Select Insurance Company COMMERCIAL AUTO CA88041013 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. Name of Person or Organization: City of Ashland Start Date of Show: Event Name: Event Location: SCHEDULE End Date of Show: (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 D. Who Is An Insured is amended by the addition of the following: The following are "insureds" for "auto dealer operations"; The person or organization listed in the Schedule above, but only with respect to liability arising out of your "auto dealer operations" or premises owned by or rented to you. 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. 02/02/2024 Sentry Select Insurance Company 7 00005 0000000736 24035 N A 0 FFED695D-E68C-4266-9138-06DC860C9CDE 0027020044373689711097520181420 Dealer Sentry Select Insurance Company 4400 E 53rd St Davenport, IA 52807 0000000736 City of Ashland 20 E Main St Ashland, OR 97520-1814 II.II"��'III"II�I�'II""IIIIIII��1'I�IIII�'I�IIIIIII����I'�I'I S S 1 00005 0000000736 24035 N A 0 72246A09-94EA-490C-AB46-3422C7643317 0027020044373689704897520181420 Dealer Sentry Select Insurance Company 4400 E 53rd St Davenport, IA 52807 0000000736 City of Ashland 20 E Main St Ashland, OR 97520-1814 II�II"��'III"II�I�'II"'�IIIIIII��I'I�1111��1�1111111����1'�I'I