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HomeMy WebLinkAboutInsurance Certificate: TC Chevrolet Inc,4v n� CERTIFICATE OF LIABILITY INSURANCE DA7011M/DDIYYYY) 1129/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE HOES 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 pollcy(fes) 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 FEDERATED MUTUAL INSURANCE COMPANY NRME: CLIENT CONTACT CENTER - — -- iArC, No, miz 8$8-333-4949 IArC, No : 507-445-4654 HOME OFFICE: P.Q. BOX 328 OWATONNA, MN 550W E-MAIL ADDRESS_: CLIENTCONTACTCENTER(aFEDINS.COM INSURERS AFFORDING COVFRAGE NAiC4 LHsuRER A:FFDERATED RESERVE INSURANCE COMPANY 16024 INSURED TC EVROLET INC PO BOX 249 INSURER a: INSURER C: INSURER D: - ASHLAND, OR 97520-0249 INSURER E: INSURER F: CvvEKAvca SkHiIFILRtt NUMBER: 1 RFVISIDN "HMRFR• R 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. LIPAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE ADDi- INSR SUER LWD POLICY NUMBER POLN:Y EFF NlMf007YYy POLICY EXP MMIGDfYYYY LIMITS X COMM ERCUILGENERAL LIASKITY EACHOCCURRENCE $500,000 CLAIMS -MADE OCCUR AATO ETEDPRMISES ancE $100, LIED EXP (My one Person) $5,000 A Y N S918174 03/01/2025 03/01/2026 PERSONAL ADVIRIURY $500 000 OENt ]OTHER: AGGREGATE LIMIT APPLIES PER: I�+q POLICY �EGT ❑ LOC GENERAL AGGRECATE $1000 000 PRODUCTS 6 COMPIOP ACC $1,B00,f700 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEa accidenq BODILY INJURY (Per Person) AJI.'Y AUTO OWNED AUTOS ONLY AU;ML,Li_D BODILY INJURY IPer Accident) H&3ED AUTOS ONLY NONAWNE� ALIT 011L PROPERTY DAMAGE Per Acci4m LIAR XOCCUR EACH OCCURRENCE $15,000,000 AEXCESS �,UMSRrLI-A LAB LYAtMS MADE Y N 9918175 B3101/2025 031OW026 AOOREOATE $45,0p0,000 DLD I RETENTIt:r1 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WH ANY PROPR €E TORIPARTNERI EXECUTIVE OfflC£R/M EMBER EXCLUDED? IMandalary in NH) It )Bs. describe under NIA PER STATUTE 7HER £_L EACH ACCIDENT El DISEASE EA ENIPLOYEE E.L DISEASE POLICY U.Y.IT DESCRIPTION OF OPERATIONS WOW AUTO DEALER UAaIUTY Y N 9918174 03/01/2025 03101=25 ALTOLNn-FAACMFNIT $500,000 A -ENERAL L3ABLITY - EACH ACCIDENT $500,000 -AGGREGATE $1,000,000 DE"WPTIOU OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, A"SmW Remarks S"duW0. may be attached It more spaea IS regrdredl SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND 20 E MAIN ST 1 B SHOULD AHY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ASHLAND, OR 97520-1814 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016)03) The ACORD name and logo are registered marks of ACORD ACC "0 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY FEDERATED MUTUAL INSURANCE COMPANY POLICY NUMBER SEE CERTIFICATE 9 1.0 CARRIER NAIC CODE SEE CERTIFICATE 0 1.0 ADDITIONAL REMARKS NAMED INWAED TO CHEVROLET INC PO BOX 249 ASHLAND, OR 9752"249 EFFECTIVE DATE: SEE CERTIFICATE ft 1.0 Page 1 of 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: — 25_ FORM TITLE: Q1211TIFICATE OF LIABILITY INSURANC9 GARAGEKEEPERS COVERAGE IS PROVIDED ON A DIRECT PRIMARY BASIS WITH A LIMIT OF 02,300,000 FOR 2045 HIGHWAY 99 N ASHLAND, OR 97520-9653, 3001 BIDDLE RD MEDFORD, OR 97504-4118, 3103 BIDDLE RD MEDFORD, OR 97504-4120, 898 LAWNSDALE AVE MEDFORD, OR 97504-4014 AND 908 LAWNSDALE AVE MEDFORD, OR 97504-4015. THE CERTIFICATE HOLDER IS A DESIGNATED INSURED ON BUSINESS AUTO LIABILITY SUBJECT TO THE CONDITIONS OF THE DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. ACORD 101 (2008101) ® 20M ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9918174 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Auto Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: TC Chevrolet Inc Endorsement Effective: 03/01/2025 SCHEDULE Name of Person(s) Or Organizationw: City of Ashland 20 E Main St Ashland, OR 97520 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 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 Name Of Person(s) Or Organization(s) Designation Of Land (Part Leased To You) City of Ashland 2045 Highway 99 N 0 E Main St Ashland, OR 97520-9653 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the land leased to you and shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured 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. 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; Insured: TC Chevrolet Inc PO Box 249 Ashland, OR 97520-0249 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance. If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Regarding: 403 Dead Indian RD, Ashland, or © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 24 12 19 Policy Number: 9918174 Transaction Effective Dale: 03/01/2025 276-176-51 #B W N©H B S BUCOO-05 - 0362 #XWXW0021 XXXXXXX5# CITY OF ASHLAN© 20 E Main S# Ashland, OR 97520-1814