Loading...
HomeMy WebLinkAboutInsurance Certificate: ASC #1 LLC DATE(MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 08/04/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR 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 Danielle Polonczyk NAME: Brown&Brown Metro,LLC HICONNo Ext: (856)552-6330 (FAX No): (856)840-8484 10 Lake Center Drive E-MAIL Danielle.Polonczyk@bbrown.com ADDRESS: Suite 310 INSURER(S)AFFORDING COVERAGE NAIC# Marlton NJ 08053 INSURERA: Ironshore Specialty Insurance Company 25445 INSURED INSURER B ASC#1 LLC INSURER C 310 East 38th Street Suite 109 INSURER D: INSURER E: Minneapolis MN 55409 INSURER F: COVERAGES CERTIFICATE NUMBER: 25-26ASC#1 LLC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEAUULbUbK POLICY EFF POLICY EXP LTR INSD WVD POLICYNUMBER MM/DD/YYY MM/DD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETCLAIMS-MADE FX OCCUR PREM SESOEa oNcMmnce $ 500,000 MED EXP(Any one person) $ 25,000 A Y IEPUW0032118000 01/22/2025 01/22/2026 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMITAPPLIES PERGENERAL AGGREGATE $ 2,000,000 POLICY ElPRO FX LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED IEPUW0032118000 01/22/2025 01/22/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident Hired&Non-owned $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS-MADE XSCUW0032118100 01/22/2025 01/22/2026 AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN/A E.L.EACH ACCIDENT $ D?OFFICER/MEMBER EXCLUDE (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractors Pollution Liability Each Occurrence 1,000,000 A IEPUW0032118000 01/22/2025 01/22/2026 Deductible 10,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Ashland Public Works Division is included as Additional Insureds if required by written contract on the captioned General Liability policies as per the attached endorsements to the extent provided therein. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland Public Works Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD