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HomeMy WebLinkAboutInsurance Certificate: TruView BSI, LLC TRUVBSI-01 EDURHAM CERTIFICATE OF LIABILITY INSURANCE IIATE(M 4/18/202YYY) 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER License#0757776 co TE cT Chloe Domange �14HUB International Insurance Services Inc. PHONE FAX 548 W Cromwell Avenue INC,No,Ext): (Arc,No): Suite101 AbRIE .chloe.domange hubintemational.com Fresno,CA 93711 _INSURER(SJ AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10851 INSURED INSURER B:Hartford Accident and Indemnl Company 22357 TruView BSI,LLC IN$VRERc:At-Bay Specialty Insurance Company 19607 225 Broadhollow Road Suite 304 INSURER D: Melville,NY 11747 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLISUBR POLICY NUMBER rPIOLICY EFF POLICY EXP iMMIDDMYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F7Z,7 OCCUR X X 51GLO17208-241 11/1312024 811/2026 pAMMGETO eEoccuDnce $ 500,000 MED EXP LAny oneperson) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIM 7 APPU ES PER: GENERALAGGREGATE $ 3,000,000 X POLICY❑JCI LOC PRODUCTS-COMP/OP AGG S 3,000,000 OTHER: JEANDO $ Included A AUTOMOBILE LIABILITY COMBINED SGLE LIMIT a accident) $ ANY AUTO 51GLO17208-241 11I13I2024 €N 8/1/2025 BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS �N BODILY INJURY Per accident.S X AUUTOS ONLY X A�7CS ONLY P�acEcldentDAMAGE $ X 8OAlHiredindw NOA1Hired incl $ 1,000,000 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB I CLAIMS-MADE SIEOOOS058-241 11/13/2024 8/1/2025 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 10,000 $ B WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY A UT' ER ANY PROPRIETOR/PARTNERIEXECUTNE YIN X 16WEQY5C2P SI1I2024 811J2025 1,000,000 OFFIC.RrEMQIF-XCLUDED? ❑ NtA E.L.EACH ACCIDENT $ (Mandatory In NH) 11000,000 E.L.DISEASE-EA EMPLOYE S If es,desoribe under 1,000,000 DESCRIPTION OF OPERAT]ONS below E.L.DISEASE-POLICY LIMIT 5 A Errorss:Omissions 51GLO17208-241 11/13/2024 8J1/2025 Incl w GLILimit 1,000,000 C CyberlPrivacylNetwor AB-6748201-04 4115J2025 4115/2026 Limit 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) City of Ashland,Oregon,and its elected officials,officers and employees are Additionally Insured on policies with respect to contractors services provided under this contract.Insurance is Primary and non-contributory.Notice of Cancelation applies. Endorsements Attached:CG2038 0413,ECG24620 0805,ECG245200805,ECG24522 0402,Workers Comp Endorsement to follow. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 N.Mountain Ave. Ashland,OR 97520 AUTHOR2ED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy No. 51 GLO17208-241 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AND NON-OWNED AUTO LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE* Insurance is provided only with respect to those coverage's for which a specific premium charge is shown: Coverage Additional Premium Non-Ownership Liability 50.00 Hired Auto Liability 50.00 *Information required to complete this Schedule, if not shown on this endorsement,will be shown in the Declarations. A. HIRED AUTO LIABILITY The insurance provided under COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY applies to"bodily injury'or"property damage"arising out of the maintenance or use of a "hired auto"by you or your"employees"in the course of your business- B. NON-OWNED AUTO LIABILITY The insurance provided under COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY applies to"bodily injury"or"property damage"arising out of the use of a"non-owned auto" by any person other than you in the course of your business. 1. With respect to the insurance provided by this endorsement: a. Exclusions 2.c.,2.e.,2.g.,2.h.,2 j.,2X,21,2.m., 2.n.and 2.o.under COVERAGE:A-- BODILY INJURY AND PROPERTY DAMAGE LIABILITY are deleted. b. Exclusion 2.p.and 2.q.under COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY are added: p. 'Bodily injury': (1) To an"employee"of the insured arising out of and in the course of employment by the insured;or (2) To the spouse,child,parent,brother or sister of that"employees"as a consequence of(1)above_ This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity;and (2) To any obligation to share damages with or repay someone else who must pay damages because of injury. ECG 04 509H 1099 Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc,with its permission Copyright, Insurance Services Office,Inc., 1999 g. "Insured contract"means that part of any contract or agreement entered into,as part of your business,by you or any of your"employees"pertaining to the rental or lease of any"auto'; An"insured contract'does not include that part of any contract or agreement: (1) That pertains to the loan,lease or rental of any"auto"to you or any of your"employees". If the"auto"is loaned,leased or rented with a driver;or (2) that holds a person or organization engaged in the business of transporting property by "auto"for hire harmless for your use of an"auto"over a route or territory that person or organization is authorized to serve by public authority. 5. OTHER INSURANCE The insurance provided by this endorsement is excess over any other valid and collectible insurance available to the insured. All other policy provisions apply. ECG 04 509H 1099 Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc.with its permission Copyright,Insurance Services Office,Inc.,1999 b. That portion of"your work" out of which the 2. Available under the applicable Limits of injury or damage arises has been put to its Insurance shown in the Declarations; intended use by any person or organization whichever is less_ other than another contractor or subcontractor engaged in performing This endorsement shall not increase the operations for a principal as a part of the applicable Limits of Insurance shown in the same project. Declarations. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 4. Required by the contract or agreement described in Paragraph A.1.; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 38 04 13 If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this meth- od, each insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. ECG 24 520 08 05 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2 E3 Used with its permission.