HomeMy WebLinkAboutInsurance Certificate: C & C Tires Inc. � DATE(MMJDDtYYYY)
'`� it CERTIFICATE OF LIABILITY INSURANCE 03/06/2026
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 NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE — FAX - —"—
HOME OFFICE:P.O.BOX 328 tA/C,No,Ext):888-333-4949 SArc,No):507 446-4664
OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024
C&C TIRES INC INSURER C:
5600 CRATER LAKE AVE -------
CENTRAL POINT,OR 97502-9472 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:19 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF I PODGY EXP LIMITS
LTR INSR WVD MMIDDIYYYY MM1DDtYYYY
COMMERCIAL GENERAL LIABILITY li EACH OCCURRENCETPREMISES.
$1,000,000
CLAIMS-MADE OCCUR DA-EsMAGE en RENTE $100,000
DAoccurrence)XBUSINESS OWNER'S LIABILITY MED EXP(Any one pA N N 0639512 04/15/2026 04/15/2027 PERSONAL&ADVIN $1,DOQ,000
GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGA $2,000,000
X POLICY �C7 ❑LOC PRODUCTS&COMPIOP A.CC $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,DOD,OOD
(Ea accident)
X ANYAUTC BODILY INJURY(Per Person)
B OWNED AUTOS ONLY]SCHEDULED N N 0639513 04/15/2026 04/15/2027 BODILY INJURY(Per Acident)AUTOSHIRED AUTOS ONLY `n E� PROPERTY—DAM—AGE—
AUTOSr Ai '}
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE. AGGREGATE
DED I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN PER STATUTE 7HEft
ANY PROPRIETORMARTNERI EXECUTIVE E-L EACH ACCIDENT
OFFICERIMEMBER EXCLUDED? NI/A.
'IMandatery in NH) E.L DISEASE EA EMPLOYEE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Addilional Remarks Schedule,may be attached If more space is required)
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND 19 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
20 E MAIN ST
ASHLAND,OR 97520-1814 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD