HomeMy WebLinkAboutInsurance Certificate: Kelley Create Co. DATE(MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
03/30/2026
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 CONTACT
AOn Risk Services Central, Inc. PAMNE FAX '
Chicago IL Office (A/C.No,Ext): C&56) 283-7122 (A C.No.): C800) 363-0105 _0
200 East Randolph EMAIL X
Chicago IL 60601 USA ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich American Ins CO 16535
Kelley Create Co. INSURER8: Federal Insurance Company 20281
22710 72nd Ave S
Kent WA 98032 USA INSURERC:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570118963515 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 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. Limits shown are as requested
INSR LTR TYPE OF INSURANCE DDLNSD SUBRI
POLICY NUMBER MMI TC7T7ID Y MOLICY X LIMITS
X COMMERCIAL GENERAL LIABILITY 6L0 4 EACH OCCURRENCE $2,000,000
CLAIMS-MADE X�OCCUR PREMISES Ea occurrence _ $1,000,000
MED EXP(Any one person) $10,000
PERSONAL&.ADV INJURY $2,000,000 r2
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000. co
X POLICY ❑FRO- ❑LOC PRODUCTS-COMP/OPAGG $4,000,000 on
JECT
OTHER: o
r
A AUTOMOBILE LIABILITY BAP 2930234-02 04/01/2026 04/01/2027 COMBINED SINGLE LIMIT $2,000,000
Ea accident' ..
X ANY AUTO BODILY INJURY(Per person) __ 0
OWNED SCHEDULED BODILY INJURY(Per accident) tea)
AUTOS ONLY AUTOS M
HIREDAUTOS NON-OWNED PROPERTY DAMAGE
{Per accident
ONLY AUTOS ONLY
d
B X UMBRELLA LIAB X OCCUR 56735196 04/01 2026 04/01/2027 EACH OCCURRENCE $10,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $10,000,000
DED RETENTION
A WORKERS COMPENSATION AND WC293023202 04/01 2026 04 01 2027 X. I PER STATUTE OR7H-
EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER I EXECUTIVE E.L.EACH ACCIDENT $1,000,000
DED?OFFICER/MEMBER EXCLU N N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000---
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The City of Ashland, Oregon its officers, agents and employees are included as Additional Insured in accordance with the policy
provisions of the General Liability, Automobile Liability and Excess Liability policies_ General Liability policy evidenced
herein is Primary and Non Contributory to other insurance available to an Additional insured, but only in accordance with the
policy's provisions.
b Go-
CERTIFICATE HOLDER CANCELLATION -
o
o
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE o
POLICY PROVISIONS.
o
City of Ashland AUTHORIZED REPRESENTATIVE
20 East Main street o
Ashland OR 97520 USA _ g
O
-^ O
01988-9015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD