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CERTIFICATE OF INSURANCE The American Hardware Mutual Insurance Company
Issue Date 02/20/06
PRODUCER
SOLTIS KEVIN 937
PO BOX 435
MINNEAPOLIS, MN 55440-0435
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
INSURED
TOWN & COUNTRY CHEVROLET OLDS INC
AS PER ATTACHED
PO BOX 249
ASHLAND, OR 97520
COMPANIES AFFORDING COVERAGE
A. American Hardware Mutual Insurance Company
B.
C.
ACCOUNT NO.: 0283812
COVERAGES:
THIS IS TO CERTIFY THAT 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 Vl/1TH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TERMS,
CO TYPE OF INSURANCE POLICY NUMBER EFF EXP LIMITS
DATE DATE
A GENERAL LIABILITY 2322332 03/01/06 03/01/07 GENERAL AGGREGATE $ 1,000,000
[Xl COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG. $
[ 1 CLAIMS MADE [Xl OCCURRENCE PERSONAL & ADVERTISING INJURY $ 500,000
[ 1 OWNERS & CONTRACTORS PROT. EACH OCCURRENCE $ 500,000
FIRE DAMAGE $ 100,000
MEDICAL EXPENSE (Anyone person) $ 5,000
A AUTOMOBILE LIABILITY 2322332 03/01/06 03/01/07 COMBINED SINGLE LIMIT $
[ 1 ANY AUTO
[Xl ALL OWNED AUTO BODILY INJURY (Per person) $
[Xl SCHEDULED AUTOS
[Xl HIRED AUTOS BODILY INJURY (Per accident) $
[Xl NON-OWNED AUTOS PROPERTY DAMAGE $
[Xl GARAGE LIABILITY COMBINED SINGLE LIMIT-EACH ACC. $ 500,000
[Xl GARAGE LIABILITY OTHER THAN AUTO AGGREGATE $ 1,500,000
[Xl GARAGE KEEPERS GARAGE KEEPERS LIMIT $ 1,800,000
A EXCESS LIABILITY 2322333 03/01/06 03/01/07 EACH OCCURENCE $ 10,000,000
[Xl UMBRELLA FORM AGGREGATE $ 10,000,000
[ 1 OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION & STATUTORY LIMITS
EMPLOYERS LIABILITY EACH ACCIDENT $
DISEASE - POLICY LIMIT $
DISEASE - EACH EMPLOYEE $
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES RESTRICTIONS/SPECIAL ITEMS:
CERTIFICATE HOLDER IS ADDITIONAL INSURED PER FORM CG 2024
CITY RECORDER'S CC)PV
CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
CITY OF ASHLAND REPRESENTATIVES.
20 E MAIN ST AUTHORIZED REPRESENTATIVE
ASHLAND, OR 97520 ~~
511-7411 (1-02)
- T
ACCOUNT NUMBER: 0283812 SALES REP: SOLTIS KEVIN 937
IT IS HEREBY UNDERSTOOD THAT THE INSURED'S NAME READ AS FOLLOWS:
TOWN & COUNTRY CHEVROLET OLDS INC
COURTESY INC
DBA COURTESY LEASING & RENT-A-CAR
DBA SOUTHERN OREGON SUBARU-VOLVO-
MITSUBISHI AIRPORT CHEVROLET INC
DBA DOLLAR GMC OLDSMOBILE
DBA AIRPORT CHEVROLET VALLEY
INVESTMENTS PROMOTIONS COURTESY
COMMERCIAL PROPERTY & DEVELOPMENT INC
ALAN & REBECCA DEBOER AS PARTNERS
ALAN DEBOER AS INDIVIDUAL
JAMES DAVID MILLS AS INDIVIDUAL
DUANE WALLACE AS INDIVIDUAL
DBA DENTS PLUS
~ T
POLICY NUMBER: 6-2322332
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CARI:FULL Y.
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
Designation of Premises (Part Leased to You):
403 DEAD INDIAN ROAD
ASHLAND OREGON
Name of Person or Organization:
CITY OF ASHLAND
20 E MAIN STREET
ASHLAND OR 97520
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to
include as an insured the person or organization
shown in the Schedule but only with respect to liability
arising out of the ownership, maintenance or use of
that part of the land leased to you and shown in the
Schedule and subject to the following additional ex-
clusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you
cease to lease that land;
2. Structural alterations, new construction or demoli-
tion operations performed by or on behalf of the
person or organization shown in the Schedule.
CG 20 24 11 85
Copyright, Insurance Services Office, Inc., 1984
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