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HomeMy WebLinkAboutInsurance Certificate: Diamond Parking OP ID: DG CERTIFICATE OF LIABILITY INSURANCE DAT 07111DIYY""' 07/11/11 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 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 425.466-1291 NAMEACT Daphne M.Gellhaus Lovsted-Worthington LLC ". __ 425-486-6140 PHONE 206-838-1042 - " FAX ac No Eat: - we No):425-486-6140 P.O. Box 607 -. E-MAIL Bothell,WA 98041 ADDRESS: Daphne@lovstedworthington.com PRODUCER DIAM001 Dean R.Young CUSTOMER to a: INSURER 5 AFFORDING COVERAGE NAIL Y INSURED Diamond Parking, Inc INSURER A:Chubb Custom 605 First Ave, Suite 600 INSURER B:Federal Insurance Company Seattle,WA 98104-2224 INSURER C:Employer's Insurance Wausau INSURER D:Scottsdale Insurance Company NSURER E: NSURER 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 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 POLICY EFF POLICY EXP LTR POLICY NUMBER MWDO MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 79572244 07115111 07115112 PREMISES Ea occurrence $ CLAIMS-MADE Fx-1 OCCUR MED EXP(Any one person) $ PERSONAL B ADV INJURY $ 1,000,00 - GENERAL AGGREGATE $- - 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,00 POLICY PRO LOC $ 1FQT AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO 73547935 07/15/11 07115112 (Ea accident) BODILY INJURY(Per person) $ X ALL OWNED AUTOS " BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Peraccident) $ X NON-OWNED AUTOS $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 D XLS0068100 07/15111 07115112 DEDUCTIBLE $ RETENTION $ - $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY T RV LIMIT C ANY PROPRIETORIPARTNER/EXECUTIVE YIN WCC-Z91-452389-010 07/15/11 07115/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED9 ❑ N/A (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) RE:Station#EA01 -City of Ashland,Ashland,OR Certificate holder is an additional insured CERTIFICATE HOLDER CANCELLATION ASHLA01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1Y Ashland ACCORDANCE WITH THE POLICY PROVISIONS. On Street Parking Enforcement AUTHORIZED REPRESENTATIVE E Main Street A Ashland,OR 97520 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD