Certificate of Insurance Requirements for AHERN Rentals

1. Certificate of Insurance Requirements
Dear Valued Customer,
We appreciate your business and look forward to a long and prosperous relationship. As you are
aware, insurance costs are skyrocketing. We are required to follow certain guidelines to satisfy the
terms of our insurance contract.
Our rental agreement states that you must have the insurance in place to rent our equipment, and our
insurance carrier requires that we obtain proper evidence of such
insurance.
In order to properly comply, we ask that you supply us with the following:
Certificate of insurance: Ahern Rentals, Inc. 1401 Mineral Ave, Las Vegas, NV 89106. This
accommodates all Ahern locations.
Ahern Rentals, Inc. must be named as additional insured and loss payee, as their interests may appear,
with respect to rented, leased, or borrowed equipment. *See Attached Example.
Minimum limits:
General Liability: $1,000,000.00/occurrence;$2,000,000.00/aggregate.
Auto Liability: $1,000,000.00
Workers Compensation/Employers Liability: WC statutory limits, Employers Liability
$500,000.00/each.
Equipment floater: $1,000,000.00 (limit must be sufficient to replace any equipment leased or
rented at full replacement value)
Ahern Rentals, Inc. will need to be provided 10 days notice or cancellation for nonpayment of premium.
Ahern Rentals, Inc.
Credit Department
1401 Mineral Ave Las Vegas, NV 89106
Phone (702) 647-8100 or (800) 598-6797 Fax (702) 647-9866
E-Mail CA@Ahern.com
LA # 11216 Last Revised: 05/2011

2. DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
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 CONTACT
NAME:
PHONE FAX
A/C, No, Ext): A/C, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Insurance Company
INSURED INSURER B:
INSURER C:
INSURER D:
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 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES (Ea occurrence) $
CLAIMS-MADE OCCUR MED EXP (Any one person) $
A XXXXX PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
PROJ-
POLICY ECT LOC $
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
A NON-OWNED
HIRED AUTOS XXXXX PROPERTY DAMAGE
AUTOS (Per accident) $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS' LIABILITY Y/N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L. EACH ACCIDENT $ 500,000
A OFFICER/MEMBER EXCLUDED? N/A XXXXX
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000
Contractors Equipment Leased/Rented Equipment - $1,000,000
A XXXXX
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: Rented, Leased or Borrowed Equipment
Ahern Rentals, Inc. is named as an Additional Insured and Loss Payee, as their interests may appear, with respect to rented, leased, or borrowed equipment
Ahern Rentals, Inc. will be provided 10 days notice of cancellation for nonpayment of premium
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ahern Rentals, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1401 Mineral Avenue
AUTHORIZED REPRESENTATIVE
Las Vegas NV 89106
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