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HomeMy WebLinkAboutInsurance Certificate: Lithia Arts Guild ACORD CERTIFICATE OF LIABILITY INSURANCE D /D o4/25/zs/2012) olz 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(les)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 .. NAME:. '-- Pacific Benefi2.Consultants,: Inc• PHONE 541.484.6624 ___ _ Ac No ExI: INC,No:541.686:2726 450 Country Club Road #330 ADDRESS: - Eugene, OR 97401 INSURER(S)AFFORDING COVERAGE NAICN INSURER A: Sentinel Insurance Company 11000 . INSURED LITHIA ARTS GUILD OF OREGON, INC. NSURERa: 26S N MAIN STREET #2 INSURER C: Suite 2 INSURER D: ASHLAND, OR 97520 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 2012-13 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, LTR TYPE OF INSURANCE INS= WVD POLICY NUMBER MMIDD/YVVV MMIDD/YVYY LIMITS GENERAL LIABILITY 52SBMVYOOSE 06/17/2012 06117/2013 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eacccunence $ 1,000,00 CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 10,000 A X PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY . PRO - JECT LOC - $ AUTOMOBILE LIABILITY Ea accident) $ ANY AUTO BODILY INJURY(Per wreon) $ ALL OWNED SCHEDULED/, AUTOS AUTOS ' BODILY INJURY(PeraccidmA) $ HIRED AUTOS NON-OWNED "-+ AUTOS (Par accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION _ AND EMPLOYERS'UABU`TY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,desaiW under DESCRIPTION OF OPERATIONB below M E.L.DISEASE-POLICY LIMIT $ P-aw 1E V DESCRIPTION OF OPERATIONS/LOCATIONS/V I (Attach ACORD 101,Additional Re s Jule,It more space Is required) APR 3 0 2012 CERTIFICATE HOLDER CANCELLATION FAX: 541.552.2059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Attn: Bryn Morrison AUTHORIZED REPRESENTATIVE 20 E. Main Street Ashland, OR 97520 Jeff Clontz/JTC ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD