HomeMy WebLinkAboutInsurance Certificate: Lithia Artisans Market 29 1201:46p Powell Insurance Assoc 5417476640 p.1
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,__, CERTIFICATE OF LIABILITY INSURANCE D"To�2012
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 CONSTIT UTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AIITHORzED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N 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 - CONTACT KELL.S POWELL
NAME: _
POWELL INSURANCE ASSOCEATES INC PHONE 541-747-6000 ac Na: 541-747-6640
PO BOX P L kalli(mpowellinsurance.biz
SPRINGFIELD OR 97477 01SUR B AFFORDINGCOIIERAGE _ NAICX
INSURERA: FIRST NATIONAL INSURANCE CO OF AMERICA !
INSURED INSURER a
LITHIA ARTISANS MARKETING INSUR RC:
INCLUDING VENDORS - INSURER O:
PO BOX 3505 INSURER E:
ASHLAND OR 97520 1 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. NOTWTTHSTANDING 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 SD- POUICYEFF POUCYEXP
LTR TYPE OF INSURANCE POLICY NUMBER LIMrrs
GENERALLIABMITY I EACH OCCURRENCE S 1,000,ODO
X COMMERCIALGEIERALLIABIUTY I DAMAGE T RENTED 1,000,0DO
PREMISES{Fa mnnmcal 5
CLNMS-MADE Fx-1 OCCUR i I MEDF An one ewr S 10,000
A , X I 01-CW933884-5 1011412012 10/1412013 pER50MAL6AOV pJA1RY s 1,000,000
I GENERAL AGGREGATE s 2.000.000
GENL AGGREGATE UNIT APPLIES PER i PRODUCTS-COMMP AEG S 2,000,000
X POLICY PRO- LOG S
AVTCLIOBILE LIABILRY COMBINED SINGLE LIMIT
aaaident
ANYAIITO BODILY INJURY(PerPvsml Is
ALL OWNED SCHEDULED GODLY IWUHY(Per a dml) E
AUTOS AUTOS
NIREO AUTOS NONOWNEp PROPERTY DAMAGE S
AUTOS d nil
$
IH®REULA UAB OCCUR EACHOCCURRENCE S
EXCESS LAB i CIAIM�E AGGREGATE S
OEO RETENTIONS S
IIIORIlEit9 COMPENSATION 1 WC STATU- On1-
AMDENPLOY6R5'LIABILITY YIN
ANY PROPRtETORIPARTNER/EXECUTNE DEL EACH ACCIDENT S
OFFI�IAEMBER EXCLUDED? NIA
(MarWrtory In NH) E.L.DISEASE-EA CJKOYEE S
Ir Yee,dasviba under _
:D-3,RIPnON OF OPERATXNVS baton E.L DISEASE-POUCV LMIT 5
DESCrtIPTION OF OPERAFM)NB/LOCATIONS/VBIM:LES(ANadb ACORD ret.Addhlmal Remrka SrMEUb,N Imre svv 6 reputed)
CITY OF ASHLAND IS LISTED AS AN ADDITIONAL INSURED PER FORM NCG7635(02 07)ATTACHED
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS,
ASHLAND OR 97520
FAX:541-48&5311 AUTHOR®REPRESENTATIVE
KELU S POWELL _
ACORD 25(2010105) m 19W2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Aug 29 12 01:46p Powell Insurance Assoc 5417476640 p.2
sit COMMERCIAL GENERAL LIABILITY
W� CG 76 35 02 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization;
ADDITIONAL INSURED — BY WRITTEN lease or occupy, subject to the following
CONTRACT, AGREEMENT OR PERMIT, OR additional provisions:
SCHEDULE (a) This insurance does not apply to
The following .paragraph is added to WHO IS AN any 'occurrence"which takes place
INSURED :Section II after you cease to be a tenant in
1 any premises [eased to or rented to
4. Any person or organization shown in the Sched- you;
ule or for whom you are required by written con- (b) This insurance does not apply to
tract, agreement or permit to provide insurance any structural alterations, new con-
is an insured, subject to the following additional stnxtion or demolition operations
provisions: performed by or on behalf of the
a. The contract, agreement or permit must be person or organization added as an
in effect during the policy period shown in insured;
the Declarations, and must have been exe- (2) Your ongoing operations for that in-
cuted prior to the °bodily injury", "properly sured, whether the work is performed
damage°, or "personal and advertising by you or for you;
injury".
(3) The maintenance, operation or use by
b. The person or organization added as an in- you of equipment leased to you by such
sured by this endorsement is an insured only person or organization, subject to the
to the extent you are held liable due to: following additional provisions:
(1) The ownership, maintenance or use of (a) This insurance does not appty to
that part of premises you own, rent, any 'occurrence°which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc-, with its permission.
Copyright, Insurance Services, 2001
CG 76 35 02 07 Page t of 4 EP
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Aug 29 12 01:46p Powell Insurance Assoc 5417476640 p.3
F _
(b) This insurance does not apply to This exclusion applies even if the claims
"bodily injury" or 'property dam- against any insured allege negligence or
age" arising out of the sole negli- other wrongdoing in the supervision, hiring,
gence of such person or employment, training or monitoring of others
organization; by that insured, if the "occurrence" which
caused the 'bodily injury" or 'property
(4) Permits issued by any state or political damage" involved the ownership, mainle-
subdivision with respect to operations nance, use or entrustment to others of any
performed by you or on your behaU, aircraft, "auto" or watercraft that is owned
subject to the following additional pro- or operated by or rented or loaned to any in-
vision: sured.
This insurance does not apply to `bodily This exclusion does not apply to:
injury", "property damage", or (1) A watercraft while ashore on premises
°personal and advertising injury' arising you own or rent;
out of operations performed for the state
or municipality. (2) A watercraft you do not own that is:
c. The insurance with respect to any architect, (a) Less than 52 feet long; and
engineer, or surveyor added as an insured (b) Not being used to carry persons or
by this endorsement does not apply to property for a charge;
`bodily injury", 'property damage", or "per-
sonal and advertising injury" arising out of (3) Parking an "auto" on, or on the ways
the rendering of or the failure to render any next to, premises you own or rent, pro-
professional services by or for you, includ- vided the "auto" is not owned by or
ing: rented or loaned to you or the insured;
(1) The preparing, approving, or tailing to (4) Uability assumed under any "insured
contract" for the ownership, mainte-
prepare or approve maps, drawings,
opinions, reports, surveys, change Hance or use of aircraft or watercraft;or
or-
ders, designs or specifications; and (5) `Bodily injury" or "property damage"
(2) Supervisory, inspection or engineering arising out of:
services. (a) the operation of machinery or
d. This insurance does not apply to 'bodily equipment that is attached to, or
PP Y y part of, a land vehicle that would
injury" or 'property damage" included within . qualify under the definition of
the 'products-completed operations haz- "mobile equipment" if it were not
and". subject to a compulsory or financial
responsibility law or other motor ve-
A person's or organization's status as an insured un- hicle insurance law in the state
der this endorsement ends when your operations for where it is licensed or principally
that insured are completed. garaged; or
No coves will be provided 'rf, in the absence of this (b) the operation of any of the machin- "
endorsemen no liability ould be imposed b law on ery or equipment listed in Paragraph pf
Y P Y f.(2) or f.(3) of the definition of
you. Coverage shall be limited to the extent of your "mobile equipment".
negligence or fault according to the applicable princi-
ples of comparative fault. (6) An aircraft you do not own provided it is
not operated by any insured.
NON-OWNED WATERCRAFT AND NON-OWNED
AIRCRAFT LIABILITY TENANTS' PROPERTY DAMAGE LIABILITY
Exclusion g. of COVERAGE A (Section D is replaced When a Damage To Premises Rented To You Limit is
by the following: shown in the Declarations, Exclusion 1, of Coverage
A, Section I is replaced by the following:
g. "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or J. Damage To Property
entrustment to others of any aircraft, "auto" "Property damage" to:
or watercraft owned or operated by or rented
or loaded to any insured. Use includes oper- (1) Property you own, rent, or occupy, including
ation and "loading or unloading". any costs or expenses incurred by you, or
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