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HomeMy WebLinkAboutInsurance Certificate: Ashland Springs Hotel-Larks OP ID: NR /261/VYYY) .4`°ROR CERTIFICATE OF LIABILITY INSURANCE „ DATE(MMIDD /26/,2 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 endorsements . PRODUCER 541-245.1111 CONTACT United Risk Solutions, Inc. NAME: Nikki Russell PHONE AX PO Box 936 541-245-1112 A/C_ 541-245-1111 ac No Extl: AID, No): 541.245-1112 Medford, 97501-0067 E-MAIL Linda Lane, CIC ADDRESS: nikkl.rUSSelI unitedrisk.com PRODUCER ASHL08C CU_STOMEft I_D a: - INSURER(S) AFFORDING COVERAGE _ NAICN INSURED The Ashland Springs Hotel INSURER A: Granite State Insurance Co. Larks Restaurant INSURERS -New Hampshire Insurance Co Waterstone Spa 212 E. Main St. INSURER[: Ashland,, OR 97520.1829 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 ~ADDLISUBRT- - I POLICY EFF POLICY E%P LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYV MMIDO/YYVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X OILX0196580774 11/17/12 11/17/13 IMAG-E-70-11- NTED- PREMiSES_ EEa occunence) $ 300,00 CLAIMS-MADE OCCUR MED EXP (Any one person) $ _ 5,00 X Professional Liab PERSONALBADV INJURY $ 1,000,00 X Liquor Liability GENERAL AGGREGATE E 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PROD UCTS_COMPIOP AGG $ 2,000,000 X POLICY PRO LOC i ~g AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT $ 1,000,00 A ANY AUTO 01LX0196580774 11117/ (Ea accident 12 11/17/13 BODILY IN JURY (Per person) E ALL OWNED AUTOS BODILY INJURY (Per accident E SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident X NON-OWNED AUTOS I E E UMBRELLA L4IB X OCCUR EACH OCCURRENCE S 5,000,00 - - EXCESS LIAR -CCAIMS-MADE B OlUD015845652.4 11/17/12 11N7N3 ;AGGREGATE a 5,000,00 DEDUCTIBLE X RETENTION $ 10,000 I I $ WORKER5 COMPENSATION AND EMPLOYERS'LIABILITY Y/N I 11 ' WLIMITS - _ER ANY PROPRIETORIPARTNER/EXECUTIVE I TORY IMII _ER OFFICER/MEMBER EXCLUDED? NIA I I E.L. EACH ACCIDEN DESCRIPTION OF (Mandatory in NH) If yes, R I . DESCRIPTION OF and O E L DISEASE - EA EMPLOYEEI S OPERATIONS Eel. I E A Employee Benefits 401LX0196680774 IEL. DISEASE-vOLICV LIMIT 11117/12 i 11117/13 11,000,000 Limi 1- 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AKach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITAS03 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 Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD