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HomeMy WebLinkAboutInsurance Certificate: Standing Stone Co OP ID: TMR CERTIFICATE OF LIABILITY INSURANCE 0 DAT1/24D/YYYY) 01/24/13 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 541-245-1111 NAME: Therese Rayburn United Risk Solutions, Inc. 541-245-1111 FAx PO Box 936 541-245-1112 PHONE 541-245-1112 ac Np : Nc N a0: Medford, OR 97501.0067 EMAIL ADDRESS: therese.rayburn@unitedrisk.com PRODUCER STAN03C COST MER ID s: INSURER(S) AFFORDING COVERAGE NAICN INSURED Standing Stone Brewing Co. INSURER A: Mutual of Enumclaw 14761 101 Oak St. INSURER B: Ashland, OR 97520-1802 - 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 S BUBB TYPE OF INSURANCE AD POLICY NUMBER MMIDDNYYY MMMD INSR MD TR NWY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIALGENERALLIABILITY X CPP001173500 07124/12 07124/13 PREMISES Ea occurrence $ 300,000 CLAIMS-MADE 191 OCCUR MED UP (My one person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS. COMP/OP AGG $ 2,000,000 POLICY PRO- X LOC $ AUTOMOBILE LIABILITY X COMBINED SINGLE UMIT E 1,000,000 A ANY AUTO CPPOO1173500 07/24112 07124113 (Ea accident) BODILY IWURY(Per Person) $ ALLOWNEDAUTOS BODILY INJURY (Par accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Par accident) $ X NON-0WNEDAUTOS $ $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LM CLAIMS-MADE AGGREGATE $ 5,000,000 A X UM0000230700 07124112 07124113 DEDUCTIBLE E RETENTION $ None $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN , TORY LIMITS R ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? r7 NIA (Mandatory in NH) E.L. DISEASE - ELI EMPLOYE $ tt yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Physical Damage CPPOO1173500 07124112 07124113 1,000 Deductible 110,000 Value DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (AKach ACORD 101, Additional Remarks Schedule, if more space Is required) The City of Ashland Is Additional Insured as respects their interests subject to policy terms, conditions and exclusions. 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 AUTHORIMD REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD