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HomeMy WebLinkAboutInsurance Certificate: Noble Coffee Roasting 9NOBLCO OP ID: SL "Ie%14 R CERTIFICATE OF LIABILITY INSURANCE 0 DAT3/06D/YYYY) 03/06/13 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 endorsements . PRODUCER 541-779-4232 CONTACT NAME: HONE AX Hart Insurance 541-772-3963 P 1123 Royal Ave. W. No ac No: Medford, OR 97504 E-MAIL Hart Insurance Agency ADDRESS: INSURERS AFFORDING COVERAGE NAIL a INSURER A: American Hallmark Ins Co of TX 43494 INSURED Noble Coffee Roasting LLC INSURER B:SAIF Corp 36196 dba Noble Coffee Roasting NSURER C: 281 Fourth Street Ashland, OR 97520 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 POLICY EFF POLI Y EXP LTR TYPE OF INSURANCE ..q. VIVO POUCY NUMBER MM/DD/YYYY MM/DO/YYYY LIMITS GENERAL LIABILTY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 44PD463762 04113113 04/13/14 PREMISES Ea occunence $ 100,00 CLAIMS-MADE O OCCUR MED EXP (Any one person) $ 5,00 X Liquor Legal Liab PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO E 2,000,00 X POLICY PR ECT O LOC Liq Liab $ 11000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea a.dc,l ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) E MIRED AUTOS NON-OWNED PROPERTY -DAMAGE AUTOS Per accident $ S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS- DE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION WC STATUS 9TH AI TORY TI I ND EMPLOYERS' UABIUTY B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 776066 01101113 01/01/14 E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? F--7 N/A 500,00 (Mancatory In NH) E. L. DISEASE - EA EMPLOYEE $ 600,00 Use desaiba under- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Aftsch ACORD 101, Additional Remarks Schedule, It more space Is npulreci) Certificate holder is additional insured per attached CBPO45 CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main Street H Ashland, OR 97520 art Insurance Agency Hart nsurance Agency II/\tVIY/I © 1988.2010 AC RD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL ADVANTAGE POLICY CBP 045 03 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL ADVANTAGE POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara- tions. The following is added to Paragraph C. Who Is An Insured in Section 11- Liability 4. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongo- ing operations or in connection with your premises owned by or rented to you. CBP'045 03 05 Includes copyrighted material of Insurance Services Office., Inc., Page 1 of 1 ❑ with its permission