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HomeMy WebLinkAboutInsurance Certificate: Sesame Asian Kitchen 9SESAAS OP ID: JS CERTIFICATE OF LIABILITY INSURANCE DATE(MMID1`13 ) 03112113 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 endorsemen s . PRODUCER 541-779-4 NCONTACT AME, Hart Insurance 541-772.3963 PHONE AX No: 1123 Royal Ave. EN . Lo Ext: Medford, OR 97504 ADDRESS: Hart Insurance I Medford INSURERS AFFORDING COVERAGE NAIC f INSURER A: General Casual Ins Co INSURED Beam Consulting & Ventures LLC INSURER 9: dba: Sesame Asian Kitchen INSURER C: 21 Winburn Way NSURER D: Ashland, OR 97520 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 rypE OF INSURANCE POLICY NUMBER MM/OD/YEYYY MM/DD/YYYY LIMITS R GENERALLIABILITY EACH OCCURRENCE f 2,000,00 A X COMMERCIAL GENERAL LIABILITY X CFB1028977 05116113 05118114' PREMISES Ea occurrence $ 100,00 CLAIMSMADE FxIOCCUR MED EXP (Any one person) $ Exclude PERSONAL S ADV INJURY S 2,000,00 GENERAL AGGREGATE $ 4,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,00 X POLICY PRO LOC Liq Liab $ 2,000,00 JECT AUTOMOBILE LIABILITY Ee BINEDi SINGLE LIMIT ANY AUTO BODILYINJURY(Perperaon) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Paraaidenl) $ PROPER DAMAGE $ NON-OWNED Per n HIRED AUTOS AUTOS $ UMBRELLA LUIS OCCUR EACH OCCURRENCE $ EXCESS LULB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECUTIVE YIN ❑ NIA E.L. EACH ACCIDENT f OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE f If es, de.cnbo under DESCRIPTION OF OPERATIONS below E1 . DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is requlred) 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. Nancy Slocum 20 E. Main Street U ¢EDREPRESENTA Ashland, OR 97520 n e ©1988-2 10 ORD CORPORATI All rig is reserved. ACORD 25 (2010105) The ACORD name and I co are istered marks o RD