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HomeMy WebLinkAboutInsurance Certificate: Agave AcoR°® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD"YYY) 3/5/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS-NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED CERTIFICATE 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 .AmEAC Ratelyn Dalgardno Beecher Carlson Insurance Agency LLC PHDNE (800)654-5565 FAX .(503)274-0323 1700 Hudson St., E-MAIL .katelyn. dalgardnogbeechercarl eon. com Suite 204 INSURERS AFFORDING COVERAGE NAIC# Longview WA 98632 INSURER A'Monterey Insurance Co 3540 INSURED INSURER B : OCAT Inc, DBA: Agave INSURER C: 380 Avery Street INSURER D: INSURER E Ashland 011 97520 INSURER F: COVERAGES CERTIFICATE. NUMBER:CL133525656 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 LTR TYPE OF INSURANCE A DBR POLICY NUMBER PODCYEFF M DDYEXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY E PREMISES Ea $ 75,000 A CLAIMS-MADE O OCCUR 7SSA31319381 /21/2013 /21/2014 MED EXP M one parson E 51000 PERSONAL d ADV INJURY E 1,000,0001 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER _ PRODUCTS - COMPIOP AGG $ 1,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT n ANY AUTO BODILY INJURY (Per parson) E ALL OWNED SCHEDULED AUTOS AUTOS 130DILY INJURY (Per accident) E HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS $ P r i n UMBRELLA LIAB OCCUR EACH OCCURRENCE ::,T EXCESS UAS CLAIMS-MADE AGGREGATE $ DED RETENTION S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PRO PRIETORJPARTNER/ ECUTIVE OFFICERIMEMBER EXCLUDED? r- I NIA E.L. EACH ACCIDENT $ (Mandalon, In NH) If yea. deecribe under E.L. DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Addltlonat Rama,ka Schedule. If mon apace la rpulAtl) Re: 92 N Main Ashland, OR Additional insured form CG2026 11/85 attached. This form is subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION 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 B Main Street Aahland, OR 97520 AUTHORIZED REPRESENTATIVE & Dalgardno/DALGAR f~tlZn - ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. POLICY NUMBER: 27-SSA-3-1319381 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Ashland (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 2611 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ r ADDITIONAL COVERAGES Ref # I Description Coverage Code Form No. Edition Date Liquor Liability- Each Common/Aggregate Limit 1,000,1000 I Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description - - Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # pDoscription Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit I Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 7 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. Additional Named Insureds Other Named Insureds Agave Doing Business As i OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC