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HomeMy WebLinkAboutInsurance Certificate: Tabu 9TABURE OP ID: JS CERTIFICATE OF LIABILITY INSURANCE DAT04122D/YYYY) 04/22/13 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 541-479-5521 CONTACT Hart Insurance NAME: P. O. Box 1240 541474-1090 Nc"NO Eat, FNC No), Grants Pass, OR 97528 E-MAIL Hart Insurance / Medford ADDRESS: INSURERS AFFORDING COVERAGE NNCIf INSURER A: Cincinnati Specialty INSURED TB3, Inc. dba: Tabu INSURER B: Employers Preferred Ins Co 76 North Pioneer St. Ashland, OR 97520 NSURER C INSURER D : INSURER E : NSURER 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 POLICY UP LTR TYPE OF INSURANCE POLICY NUMBER (MMIODtYYYY) (MMI[IDIYYYY) UNnS GENERALLUIBILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CS00036943 04122/13 04122114 PREMISES Eaocamence s 100,00 CLAIMS-MADE I OCCUR MED EXP (Any one person) S Exclude X Liq Liability PERSONAL S ADV INJURY f 1,000,00 GENERAL AGGREGATE f 2,000,00 DEW AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGO f 2,000,00 X POLICY PRO LOC Liq Liab f 1,000,00 JFCT -1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accdent ANY AUTO BODILY INJURY (Per person) f A OWNED SCHEDULED AUTOS S AUTOS BODILY INJURY (Per accident) f NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident f UMBRELLA LWB OCCUR EACH OCCURRENCE f EXCESS LIAB CLAIMS-MADE AGGREGATE f DELI RETENTIONS S WORKERS COMPENSATION WCSTATU- OTH LIM AND EMPLOYERS' LIABILITY B ANY PROPRIETORIPARTNER/EXECUTIVE YIN EIG1604265 01101113 01101114 E.L. EACH ACCIDENT Is 500,00 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 500,00 If yes, describe under DESCRIPTION OF OPERATIONSbelox E.L. DISEASE - POLICY LIMIT S 600,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Ashland is included as additional insured as respects to general liability per form CSIA405 08/09 attached. 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 Ashland, OR 97520 UTHORIZED REPRESENTATN gran / d © 1988-2 A ORD CORPORATION All rights reserved. ACORD 25 (2010105) The ACORD name and I go are gistered marks of RD 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 Additional Insured Persons or Organization(s) City of Ashland its officers and employees 20 E Main St. Ashland, OR 97520 Information required to complete this Schedule if not shown above, will be shown in the Declarations. Section II - Who is an Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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 omis- sions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing opera- tions, or B. In connection with your premises owned by or rented to you. CSIA405 (08/09)•B + ISO Properties, Inc., 2004 Page 1 of 1