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HomeMy WebLinkAboutInsurance Certificate: Paddington Station N 9PADDST OP ID: JS Y) s l izo CERTIFICATE OF LIABILITY INSURANCE 06/11 DATE(M88//13 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 541-779-4232 CONTACT Hart Insurance 541-772-3963 PHONE FAX 1123 Ro al Ave. ac No Est: A/C No: Medford, OR 97504 E-MAIL Hart Insurance I Medford ADDRESS: INSURER(S) AFFORDING COVERAGE NAICd INSURER A: Hanover American Ins Co INSURED Hammond Family Corporation INSURER B: dba: Paddington Station dba: Paddington Jewel Box INSURER C: 125 E Main Street INSURERD: Ashland, OR 97520-1830 INSURERE: NSURERF: 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 EFF POLICY EXP LTR POLICY NUMBER (MMIDDNYYYJ MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY OZ29884959 03/26113 03126114 PREMISES Eass¢nence $ 300,00 CLAIMS-MADE Fx]OCCUR MED EXP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,88 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG. S 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OSMEO SCHEDULED BODILY INJURY (Per accident) S AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident E UMBRELLA UAB OCCUR - EACH OCCURRENCE Is EXCESS UALB CLAIMS-MADE AGGREGATE E DIED RETENTIONS Is WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILJTY YIN ,LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT E OFFICER/MEMBER EXCLUDEOP ❑ N/A (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AfteO ACORD 101, AWidonal Remarks schedule, if more space I. reWirvd) email: jodi.vizzini®ashland.or.us 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. Attn: Jodi Vizzini 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Hart Insurance / Medford . ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD