HomeMy WebLinkAboutInsurance Certificate: Lithia Artisans Market/Vendors g301308:28a Powell Insurance Assoc 5417476640 P.1
AC CERTIFICATE OF LIABILITY INSURANCE DATE vI[MIDD1YrY
013
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: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATH)N IS WAIVED, subject to
the terns 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 CO~ KELLI S HENSLEY
POWELL INSURANCE ASSOCIATES INC PHONE . 541-747-6080 ac M. 541-747640
PO BOX P ADDRESS: Kell;@powellinsurance.biz
SPRINGFIELD OR 97477 RISURER S AFFORDING COVERAGE nANa
e1111RERA: FIRST NATIONAUNSURANCE CO OF AMERICA
INSURED NSURER B:
LITHIA ARTISANS MARKET INC INSURER C:
INCLUDING VENDORS INSURER D_:
PO BOX 3585 NSURER E:
ASHLAND OR 97520 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, TERN 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.
ILTRR TYPEOFINSIIIANCE ISD =R POUCY NUMBER MWDpYEFF MONULIICYE%P UNITS
GENERALLIABILffY EACH OCCURRENCE $ 1,000,000
DANA E R N 000
X COMMERCIAL GcTIERA-~L LIIABILRY MISES Eed ce S 1000
C IMS-MADE JI OCCUR MEDEXP me n S 10,400
A Y 01-CH-9338114-6 10114/2013 70;1412014 pERSONALAADvw.IURY s 1,000,000
CENERALAGGREGATE S 2,000,000
GENT AGGREGATE U MIT APPLIES PER: PRODUCTS-COMP.OPAGG S 2,000,000
X POLICY PRO- LOO $
jFCT
AUTOMOBILE UABrUfY COMBINED SINGLE U MIT
Ee acadasL-
MYAUTO BODILY INJURY (Per Pe,spn) S
ALL OWNED SCHEDULED BODILY IWURY(Per=a I) S
AUTOS AUTOG
HIREDAUTOS ALIjTO NED PROas DPLLIGE $
b
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS I" GAMS-MADE AGGREGATE S
DED RETENTION s
WORKERSCOMRENSATION
CF WC STATU- Oi14
AN09KPLOYERS'IIABILIIY YIN T
ANY PROPRIEIOWPARTNER/FJ(ECUWI ❑ NIA ELL=ACCIDeW S
FICERMEMBERIXCLUDEDY
(M.naao Inlet) E.L. DISEASE - EA. EMPLOYE S
It yes, desadbe Mwer
DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LINT S
I
DESCRIPTON OFOPFAATIOFS I LDUnOMSI VEHIQES (AltaN ACORD 101. Atldibnel Remarb SsNetlale, ll mwe space s reRUlretl)
CITY OF ASHLAND IS LISTED AS AN ADDITIONAL INSURED, PER ATTACHED FORM CG 75 35 (02 07)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF ASHLAND 51ACCORDANCe HE EXPIRATION WI DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E MAIN ST WITH THE POLICY PROVISIONS.
ASHLAND OR 97520 FAX: 541-488-5311 LLI S H
LI S ENSLESLEY
rACORD 25 (2019/05) 1988- 0 ACORD CORPORATIO - rights reserved.
gistered marks of ACORD
Aug 30 13 08:28a Powell Insurance Assoc 5417476640 p.2
No~~ COMMERCIAL GENERAL LIABILITY
CG 76 35 02 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
ADDITIONAL INSURED - BY WRITTEN lease or occupy, subject to the following
K CONTRACT, AGREEMENT OR PERMIT, OR additional provisions:
SCHEDULE (a) This insurance does not apply to
The following paragraph is added to WHO IS AN any "occurrence" which takes place
INSURED Bechar II): after you cease to be a tenant in
any premises leased to or rented to
4- Any person or organization shown in the Schad- you;
ule or for whom you are required by written con- (b) This insurance does not apply to
tract, agreement or permit to provide insurance any structural alterations, new con-
is an insured, subject to the following additional struction or demolition operations
provisions: performed by or on behalf of the
a. The contract, agreement or permit must be person or organization added as an
in effect during the policy period shown in insured;
the Declarations, and must have been exe- (2) Your ongoing operations for that in-
cuted prior to the "bodily injury", "property sured, whether the work is performed
damage", or "personal and advertising by you or for you;
= injury".
The b. The person or organization added as an in- (3) you of maintenance, operation or use by
sured by this endorsement is an insured onl Y equipment leased to you by such
2 Y Y person or organization, subject to the
to the extent you are held liable due to: following additional provisions:
o (1) The 'ownership, maintenance or use of (a) This insurance does not apply to
that part of premises you own, rent, any "occurrence" which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services, 2001
CG 78 35 02 07 Page 1 0l4 EP
L-AG23-PRINTM-f 5974V 35
Aug 30 13 08:28a Powell Insurance Assoc 5417476640 P.3
(b) This insurance does not apply to This exclusion applies even if the claims
"bodily injury" or "property dam- against any insured allege negligence or
age" arising out of the sole negli- other wrongdoing in the supervision, hiring,
gence of such person or employment, training or monitoring of others
organization; by that insured, if the "occurrence" which
caused the todily injury" or "property
(4) Permits issued by any state or political damage" involved the ownership, mainto-
subdivision with respect to operations nance, use or entrustment to others of any
performed by you or on your behalf, aircraft, "auto" or watercraft that is owned
subject to the following additional pro- or operated. by or rented or loaned to any in-
vision: sured.
This insurance does not apply to "bodily This exclusion does not apply to:
injury", "property damage", or (1) A watercraft while ashore on premises
"personal and advertising injury" arising you own or rent;
out of operations performed for the state
or municipality. (2) A watercraft you do not own that is:
c. The insurance with respect to any architect, (a) Less than 52 feet long; and
engineer, or surveyor added as an insured (b) Not being used to carry persons or
by this endorsement does not apply to property for a charge;
"bodily injury", "property damage', or "per-
sonal and advertising injury" arising out of (3) Parking an "auto" on, or on the ways
the rendering of or the failure to render any next to, premises you own or rent, pro-
professional services by or for you, includ- vided the "auto" is not owned by or
ing: rented or loaned to you or the insured;
(1) The preparing, approving, or failing to (4) Liability assumed under any Insured
prepare or approve maps, drawings, contract" for the ownership, mainle-
opinions, reports, surveys, change or- nance or use of aircraft or watercraft; or
ders, designs or specifications; and (5) "Bodily injury" or "property damage"
(2) Supervisory, inspection or engineering
services. (a) the operation of machinery or
equipment that
d. This insurance does not apply to "bodily part of, a land vehicle that would
injury" or "property damage" included within qualify under the definition of
the "products-completed operations haz- "mobile equipment" if it were not
and". subject to a compulsory or financial
responsibility law or other motor ve-
A person's or organization's status as an insured un- hicle insurance law in the state
der this endorsement ends when your operations for where it is licensed or principally
that insured are completed. garaged; or
No coverage will be provided if, in the absence of this (b) the operation of any of the machin-ery endorsement, no liability would be imposed by f.( law on f.(or
equipment listed in Paragraph
2) or f.(3) of the definition of
you. Coverage shall be limited to the extent of your "mobile equipment".
negligence or fault according to the applicable princi-
ples of comparative fault. (6) An aircraft you do not own provided it is
not operated by any insured.
NON-OWNED WATERCRAFT AND NON-OWNED
AIRCRAFT LIABILITY TENANTS' PROPERTY DAMAGE LIABILITY
Exclusion g. of COVERAGE A (Section I) is replaced When a Damage To Premises Rented To You Limit is
by the following: shown in the Declarations, Exclusion of Coverage
A, Section I is replaced by the following:
g. "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or Damage To Property
entrustment to others of any aircraft, "auto" "Property damage" to:
or watercraft owned or operated by or rented
or loaned to any insured. Use includes oper- (1) Property you own, rent, or occupy, including
ation and "loading or unloading". any costs or expenses incurred by you, or
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