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HomeMy WebLinkAboutInsurance Certificate: Mix Sweet Shop Inc 9MIXSWE OP ID: SL CERTIFICATE OF LIABILITY INSURANCE 1 D0104/201""' 10/04/2013 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 Phone: 541-779-4232 CONTACT Hart Insurance 1123 Royal Ave. Fax: 541-772-3963 a/CC, NO at: VC No: Medford, OR 97504 AE MAIL DDRESS: Hart Insurance Agency INSURERS AFFORDING COVERAGE NAIC a INSURERA: CNA Insurance Co. INSURED Mix Sweet Shop, Inc INSURER B : 57 N Main Street Ashland, OR 97520 INSURER C: INSURER D : 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 l TR TYPE OF INSURANCE POLICYNUMBER MMIDDmYY MMIDDMYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY X 5094632420 0912612013 0912612014 PREMISES Ea occurrence S 300,00 CLAIMS-MADE [A OCCUR MEDEXP(Myme person) E EXCLUDE X Liquor Liability PERSONAL S ADV INJURY E 2,000,00 GENERAL AGGREGATE S 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 4,000,00 X POLICY PRO- LOC E q OMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) E - HIREDAUTOS AUTOSSWNEO PROPERTY DAMAGE S q - I - Par aecitlent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ E WORKERS COMPENSATION 11 WC STATU. OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS R ANY PROPRIETONPARTNERIEXECUTIVE E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDEDT F-1 N/A (Mandatory In NH) E.L. DISEASE-EA EMPLOYEE E d : daso "c"Und r DESCRIPTION OF OPERATIONS Wt. I E.L. DISEASE -POLICY LIMIT E DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Ashland is an additional insured per attached form SB146932E 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. Public Works Dept. 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Hart Insurance Agency u~` f ©1988-2010 ACORD CORPORATION. lAll..riigghts reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD