HomeMy WebLinkAboutInsurance Certificate: Ashland Springs Hotel
OP ID: SHJ
D/
CERTIFICATE OF LIABILITY INSURANCE 1 DA1119/013
11/19/2
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 .
CONTACT
PRODUCER Phone: 541-245-1111 N
AME' Nikki Russell
United Risk Solutions, Inc. Fax: 541-245-1112 PHONE 541-245-1111 FAx
PO Box 936 ac No Eae: C No): 541-245-1112
Medford, OR 97501.0087' ADDRESS, nikki.russell@unitedrisk.com
PRODUCER ASHLOBC
CUSTOMER R, 4,
INSURER(S) AFFORDING COVERAGE NAIC R
INSURED Ashland Springs Hotel INSURER A: Granite State Insurance Co.
Larks Restaurant INSURER B: New Hampshire Insurance Co
212 E. Main St.
Ashland„ OR 97520-1829 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 rypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR POLICY NUMBER (MMIDDIYYYY) MM/DDIYYYY LIMITS J= MD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X DILX0196580774 11/17/2012 12117/2013 PR MISES Ea occurrence $ 300,000
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00
X Professional Liab PERSONAL &ADV INJURY $ 1,000,000
X Liquor Liability GENERAL AGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,00
X POLICY PRO LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
A ANY AUTO OILXD196580774 11/17/2012 12117/2013 (Ea accident)
BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PRO=t DAMAGE
X HIREDAUTOS (Per $
X NON-OWNED AUTOS $
$
UMBRELLALIAB X OCCUR tTWOCRYSTIM RRENCE $ 5,000,00
EXCESS LIAR CLAIMS-MADE E $ 5,000,00
B OfUD0158456524 11/1712012 1211712013
DEDUCTIBLE $
X RETENTION $ 10,000 - $
WORKERS COMPENSATION ATUOTH-
AND EMPLOYERS' LI ABILITY YIN ITS R
ANY PROPRIETORJPARTNERIEXECUTIVE EL EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? ❑ NIA
(Mandatory in NH) E.L. DISEASE -EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
A Employee Benefits 01LX0196580774 11/1712012 12117/2013 1,000,000 Limi
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES `Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
The Imagine Project, The City Of Ashland, its officers, and employees are
Additional Insured as respects operations of the named insured
CERTIFICATE HOLDER CANCELLATION
CITAS01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
90 N. Mountain Ave.
Ashland, OR 97520-2014 AUTHORIZED REPRESENTATIVE
@ 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD