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HomeMy WebLinkAboutInsurance Certificate: Ashland Springs Hotel (2) OP ID: SHJ 2013 Y) CERTIFICATE OF LIABILITY INSURANCE 1 D1119//2013 11119 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 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: 541-245.1111 CONTACT Nikki Russell NAME: United Risk Solutions, Inc. PHONE j FAX PO Box 936 Fax: 541.245-1112 Jac,NQ,.E,t), 541-245=1111 (11Not 541-245-1112 Medford, OR 97501-0067 E-MAIL ADDRESS_nikki.russellla unitedrisk.com PRODUCER ASHL08C -CUSTOMER, I":__ INSURER(S) AFFORDING COVERAGE NAICIf INSURED Ashland Springs Hotel INSURER A: Granite Slate Insurance Co. Larks Restaurant New Hampshire insurance CO 212 E. Main St. INSURERe: Ashland„ OR 97520-1829 INSURER C__ 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 ~tDL SUa - 1 POLIC Y _ EFF POLICY EXP LTR TYPE OFINSURANCE "AO POLICY NUMBER I MM/DDIYYYY MMIDD/YYYY : LIMITS GENERAL LIABILITY EACHOCCURRENCE $ 1,000,00 A tX]MMERCIAL GENERAL LIABILITY X OILX0196580774 11/17/2012 12/17/2013 PREMISES Ea occurrence S 300,00 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5,00 essional Liab - I PERSONAL S ADV INJURY _ J $ 1,000,00 X Liquor Liability I I GENERAL AGGREGATE $ 2,000,00 DEVIL AGGREGATE LIMIT APPLIES PER: I'PRODUCTS - COMPI$ 2,000,00 X POLICY PRO- LOC I 1 $ ECT AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,00 A ANY AUTO 01LX0196580774 11/1712012 12117120131 (Ea acndenp BODILY INJURY (Per person) $ ALLOWNEDAUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NOWOWNED AUTOS I $ 1 $ UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSIL CLAIMS-MADE AGGREGATE $ 5,000,00 B - ofu0015e456524 11/1712012 1211712013 DEDUCTIBLE $ WORKERS COMPENSATION WCSTATU- I JOTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA I ~I ESL. EACH ACCIDENT $ (Mandatory in NH) 1 E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E1 . DISEASE -POLICY LIMIT $ A Employee Benefits I 01LX0196580774 111117/2012 12/17/201311,000,000 Limit DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space is required) CERTIFICATE HOLDER CANCELLATION CITAS03 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. 20 E Main Street Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE otw"~dt.~1$GN~ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD