HomeMy WebLinkAboutInsurance Certificate: Ashland Springs Hotel
NEUM03C OP ID: TMR
CERTIFICATE OF LIABILITY INSURANCE 112J31/2013
°"'2`MM'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(les) 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 CONETACT
Phone: 641-245-1111 NAM: .Therese Ra bum
United Risk Solutions, Inc. Fax: 541-245-1112 PHONE 541-2451-1111 FAx
PO Box 936 AIC xo: 541.245-1112
Medford, OR 97501-0067 E-MAIL
ADDRESS: therese.raybum@unitedrisk.com
INSURE E AFFORDING COVERAGE NJUCa
INSURER A: Zurich North America
INSURED Neuman Hotel Group, LLC INSURER B:
Ashland Springs Hotel
dba: Waterston Spa INSURER C :
212 E Main Street INSURER D:
Ashland, OR 97520.1829
INSURER E
INSURER F I
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.
NTR TYPE OF INSURANCE ADOL SUB POLICY NUMBER IMMMDMYYI POLICY EFF fMMtDDNYYYI POLICY EXP UNITS
GENERAL LIABILITY EACH OCCURRENCE E 1,000,00
A X COMMERDALGENERALLIABIDTY CP0553794300 12117/2013 1010112014 PREMISES Ea.cameos. S 1,000,00
CLAIMS-MADE a OCCUR MED EXP (My we Person) $ 5,000
X P,olesslonel uab PERSONAL BADV INJURY $ 1,000,000
X Liquor GENERAL AGGREGATE $ 3,000,08
GEM AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP AGG $ 3,000,00
POLICY PRO X LOC $
JFQ.T
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
Ea acdOent
A X ANY AUTO CP0553794300 1211712013 12/77/2016 BODILY INJURY(Per person) E
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Poracddeni) E
NON WNED PROPERTY DAMAG
HIREDAUTOS AUTOS Per awinenl $
E
X UMBRELLA LUV3 X OCCUR EACH OCCURRENCE E 5,000,00
A EXCESS LIAR CLAIMS-MADE UMB553794400 12117/2013 1211712014 AGGREGATE E 5,000,00
DED RETENTIONS E
WORKERS COMPENSATION WC STATLL OTH-
AND EMPLOYERS' LUBILRY YIN T UNITS
ANY PROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT Is
OFFICER/MEMBER EXCLUDED? O NIA -7 (MarMatacy in NN) EL_DISEASE -EA EMPLOYE b_._._
- _ 0 dwer
DESCRIPnON OF OPERATIONS below I E.L. DISEASE-POLICY LIMIT E
A Emvloyee e.nana CP0553794300 12117/2013 1211712014 EBL 11000,00
Ded 1,000
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES(Ae ACORD 101, MdlUOnM R.ms,ks Stl IuN, Hmom spec. Is, Wn)
City of Ashland, itra officers & employees are named Additional
Insured per form CG2026 (07/04)
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
20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland, OR 97520.1814 AUTHORIZED REPRESENTATIVE
I A,yb44-~
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL 0 L26 07 IABILITY
POLICY NUMBER: CP0553794300
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL_GENERA LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization (s)
City of Ashland
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
respect to liability for 'bodily injury", "property
damage" or "personal and advertising injury" caused,
in whole or in part, by your acts or omissions or the
acts or omissions of those acting on your behalf:
A. In the performance of your ongoing operations;
or
B. In connection with your premises owned by or
rented to you.
® ISO Properties, Inc., 2004
EP
CG 20 26 07 04