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HomeMy WebLinkAboutInsurance Certificate: Ashland Springs Hotel-Larks Restaurant ` NEUM03C OP ID: TMR 2014Y) ATE CERTIFICATE OF LIABILITY INSURANCE 01/30/ 12014 01/30 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 CONTACT 1 NAME; Therese Rayburn Phone: 541-245-111 United Risk Solutions, Inc. Fax: 541-245-1112 PHONE 541-245-1111 FAX PO Box 936 a0 N E, aC No : 541-245-1112 Medford, OR 97501.0067 ADDRESS: therese.rayburn@unitedrisk.com INSURER(S) AFFORDING COVERAGE NAICN INSURER A : Zurich North America INSURED Neuman Hotel Group, LLC INSURER B: Ashland Springs Hotel Larks Restaurant INSURER C : 212 E Main Street INSURERD: Ashland, OR 97520.1829 INSURER E INSURER F: J 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 TYPE OF INSURANCE ADDLISU. POLICY NUMBER MOLICY Ern POLICY EXP LIMITS TR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CP0553794300 1211712013 10101/2014 PREMISES Ea occurrence $ 1,000.000 CLAIMS-MADE OCCUR MED UP (My one person) $ 5,000 X Professional Led PERSONAL S ADV INJURY $ 1,000,00 X Liquor GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 31000,000 POLICY PRO- X LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident A X ANY AUTO CP0553794300 1211712013 10101/2014 BODILY INJURY (Par Person) $ ALLOWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOSWNED Pe acccid.eDAMAGE $ J( UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIM CLAIMS-MADE UMB553794400 12/1712013 10/0112014 AGGREGATE $ 5,000,000 OEO RETENTIONS 1 $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERSLIABILITY YIN TORY LIMITS ER ANY PROPRIETOWPARTNER/EXECUTIVEâť‘ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'! (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ D descdbeunder _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Employee Beneflb CP0553794300 1211712013 1010112014 EBL 1,000,00 Ded 1,000 1 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101. Additional Remarks Schedule, ttmore space is required) The Imagine Project, the City of Ashland, its officers, and employees are Additional Insured per CG2026 07/04 This supercedes certificate issued on 12/31/13 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 ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland, OR 97520-2014 AUTTHHOOFUMD~REPRESENNTTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 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 GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) The Imagine Project, the City of Ashland, its officers, and employees 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 with 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 CG 20 26 07 04 EP