HomeMy WebLinkAboutInsurance Certificate: Ashland Bed & Breakfast Network
Certificate of Insurance
This certifies that x State Farm Fire and Casualty Company, Bloomington, Illinois
State Farm General Insurance Company, Bloomington, Illinois
State Farm Fire and Casualty Company, Aurora, Ontario
,.~ua~urt State Farm Florida Insurance Company, Winter Haven, Florida
State Farm Lloyds, Dallas, Texas
I
insures the following policyholder for the coverages indicated below:
Policyholder
Address of policyholder 586 E MAIN ST ASHLAND OR 97520
Location of operations
Description of operations BED & BREAKFAST
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
Policy Period Limits of Liability
Policy Number Type of Insurance Effective Date i Expiration Date at be innin of olic clod
97-SC-1.16119-5 Comprehensive 11.14.2013 11-14-2014 PBODILY INJURY AND
ROPERTY DAMAGE
Business Liability
-
This insurance includes: Products - Completed Operations Each Occurrence $ 500,000.00
X Contractual Liability X Personal Injury
General Aggregate $ 1,000,000.00
X Advertising Injury I
Product - Completed $ 1,000,000.00
Operations Aggregate
Policy Period BODILY INJURY AND PROPERTY DAMAGE
Poll Number EXCESS LIABILITY Effective Date i Expiration Date Combined Single Limit)
Umbrella Each Occurrence
Aggregate
Other $
Policy Period
Effective Date i Expiration Date Part I - Workers Compensation - Statutory
Workers' Compensation Part 11 - Employers Liability
and Employers Liability Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
Policy Period Limits of Liability
at be hi of oli iod)
Policy Number T of Insurance Effective Date Expiration Date DEDUCTIBLE
500.00
ANNUAL PREMIUM $415.00
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certification Holder If any of the described policies are canceled before
their expiration date, State Farm0 will try to mail a
written notice to the Certificate holder 30 days
AD T INSURED -SECTION II before cancellation. If we fail to mail such notice, no
CITY FASHLAND obligation or liability will be imposed on State Farm or
ITS OF FFICERS & EMPLOYEES its agents or representatives.
20 E MAIN ST
ASHLAND OR 97520-1814 i~l ,Rvi ( 6)f~
Signature of Authorized Represent ve ~w J
FINANCIAL SERVICES REP 02124114
Title Date
BRIAN CONRAD
Agent Name
Telephone Number (541) 482-8470
Agenre Cade Stamp
Agent Code 37-2155
AFO Code F~72
10aa99.10 o9-25-2009
10a126a