HomeMy WebLinkAboutInsurance Certificate: Pangea Grills & Wraps
9PANGGR OP ID: MW
CERTIFICATE OF LIABILITY INSURANCE 0 °21281°28/20014
14
02/
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 endorsemen s . - -
PRODUCER Phone: 541 -4791-5521 CANT: T
Hart Insurance Fax•541-474-1890 PHONE FAX
P. 0. BOX 1240-: IAIC. No Ex : AC No:
Grants Pass, OR 97528 - - - - -MAIL _
Hart Insurance Agency ADDRESS:
" INSURERS AFFORDING COVERAGE NAIC#
INSURERA:American Hallmark Ins Co of TX 43494
INSURED Pangea Grills & Wraps Inc INSURERS:
Dba:Pangea INSURERC:
272 East Main Street
Ashland, OR 97520 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.
ILTR TYPE OF INSURANCE POLIGYNUMBER IMWODNYYY) MM/DD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000.00
A X COMMERCIAL GENERAL LIABILITY PB454251 05/01/2014 0510112015 p EMISES F~.aaecun E 100,00
CLAIMS-MADE ❑X OCCUR MED EXP (Pry ora person) $ 5,00
X Liquor Liab PERSONAL S ADV INJURY S 1,000,00
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMr APPLIES PER: 2,000,00(
PRODUCTS-COMP/OP AGO $
X POUCV PRO- LOC - - LIQUOr - - S 1,000,00
AUTOMOBILE LIABILITY COMBINED SINGLE LIMB -
_ Ea eoddenl
ANY AUTO BODILY INJURY (Per persm) S
ALL OWNED SCHEDULED -
AUTOS AUTOS BODILY INJURY (Per ertitlenp E
HIRED AUTOS A~UjTTOSNMED FwOPEa M S
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LUIS CLAIMS-MADE AGGREGATE E
DEO RETENTION S
WORKERS COMPENSATION ME STATU- OTM-
ANDEMPLOYERS'LIABIIJTY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT S
OFFICERISIEMSER EXCLUDED? MIA
IMandMor in NH) E.L. DISEASE - EA EMPLOYE S
- -if clesargis uMer---.__-.
DESCRIPTION OF OPERATIONS below --E.LDISEASE-POLICYLIMIT'-Y -
DESCRIPTION OF OPERATIONS I LOCATIONS / VFAICLES (Attach ACORD 101, Additional RonwAs Sehsduls, H moo span Is raquirod)
CERTIFICATE HOLDER CANCELLATION
CITYASH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 E. Main Street AUTHORIZED REPRESENTATIVE
Ashland, OR 87520 Hart s ranee Age
®1988-2 10 ACORD CORPORATION. 11 rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD