HomeMy WebLinkAboutInsurance Certificate: Martollis Hand Tossed Pizza c
BPADPIZ-01 DONNA
1 DATE (MMIODIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 41712014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTATE DOES NOT BELOW THIS CERTIFICATE FOF INSURANCE DOES NOTLCO ST AMEND, AECONTRACT BETWETHE EN OTHE 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 al.
coNrA~
PRODUCER NAME
, (641 549-3172 FAx No : 541 549-9374
Fullhart Insurance of Sisters PHONE
704 W. Hood Ave. Dn
P.O. .
P.OBox 1890 Sistere, OR 97759 ERS AFFORDING COVERAGE NAIC E
: t Si nature 41513
INSURED Bradford Pizza Inc DBA: Martolli's Hand Tossed Pizza 38 E Maln Ashla
nd, OR 97620
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 SUBJECTTO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR L POLICY EFF POUCY EXP UNITS
LT TYPEOFINSURANCE POLICY NUMBER dM10 (MWDDfYYYYI
1,000,00
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S
cLADJS+dADE OCCUR .X PPS003959303 1211812013 12118/2014 PREMISES Eaam mence E 1'000'00 MED E%P (Any one person) E 10,00
PERSONAL E ADV INJURY $ 1,000,00
GENERAL AGGREGATE S 2,000,00
GENL AGGREGATE LIMIT APPLIES PER: •1,000.00
POLICY❑JEOT LOC PRODUCTS -COMPlOP AGG S
S
OTHER: COMBINED SINGLE La1n E
AUTOMOBILE LULBIUTY O BIKED
A AUTO BODILY INJURY (Per person) E
ALL OWNED SCHEDULED BODILY INJURY (Per e,ritlnH) E
AUTOS NAUTOS
ON-OWNED i PROPERTY DAMAGE y
HIRED AUTOS AUTOS Peraccident
$
UMBRELLA UPS OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MAE) AGGREGATE $
$
DEO RETENTION N PER OTH-
AND EMPSLO YERS! ERS' LIABILITY A YIN STATUTE ER
AND EMP E.L EACH ACCIDENT $
ANYPROPRIR1P-TIVE ❑NLA
-_R MBEREXCLUDEW%CLUDED9-- - - E.L. DISEASE - EA EMPLOYE E
(Mandatory ry In In N NH)
(Mandatory
IIyes desc ipa,+IEer E.L. DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONS bekrx
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addidonal Remarks Schedule, my be attached N more apace b raqulred)
City of Ashland is named as additional Insured with respects to General Liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WRL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS:
20 E Main
Ashland, OR 97620 AUTHORIZED REPRESENTATIVE
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD