HomeMy WebLinkAboutInsurance Certificate: Tabu
9TABURE OP ID: ME
CERTIFICATE OF LIABILITY INSURANCE 0412512014 D ) 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 Phone: 541-779-4232 NAMEACT
Hart insurance - - Fax: 541-772-3963PHONE - - - FAX
1123 Royal Ave. o ac No :
Medford, OR 97504 E-MAIL'
Michelle L.-Ely ADDRESS:
INSURERS AFFORDING COVERAGE NAICr
INSURER A:CinCinnati Specialty
INSURED TB3, Inc. dba: Tabu INSURER a:Em to ers Preferred Ins Cc
76 North Pioneer St INSURER C:
Ashland, OR 97520
INSURER D :
INSURER E
NSURER F
COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER:
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 POLICY
TR TYPE OF INSURANCE POLICY NUMBER MM/DDS MIDQYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE S 1,000,00
A X COMMERCIAL GENERAL LIABILITY X CS00036943 W2212014 0412212015 PREMISES Es ocarrence f 100,00
CLNMS44ADE a OCCUR MED EXP(Any one Perron) S Exclude
PERSONAL S ADV INJURY S 1,000,00
GENERAL AGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER: - PRODUCTS -COMPIOP AGG E 2,000,00
X POLICY PRO LOC - - LIquor $ 1,000,00
AUTOMOBILE LIABILITY COMBINED LIMB S
ANY AUTO - - - - - BODILY INJURY (Per
Paaon). S "
ALLOWNED SCHEDULED BODILY INJURY Per accident E
AUTOS AUTOS ( )
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
$
AUTOS Per ac;went
S
UMBRELLA LIAB OCCUR - EACH OCCURRENCE 3
EXCESS LMB CLAIMS-MADE AGGREGATE E
DED RETENTIONS 3
WORKERS COMPENSATION VaC STATIC 0TH-
TS1
AND EMPLOYERS' LIABILITY
B ANY PROPRIETORIPARTNERIEXECUnVE YIN EIG1604265 0110112014 0110112015 E.L. EACH ACCIDENT f 600,00
OFFICERIMEMBER EXCLUDED? ~ NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE 3 600,00
11 yyeea, dwcrbe under
OESCRIPTIOH OF OPERATIONS EeM _ - -EA_ DISEASE- POLICY LIMIT 3- - 600,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, AddlBonal Ramarb Schedule, H Bare apace is raquh,ed)
City of Ashland is included as additional insured as respects to general
liability per form CG2026 04/13
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
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
Michelle L. Ely ®1988-2010 ACORD CORPORATIO All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CSU0036943 COMMERCIAL GENERAL LIABILITY
CG 20 26 0413
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):
City of Ashland It's Officers 6 Employees 20 E Main Street Ashland, OR 97520
Information required to complete this Schedule if not shown above will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to that which you are required by the contract
include as an additional insured the person(s) or agreement to provide for such additional
or organization(s) shown in the Schedule, but insured.
only with respect to liability for "bodily injury",
"property damage" or "personal and advertising B. With rasped to the insurance afforded to these
injury" caused, in whole or in part, by your acts additional insureds, the following is added to
or omissions or the ads or omissions of those Section 10 - Limits Of Insurance:
acting on your behalf: If coverage provided to the additional insured is
1. In the performance of your ongoing required by a contract or agreement, the most
operations; or we will pay on behalf of the additional insured is
the amount of insurance:
2. In connection with your premises owned by
or rented to you. 1. Required by the contract or agreement; or
However.- - - - - - - 2.-Available--under -the -applicable omits-of - - -
Insurance shown in the Declarations;
1. The insurance afforded to such additional
insured only applies to the extent permitted whichever Is less
by law; and This endorsement shall not increase the
2. If coverage provided to the additional applicable Limits of Insurance shown In the
insured is required by a contract or Declarations.
agreement, the insurance afforded to such
addtional insured will not be broader than
CG 20 26 0413 0 Insurance Services Office, Inc. 2012 Page 1 Of 1