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HomeMy WebLinkAboutInsurance Certificate: Standing Stone Brewing Company ® DATE (MWDDfYYYY) A~oRO CERTIFICATE OF LIABILITY INSURANCE 7/25/2014 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 Brown & Brown Northwest NAME: CONTACT Kim Edwards 3256 Hillcrest Park Drive IAIC,J o 541-494-2663 Alt No : 541-494-2763 Medford, OR 97504 E-MAIL ADDRESS: kedwards@bbnw.com INSURER S) AFFORDING COVERAGE NAIC # www.bbnw.com INSURERA: Allied Insurance Company 10127 INSURED INSURER B : Nationwide Agribusiness 28223 Standing Stone Brewing Company 101 Oak Street INSURER C : Ashland OR 97520 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 21007404 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. POLICY EFF POLICY EXP INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER (MM/DD /YYYY MM/DD/YY LTR YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 12 OCCUR ACP3006604826 7/24/2014 7/24/2015 DAMAGE TO RENTED Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ✓ POLICY F7 PRO ❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER. JECT Liquor Liability $ 1,000,000 (COMBINED SINGL acctNEDtSINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY ✓ A ✓ ANY AUTO ACP3006604826 7/24/2014 7/24/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PeOa cRdentDAMAGE $ ✓ HIRED AUTOS ✓ AUTOS Uninsured Motorist CSL $ 1,000,000 A UMBRELLA LIAB OCCUR ACP3006604826 7/24/2014 7/24/2015 EACH OCCURRENCE $ 5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Farm Liability ✓ FPK7806334608 7/24/2014 7/24/2015 $1,000,000 OCC - $2,000,000 Agg B Farm Umbrella FPKFAEN7806334608 7/24/2014 7/24/2015 $4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 101 Oak Street, 89-93 Oak Street, Ashland, OR 97520 and 38 IE 32 LT 100, IE 33 Lot 200, Ashland, OR 97520 - 265 Acres The City of Ashland is Additional insured as respects to their interests by written contract per attached endorsements: AC0102, GL00030 and FL70610. This form is subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE Kim Edwards ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 1 of 7 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT (PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED UNDER CONTRACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section 11 - Who Is An Insured is amended to include any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy. However, the insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy; or b. The coverage and/or limits required by said contract or agreement. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization where required of you by written contract or agreement. GL 00030 00 (10/09) CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 2 of 7 COMMERCIAL AUTO AC 01 02 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM A. CHANGES FOR TRAILERS AND FARM rental of a vehicle is an "insured" for Liability EQUIPMENT Coverage, but only to the extent that person 1. Under the COVERED AUTOS SECTION, or organization qualifies as an "insured" un- the following are added to Paragraph C. der the Who Is An Insured Provision con- Certain Trailers, Mobile Equipment and tained in the LIABILITY COVERAGE Temporary Substitute Autos: SECTION of the Coverage Form 4. "Trailers" designed to be towed by a pri- D. REPLACED EXCLUSIONS vate passenger type "auto" or a pickup, The Expected or Intended Injury Exclusion panel truck or van if not used for busi- in the LIABILITY COVERAGE SECTION is ness purposes, other than farming or replaced by the following: ranching. Expected or Intended Injury 5. Farm wagons or farm implements while "Bodily injury" or "property damage" which is being towed by a covered "auto". expected or intended by the "insured". This B. CHANGES FOR ADDITIONAL NEWLY exclusion applies even if the resulting "bodi- ACQUIRED VEHICLES ly injury" or "property damage": 2. Paragraph B.2 of the COVERED AUTOS a. is of a different kind, quality or degree SECTION is replaced by the following: than initially expected or intended; or 2. If Symbol(s) 7 or 67 is entered next to b. is sustained by a different person, entity, coverage in Item Two of the Declara- real property, or personal property than tions, an "auto" you acquire will be a that initially expected or intended. covered "auto" for that coverage only if: E. ADDITIONAL EXCLUSIONS a. We already cover at least one "auto" The following exclusions are added to the you own for that coverage or it rep- LIABILITY COVERAGE SECTION: laces an "auto" you previously Damage to Named Insured's Property owned that had that coverage; and b. You tell us within 30 days after you Any claim or "suit" for "property damage" by acquire it that you want us to cover you or on your behalf against any other per- afor that coverage. son or entity that is also a Named Insured under this policy. The most we will pay for Physical Damage Abuse or Molestation Coverage for "loss" under this Coverage Ex- tension is $100,000 per "auto", subject to "Bodily injury" or "property damage" arising the largest deductible applicable to any "au- out of: to" for that Coverage. a. The actual or threatened abuse or C. BLANKET ADDITIONAL INSURED molestation by anyone or any person Any person or organization which you have while in the care, custody or control of agreed to name as an additional insured in a any "insured", or written contract, executed prior to an acci- b. The negligent: dent, other than a contract for the lease or 1) Employment; AC 01 02 03 10 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 4 with its permission. CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 3 of 7 AC 01 02 03 10 2) Investigation; This insurance does not apply to: 3) Supervision; a. "Loss" to the covered "auto's" contents, 4) Reporting to the proper authorities, except equipment usual to trucks or pri- or failure to so report; or vate passenger "autos". 5) Retention; b. "Loss" to TV antennas, awnings or ca- banas. of a person for whom any "insured" is or ever was legally responsible and whose c. "Loss" to equipment designed to create conduct would be excluded by Para- added living facilities. graph a. above. However, these exclusions do not apply if Abuse means an act which is committed Miscellaneous Personal Property Coverage with the intent to cause harm. is provided by endorsement to this policy. Explosives G. ACCIDENTAL AIRBAG DISCHARGE "Bodily injury" or "property damage" caused COVERAGE by the explosion of explosives you make, Under Paragraph B.3.a. of the PHYSICAL sell or transport. DAMAGE SECTION, the following is added: Rolling Stores Mechanical breakdown does not include the ac- If a covered "auto" is a rolling store, "bodily cidental discharge of an airbag. injury" or "property damage" resulting from H. PHYSICAL DAMAGE LIMIT OF INSURANCE the handling, use or condition of any item Under PHYSICAL DAMAGE COVERAGE the "insured" makes, sells or distributes if SECTION, Paragraph C., Limit of Insurance is the injury or damage occurs after the "in- replaced by the following: sured" has given up possession of the item. C. Limit Of Insurance Wrong Delivery of Liquid Products 1. The most we will pay for "loss" in any "Bodily injury" or "property damage" result- one "accident" is the lesser of: ing from the delivery of any liquid into the a. The actual cash value of the damaged wrong receptacle or to the wrong address, or stolen property as of the time of the or from the delivery of one liquid for another, "loss", or if the "bodily injury" or "property damage" b. The cost of repairing or replacing the occurs after the delivery has been com- damaged or stolen property. pleted. Delivery is considered completed even if fur- 2. $1,000 is the most we will pay for "loss" in ther service or maintenance work, or correc- any one "accident" to all electronic equip- tion, repair or replacement is required be- ment that reproduces, receives or transmits cause of wrong delivery. audio, visual or data signals which, at the time of "loss", is: Professional Services a. Permanently installed in or upon the "Bodily injury": covered "auto" in a housing, opening or a. Resulting from the providing or the fail- other location that is not normally used ure to provide any medical or other pro- by the "auto" manufacturer for the instal- fessional services. lation of such equipment. b. Resulting from food or drink furnished b. Removable from a permanently installed with these services. housing unit as described in Paragraph "Bodily injury" or "property damage" result- 2.a. above or is an integral part of that ing from the handling of corpses. equipment; or F. MOTOR HOME CONTENTS COVERAGE c. An integral part of such equipment. 1. For a covered "auto" that is a motor home 3. An adjustment for depreciation and physical the following exclusions are added to the condition will be made in determining actual PHYSICAL DAMAGE COVERAGE cash value in the event of a total "loss". SECTION: Motor Home Contents Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc., AC 01 02 03 10 with its permission. CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 4 of 7 AC 01 02 03 10 4. The cost of repairing or replacing may: 4. A member, if you are a limited liability com- a. Be based on an estimate which includes pany. parts furnished by the original equip- K. UNINTENTIONAL FAILURE TO DISCLOSE ment manufacturer or other sources in- HAZARDS cluding non-original equipment manu- The BUSINESS AUTO CONDITIONS SECTION facturers and and MOTOR CARRIER CONDITIONS b. Include a deduction for betterment for a SECTION- B.2. are amended by the addition of part or parts that are normally subject to the following: repair or replacement during the useful If you unintentionally fail to disclose any hazards life of the "auto", such as, but not limited existing at the inception date of your policy, we to tires and batteries. will not deny coverage under this Coverage Betterment means the difference be- Form because of such failure. However, this tween the actual cash value of a part provision does not affect our right to collect addi- immediately before the "loss" and the tional premium or exercise our right of cancella- cost to replace that part with a new part. tion or nonrenewal. 5. If we offer to pay the actual cash value of L. AUTOS HIRED OR RENTED BY the damaged or stolen property, we will val- EMPLOYEES ue auto advertising wraps, paint customize- If hired or rented "autos" are covered "autos" on tion, and similar business related advertising this policy, the following provisions apply: modifications, in addition to the actual cash A. Changes In Liability Coverage value of the property. Auto advertising The following is added to the Who Is An In- wraps, paint customization, and similar sured Provision in the LIABILITY business related advertising modifications COVERAGE SECTION: will be valued at the cost to replace them with an adjustment made for depreciation An "employee" of yours is an "insured" while and physical condition. operating an "auto" hired or rented under a 1. GLASS REPAIR -WAIVER OF DEDUCTIBLE contract or agreement in that "employee's" Under Paragraph D. Deductible of the name, with your permission, while performing PHYSICAL DAMAGE COVERAGE SECTION, duties related to the conduct of your busi- the following is added: ness. No deductible applies to glass damage if the B. Changes In General Conditions glass is repaired rather than replaced. Paragraph 5.b. of the Other Insurance J. AMENDED DUTIES IN EVENT OF ACCIDENT, Condition in the Business Auto Coverage CLAIM, SUIT, OR LOSS Form and Paragraph 5.f.of the Other Insur- ance Condition in the Motor Carrier Cover- The requirement in Loss Condition 2.a. Duties In age Form are replaced by the following: the Event Of Accident, Claim, Suit Or Loss - of For Hired Auto Physical Damage Coverage, the BUSINESS AUTO CONDITIONS SECTION the following are deemed to be covered "au- and the MOTOR CARRIER CONDITIONS tos" you own: SECTION that you must notify us of an "acci- dent", "claim", "suit", or "loss" applies only when 1. Ariy covered "auto" you lease, hire, rent the "accident", "claim", "suit", or "loss" is known or borrow; and to : 2. Any covered "auto" hired or rented by 1. You, if you are an individual your "employee" under a contract in that 2. A partner, if you are a partnership; individual "employee's" name, with your permission, while performing duties re- 3. An executive officer or the employee desig- lated to the conduct of your business. nated by you to give such notice if you are a However, any "auto" that is leased, hired, corporation; or rented or borrowed with a driver is not a covered "auto". AC 01 02 03 10 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 4 with its permission. CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 5 of 7 AC 01 02 03 10 M. EMERGENCY LOCKOUT - PRIVATE 3. Original copies of receipts for services of a PASSENGER VEHICLES locksmith must be provided before reim- We will reimburse you up to $50 for reasonable burse ment is payable. expense incurred for the services of a locksmith N. LIBERALIZATION to gain entry into your covered "auto" of the pri- Paragraph 3, of the General Conditions is re- vate passenger type subject to these provisions: placed by the following: 1. Your door key or key entry pad has been If we adopt any revision that would broaden the lost, stolen or locked in your covered "auto" coverage under this policy without additional and you are unable to enter such "auto" , or premium within 60 days prior to or during the 2. Your key or key entry pad has been lost or policy period, the broadened coverage will im- stolen and you have changed the lock to mediately apply to this policy. prevent an unauthorized entry; and All terms and conditions of this policy apply unless modified by this endorsement. Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc., AC 01 02 03 10 with its permission. CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 6 of 7 EFFECTIVE DATE: 12:01 AM Standard Time. FARM (at your principal place of business) FL 706 10 (01-01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REACT IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED OPERATION, LOCATION OR EQUIPMENT COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: FARM LIABILITY COVERAGE FORM This endorsement applies only to the person+,;s) or equipment shown on Form 8110, subject to the fol- organization(s) identified on Form 8110 (Additional lowing additional exclusion: Endorsement Information) of this policy. This insurance, including any duty .ve have to do- Under Section C. WHO IS AN INSURED, in paragraph fend "suits", does not apply to "bodily injury"2.. each of the following is also an insured: 11 property damage" or "personal and advertising in- jury" that arises out of, in whole or in part, or is a The persons or organizations shown on Form 8110, result of, in %vhole or in part, the active or primary but only with respect to liability arising out of the negligence of any person or organization designated designated operation or location or your use of as an additional insured on Form 8110. All terms and conditions of this policy apply unless modified by this endorsement. FL 706 10 (01-01) FPK HAM 7806334608 INSURED's COPY 78 0071993 CERT NO.: 21007404 Kim Edwards 7/25/2014 3:21:05 PM (PDT) Page 7 of 7