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HomeMy WebLinkAboutInsurance Certificate: Lithia Artisans Market g28,1409:42a Powell Insurance Assoc 5417476640 P.1 1 a DATE (MMIDDIYYYY) CORD CERTIFICATE OF LIABILITY INSURANCE 06/2812014 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 NAOMNEACT KELL1 S HENSLEY POWELL INSURANCE ASSOCIATES ING PHONE 541-747-BOBO FAX No): 541-747-6840 1N&_ho Ex1J- A1C PO BOX P ADDRESS: kelli@powellinsurance.biz SPRINGFIELD OR 97477 INSURE S AFFORDING COVERAGE NAX: A INSURERA : FIRST NATIONAL INSURANCE CO OF AMERICA INSURED INSURER B : LITHIA ARTISANS MARKET, INC. INSURER C : INCLUDING VENDORS INSURER 0: PO BOX 3585 INSURER E : ASHLAND OR 97520 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- INSR ADOL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD(YYYY MMIODNYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAfJ1A- E 70 RENT 1000,000 X COMMERCIALGENERAL LIABILITY PREMISES Ea occurrence , $ CLAIMS-MADE a OCCUR MEO EXP Any one person) $ 10,000 A I Y 01-CH-933884-7 1011412014 1011412015 PERSONAL & ADV INJURY $ 1,000,000 GENERALAG_GREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COLIP/OPAGG $ 2,000,000 PRO- $ X POLICY T LOC t $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per Person) $ : BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS NAUTOS PROPERTY DAMAGE ON-OWNED $ ;HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ i F EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEO RETENTION $ $ TATU- OTH- WORKERS COMPENSATION WCSY IMI E AND EMPLOYERS' LIABILITY Y I N T ANY PROPRIETORIPARTNERI'eXECUTIVE ❑IHIA E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Nlandalory In NH) E.L. DISEASE-FA EMPLOYE $ _ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (AHach ACORD 171, Additional Remarks Schedule, if more space is required) CITY OF ASHLAND IS LISTED AS AN ADDITIONAL INSURED, PER ATTACHED FORM CG 76 35 (02 07). FAX: 541-488-5311 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND OR 97520 AUTHORIZED REPRESENTATIVE KELLI S HENSLEY , ACORD 25 (2010105) ©1988-2 10 ACO CORPORATION. rights reserved. The ACORD name and logo are registered marks of ACORD Aug 28.14 09:42a Powell Insurance Assoc 5417476640 p.2 Liberty COMMERCIAL GENERAL LIABILITY Northwest. CG 76 35 02 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ADDITIONAL INSURED BY WRITTEN lease or occupy, subject to the following j~ CONTRACT, AGREEMENT OR PERMIT, OR additional provisions: ~C• SCHEDULE (a) This insurance does not apply to The following paragraph is added to WHO IS AN any "occurrence" which takes place INSURED (Section 11): after you cease to be a tenant in any premises leased to or rented to 4. Any person or organization shown in the Sched- you; ule or for whom you are required by written con- (b) This insurance does not apply to tract, agreement or permit to provide insurance any structural alterations, new con- is an insured, subject to the following additional struction or demolition operations provisions: performed by or on behalf of the a. The contract, agreement or permit must be person or organization added as an in effect during the policy period shown in insured; the Declarations, and must have been exe- cuted prior to the "bodily injury", "property (2) suYour red,o whether herewo k isoperformed damage", or "personal and advertising by you or for you; injury". (3) The maintenance, operation or use by b. The person or organization added as an in- you of equipment leased to you by such sured by this endorsement is an insured only person or organization, subject to the to the extent you are held liable due to: following additional provisions: (1) The ownership, maintenance or use of (a) This insurance does not apply to that part of premises you own, rent, any "occurrence" which takes place after the equipment lease expires; Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 CG 76 35 02 07 Page 1 of 4 EP GAr-2XPR rNT001-1597W 3S Aug 28.14 09:42a Powell Insurance Assoc 5417476640 p.3 (b) This insurance does not apply to This exclusion applies even if the claims "bodily injury" or "property dam- against any insured allege negligence or age" arising out of the sole negli- other wrongdoing in the supervision, hiring, gence of such person or employment, training or monitoring of others organization; by that insured, if the "occurrence" which caused the "bodily injury" or "property (4) Permits issued by any state or political damage" involved the ownership, mainte- subdivision with respect to operations nance, use or entrustment to others of any performed by you or on your behalf, aircraft, "auto" or watercraft that is owned subject to the following additional pro- or operated by or rented or loaned to any in- vision: sured. This insurance does not apply to "bodily This exclusion does not apply to: injury', "property damage", or (1) A watercraft while ashore on premises "personal and advertising injury" arising you own or rent; out of operations performed for the state or municipality. (2) A watercraft you do not own that is: c. The insurance with respect to any architect, (a) Less than 52 feet long; and engineer, or surveyor added as an insured (b) Not being used to carry persons or by this endorsement does not apply to property for a charge; "bodily injury", "property damage", or "per- sonal and advertising injury" arising out of (3) Parking an "auto" on, or on the ways the rendering of or the failure to render any next to, premises you own or rent, pro- professional services by or for you, includ- vided the "auto" is not owned by or ing: rented or loaned to you or the insured; (1) The preparing, approving, or failing to (4) Liability assumed under any "insured prepare or approve maps, drawings, contract" for the ownership, mainte- opinions, reports, surveys, change or- nance or use of aircraft or watercraft; or ders, designs or specifications; and (5) "Bodily injury" or "property damage" (2) Supervisory, inspection or engineering arising out of: services. (a) the operation of machinery or equipment This insurance does not apply to "bodily part of, a land vehicle that would injury" or "property damage" included within qualify under the definition of the "products-completed operations haz- "mobile equipment" if it were not and". subject to a compulsory or financial responsibility law or other motor ve- A person's or organization's status as an insured un- hicle insurance law in the state der this endorsement ends when your operations for where it is licensed or principally that insured are completed. garaged; or No coverage will be provided if, in the absence of this (b) the operation of any of the machin- ery or equipment listed in Paragraph endorsement, no liability would be imposed by law on f.(2) or t.(3) of the definition of you. Coverage shall be limited to the extent of your °'mobile equipment". negligence or fault according to the applicable princi- ples of comparative fault. (S) An aircraft you do not own provided it is not operated by any insured. NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT LIABILITY TENANTS' PROPERTY DAMAGE LIABILITY Exclusion g. of COVERAGE A (Section l) is replaced When a Damage To Premises Rented To You Limit is by the following: shown in the Declarations, Exclusion J. of Coverage A, Section I is replaced by the following: g. "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or j- Damage To Property entrustment to others of any aircraft, "auto" "Property damage" to: or watercraft owned or operated by or rented or loaned to any insured. Use includes oper- (1) Property you own, rent, or occupy, including ation and "loading or unloading any costs or expenses incurred by you, or Page 2 of 4 C-AG-23-PA I KT001.1597.014S