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HomeMy WebLinkAboutInsurance Certificate: Ashland Springs Hotel Larks Restaurant NEUM03C OP ID: CDL AcoRr~ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/06/2014 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 Phone: 541-245-1111 NAMEACT Cathy Damstra-Lepley, CIC United Risk Solutions, Inc. Fax: 541-245-1112 PHONE 541-494-7725 ac No ; 541-245-1112 PO Box 936 AIC No EXt Medford, OR 97501-0067 ADDRESS: cathy.damstra-lepley@unitedrisk.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : American Guarantee & Liability INSURED Neuman Hotel Group, LLC INSURER B : Ashland Springs Hotel Larks Restaurant INSURER C : 212 E Main Street INSURER D : Ashland, OR 97520-1829 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. INSR TYPE OF INSURANCE A DL UBR POLICY NUMBER POLICY POLICY EFF LIMITS MMDDIYYYY MDDYYYY LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CP0553794301 10/01/2014 10/01/2015 AMA ET RENT ence $ 1,000,000 PREMISES Ea occurr CLAIMS-MADE Fx~ OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00 X POLICY PRO LOC Liquor $ 1,000,00 INGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY COEaMBINED accidentS $ A X ANY AUTO CP0553794301 10/01/2014 10/01/2015 BODILY INJURY (Per person) $ ALLOWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY MAGE HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE UMB553794401 10/01/2014 10/01/2014 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/0' (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured - Designated Person or Organization, CG2026, 07/04. Coverage is subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION CITAS03 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. it's officers & employees 20 E. Main St. AUTHORIZED REPRESENTATIVE Ashland, OR 97520-1814 4_~ - D~ © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 POLICY NUMBER: CP0553794301 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 , its officers and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. 0ISO Properties, Inc., 2004 CG 20 26 07 04 EP