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HomeMy WebLinkAboutInsurance Certificate: Pure Sound Entertainment Hope Caster RO® CERTIFICATE OF LIABILITY INSURANCE OP ID DR PATE (MMIDDNYYY) 12/11/14 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 NAME: PHONE Insurance Marketplace, Inc. ac, No, Ext : (AIC, No): 1998 Skypark Dr Suite 100 ADDRESS: Medford OR 97504 CUSTOMERID#: PURES-1 Phone:541-779-0177 Fax:FAX 772-8235 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A : RLI (mail to IAS ) Pure Sound Entertainment INSURER B: Hope Caster 148 S. Haskell #C INSURER C : Central Point OR 97502 INSURER D: 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 3 0 0 0 0 0 A COMMERCIAL GENERAL LIABILITY BOP1021592 10/26/14 10/26/15 PREMISES (Ea occurrence) $ 50000 CLAIMS-MADE F] OCCUR MED EXP (Any one person) $ 5 0 0 0 X Business Owners X PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 600000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY JE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETORMARTNERIEXECUTIVED E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ PROPERTY 5848 7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) add'1 insd per attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE 20 East Main St Ashland OR 97520 R. Scott Weaver, CIC 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Policy Number: BOP1021592 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): CITY OF ASHLAND 20 EAST MAIN ST ASHLAND OR 97520 Additional Premium: $20.00 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11- Liability is amended as follows: B. With respect to the insurance afforded to these additional insureds the following additional exclusions A. The following is added to Paragraph C. Who Is An apply: Insured: This insurance does not apply to: 3. The person(s) or organization(s) shown in the Schedule is also an additional insured, but only 1. Any "occurrence" that takes place after you cease with respect to liability arising out of the owner- to be a tenant in the premises described in the ship, maintenance or use of that part of the Schedule. premises leased to you and shown in the Schedule. 2. Structural alterations, new construction or demolition operations performed by or for the However: person(s) or organization(s) designated in the Schedule. a. The insurance afforded to such additional insured only applies to the extent permitted by C. With respect to the insurance afforded to these law; and additional insureds, the following is added to Paragraph D. Liability And Medical Expenses b. If coverage provided to the additional insured Limits Of Insurance: is required by a contract or agreement, the insurance afforded to such additional insured if coverage provided to the additional insured is will not be broader than that which you are required by a contract or agreement, the most we will required by the contract or agreement to pay on behalf of the additional insured is the amount provide for such additional insured. of insurance: BP 04 02 0713 © Insurance Services Office, Inc., 2012 Page 1 of 2 Company Copy 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. BP 04 02 0713 © Insurance Services Office, Inc., 2012 Page 2 of 2 Company Copy 1st Add ntl Ins Copy BUSINESSOWNERS BP 12 01 08 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS POLICY CHANGES THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY BOP1021592 112/20/14 RLI Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE HOPE CASTER DBA PURE SOUND ENTERTAINMENT CHANGES # Additional Insured Endorsement form, BP 04 02 , has been added. 12/05/14 Insurance Association Svcs./34688 Insurance Marketplace, Inc./39607 BP 12 01 0810 © Insurance Services Office, Inc., 2009 Page 1 of 2 POLICY AMOUNT AND PREMIUM ADJUSTMENT Limits of Insurance Premiums Coverage Previous Limit New Limit Previous New ®Add'I Premium Description of Insurance of Insurance Premium Premium ❑Return Premium ADDITIONAL INSURED . $20.00 L OPTIONAL COVERAGES The following optional coverages are added under this policy when ❑ Add'I. Premium designated by an "X" in the box(es) shown below. ❑ Return Premium Limits of Insurance ❑ Outdoor Signs ` ❑ Burglary and Robbery (Named Peril Endorsement only) Inside the Premises or ❑ Money and Securities Outside the Premises ❑ Employee Dishonesty Each Occurrance ❑ Equipment Breakdown TOTAL PREMIUM ADJUSTMENTS PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE ADDITIONAL $20 RETURN REMOVAL If Covered Property is removed to a new location that is described on this Policy Change, you may extend this PERMIT insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change: after that, this insurance does not apply at the previous location. Authorized Representative Signature BP 12 01 0810 © Insurance Services Office, Inc., 2009 Page 1 of 2 Policy Number: BOP1021592 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): CITY OF ASHLAND 20 EAST MAIN ST ASHLAND OR 97520 Additional Premium: $20.00 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11- Liability is amended as follows: B. With respect to the insurance afforded to these additional insureds the following additional exclusions A. The following is added to Paragraph C. Who Is An apply: Insured: This insurance does not apply to: 3. The person(s) or organization(s) shown in the Schedule is also an additional insured, but only 1. Any "occurrence" that takes place after you cease with respect to liability arising out of the owner- to be a tenant in the premises described in the ship, maintenance or use of that part of the Schedule. premises leased to you and shown in the Schedule. 2. Structural alterations, new construction or demolition operations performed by or for the However: person(s) or organization(s) designated in the Schedule. a. The insurance afforded to such additional insured only applies to the extent permitted by C. With respect to the insurance afforded to these law; and additional insureds, the following is added to Paragraph D. Liability And Medical Expenses b. If coverage provided to the additional insured Limits Of Insurance: is required by a contract or agreement, the insurance afforded to such additional insured If coverage provided to the additional insured is will not be broader than that which you are required by a contract or agreement, the most we will required by the contract or agreement to pay on behalf of the additional insured is the amount provide for such additional insured. of insurance: BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 1 st Addntl Ins Copy 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 1st Addntl Ins Copy