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ACCN?" DATE(MMIDOIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 108/22/2014
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 POLICIE
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 cNAMIACT Lockton Affinity, LLC
PHONE 888-305-9827 -'-FAX
Lockton Affinity, LLC (W-No, EA); tNC,No) _
E-MAIL
P.O. Box 410679 AODRESS:_
Kansas City, MO 64141-0679 INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A : Mount Vernon Fire Insurance Co. 26522
INSURED MiSURER 8 : _
Stories Alive
INSURER C
800 Ashland Street -
INSURER D
Ashland, OR 97520 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 PERIO
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 TERM
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLX:Y EXP LIMITS
LTR i TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/OD
A GENERAL LIABILITY NPP2560496 108/10/2014 08/10/2015 EACH OCCURRENCE $ 1,000,000
$
}C i COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 000
i I PREMISES Ea occurrence) 10010
CLAIMS-MADE L~ OCCUR I MED EXP (An one person) S 5 , 000
PERSONAL & ADV INJURY j S 1,000,000
i i GENERAL AGGREGATE 2,000,000
I
- I i
GEN'L AGGREGATE LIMIT APPLIES PER I I PRODUCTS - COMPtOP AGG' S Included
K POLICY PRO- I LOC
AU7OMOBIL£ LIABILITY I i COMBINED SINGLE LIMIT
a accident $
ANYAUTO i i BODILY INJURY (Per Person) $
ALL OWNED r-r SCHEDULED i BODILY INJURY (Per accident) $
AUTOS AUTOS ( I
WON-OWNED PROPERTY DAMAGE 1
l 1 $
i _ HIRED AUTOS ~ I AUTOS l1 Per accident.
UMBRELLA LIAB ( OCCUR EACH OCCURRENCE I $
EXCESS LIA.B ` CLAIMS-MADE ( ~ ( AGGREGATE 1
DIEDD RETENTION $ I $
WORKERS COMPENSATION !TORY WC STATU- iOTH-
AND EMPLOYERS L ABILITY
ANY PROPRIETOR/PARTNEPJEXECUTI Y/ N ! EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? L 41A
) 1
(Mandatory In NH) i EL DISEASE - EA EMPLOY
I If yes, describe under i
DESCRIPTION OF OPERATIONS below j E.L. DISEASE - POLICY LIMIT 1 $
~ I I j I
i i
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
Proof of Coverage
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTOO REPRESEN7ATME
19,8 2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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