HomeMy WebLinkAboutInsurance Certificate: Ashland Flower Shop & Green House
ASHL05W OP ID: KCF
ACORl~ F DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 08/10/2015
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 NAAMEACT KC Ferguson
-
United Risk Solutions, Inc. _ -
PO Box 936 AA/COC N E:t)_541-494-7752 lac No); 541-245-1112
Medford, OR 97501-0067 E-MAIL
DCindi L. Jayubo, CIC, CRM SS: kc.ferguson@unitedrisk.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: SAW Corporation
INSURED Ashland Flower Shop INSURER B
and Green Houses, Inc.
87 W Nevada St. INSURER C
Ashland, OR 97520-1027 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.
- - -
INSR TYPE OF INSURANCE ADDLi SUER - POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE 1:1 OCCUR DAMAGE T RENTED
PREMISES (Ea occurrencel_ _ $
MED EXP (Anyone person)
I~ PERSONAL & ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S
POLICY jECT LOC PRODUCTS - COMP/OP AGG $
OTHER:- $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS ICI Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE, AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS' LIABILITY STATUTE
~ $ 500,00
A (OFFICER//MEMBER/EXCLUDR/EXECUTIVE Y/" "/AEI (764581 ' 09/01/2015 09101/2016 E.L. EACH ACCIDENT ER
(Mandatory in NH) ~i E.L. DISEASE - EA EMPLOYEE $ 500,00
If yes, describe under -
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: All Operations of the named insured
CERTIFICATE HOLDER CANCELLATION
CITAS03
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
20 E. Main St.
Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE
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