HomeMy WebLinkAboutInsurance Certificate: Bradford Pizza
__-"N BRADPIZ-01 RICKIE
'4 . " AT
CERTIFICATE OF LIABILITY INSURANCE DDIYYYY)
100/6/2/6/2015
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 CONTACT
NAME:
Fullhart Insurance of Sisters PHONN E. (541) 549-3172 FAX (541) 549-9374
704 W. Hood Ave. (A/C, No); P.O. Box 1890 EMAIL ADDRESS: info@fullhartinsurance.com
Sisters, OR 97759
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Oregon Mutual Insurance 114907
INSURED INSURER B : SAIF Corporation 136196
Bradford Pizza Inc. (Ashland) INSURER C:
1PMB467 Sis iskiyou Blvd.
INSURER D : 232 ~
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 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 I AD U R'. POLICY EFF POLICY EXP LIMITS
LTR I TYPE OF INSURANCE INSD WVD' POLICY NUMBER MM/DDlYYYY ! MMlDDIYYW
A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
MAI'E
"MSES ence) S 1,000
CLAIMS-MADE Axi OCCUR X BSP720052 11/12/201511/12/2016 '1 PA , TO 1E1 ED-
MED EXP (Any one person) S 5,000
I PERSONAL & ADV INJURY 1 S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GE' L AGGREGATE S _ 2,000,000
PRO-
X POLICY JECT 1~7 LOC PRODUCTS -COMP/OP AGG I, S 2,000,000
OTHER: S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
Ea accident) _
ANY AUTO BODILY INJURY (Per person) ! S
ALL OWNED SCHEDULED I BODILY INJURY (Per accident) S
AUTOS AUTOS
I 1 g
NON-OWNED (Per PROP ERT ntDAMAGE
HIRED AUTOS i AUTOS f_LP
UMBRELLA LIAB OCCUR ! EACH OCCURRENCE S
-
EXCESS LIAB CLAIMS-MADE', AGGREGATE S
S
DED RETENTION S '
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY j STATUTE ER
rYIN:
1774382 11/01/2016; 11101/2016 E.L. EACH ACCIDENT $ 500,000
B ANY PROPRETORlPARTNER/EXECUTIVE NIA
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 500,000
If yes, describe under
-1 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S 500,000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E. Main
Ashland, OR 97520
AUTHORIZED REPRESENTATIVE
I
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD