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Home My WebLink AboutInsurance Certificate: Stories Alive Mount Vernon Fire Insurance Company 11`0 Devon Park Dncc Wa%nc, PA 1")87 (tit#(} 523-5545 5 To. LOCKTON AFFINITY. LLC * BINDER 08/05/2015 @ 2.30 PM Attn: Michael Swartz Commission: 13.5% mswartz@locktonaffinity.com Renewal Of: NPP2560496 From: Madeline Harney mharney@usli.com/(888) 523-5545 ext.6126 Insured Stories Alive Thank you for your order to bind. We appreciate your business! We have bound the below coverage. Policy to Follow Shortly POLICY INFORMATION NON-PROFIT PACKAGE POLICY Policy Number: NPP2560496A Policy Period: 08/10/2015 to 08/1012016 Farrier. Mount Vernon Fire Insurance Company atus. Non-Admitted A.M. Best Rating: A++ (Superior) - IX COVERAGE PART PREMIUM Commercial Liability $500.00 Each Occurrence Limit $1,000.000 Personal & Advertising Injury Limit (Any One Person/Organization) $1,000,000 Medical Expense Limit (Any One Person) $5,000 Damages To Premises Rented To You (Any One Premises) $100,000 Products/Completed Operations Aggregate Limit Included General Aggregate Limit $2.000,000 Abuse And Molestation Liability Each Occurrence $100.000 Abuse And Molestation Liability Aggregate $300,000 POLICY PREMIUM (This premium maybe subject to adjustment.) $500.00 ADDITIONAL COSTS Surplus Lines Tax $10.00 Service Charge $15.00 Fire Marshal Tax $1.50 TOTAL $526.50 ;OVERED LOCATION(S) 8r `shland Street, Ashland, OR 97520 ►PPLICABLE FORMS & ENDORSEMENTS ease contact us with any r)uesbons regarding the terminology used or the coverages provided. Page 1 of 2 The following forms apply to the Commercial Liability coverage part 2110 09/110 Service Of Suit CG0001 12/07 Commercial General Liability Coverage Form CGO068 05/09 Recording And Distribution Of Material Or CG2107 05/14 Exclusion - Access Or Disclosure Of Confidential Information In Violation Of Law Exclusion Or Personal Information And Data-Related Liability Limited Bodily Injury Exception Not Included 7 ?136 01/96 Exclusion - New Entities CG2147 12107 Employment-Related Practices Exclusion 017 11!98 Common Policy Conditions IL0021 09!08 Nuclear Energy Liability Exclusion Endorsement IL0142 09/08 Oregon Changes - Domestic Partnership L-224 10/10 Punitive Or Exemplary Damages Exclusion L-278 03/14 Independent Contractors/Subcontractors Exclusion L-367 02/11 Minimum Earned Premium Endorsement L-423 02/11 Exclusion For Structure Collapse L-472 07/08 Exclusion - Injury To Performers Or Entertainers L-500 02/11 Bodily Injury Exclusion - All Employees, Volunteer L-526 06/06 Absolute War Or Terrorism Exclusion Workers, Temporary Workers, Casual Laborers, Contractors, And Subcontractors L-581 02/11 Certain Animal Exclusion L-599 10/12 Absolute Exclusion for Pollution, Organic Pathogen, Silica, Asbestos and Lead with a Hostilr Fire Exception L-610 11/04 Expanded Definition Of Bodily Injury L-61 8C 09/09 Amendment Of Premium Audit Conditions L-631 02111 Event Vendor/Exhibitor & Contractor - Exclusion L-686 10/12 Absolute Exclusion for Liquor and Other Related Liability L-703 12/09 Molestation Or Abuse Insurance L-744NPP 06/10 Blanket Additional Insured Endorsement L-756 08111 Exclusion - Sponsored Athletic Programs Or LLQ100 07/06 Amendatory Endorsement Competition LL0368 08110 Separation Of Insureds Clarification Endorsement TRIADN 01/15 Disclosure Notice of Terrorism Insurance Coverage NPP Jacket 09/10 Non Profit Package Policy Jacket 0 ~IIPase contact us with any questions regarding the terminology used or the coverages provided Page 2 of 2