HomeMy WebLinkAboutInsurance Certificate: Ashland Bed & Breakfast Network (2)
Certificate of Insurance
This certifies that ❑x State Farm Fire and Casualty Company, Bloomington, Illinois
STPTF iPRM ❑ State Farm General Insurance Company, Bloomington, Illinois
n ❑ State Farm Fire and Casualty Company, Aurora, Ontario
INSURPNCF ❑ State Farm Florida Insurance Company, Winter Haven, Florida
❑ State Farm Lloyds, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder ASHLAND BED & BREAKFAST NETWORK INC
Address of policyholder 586 E MAIN ST ASHLAND OR 97520
Location of operations
Description of operations BED & BREAKFAST
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
Policy Period Limits of Liability
Policy Number Type of Insurance Effective Date ! Expiration Date (at beginning of policy period)
97-BC-U619-5 Comprehensive 11-14-2015 11-14-2016 BODILY INJURY AND
Business Liability 1 PROPERTY DAMAGE
-
This insurance includes: X Products - Completed Operations
X Contractual Liability Each Occurrence $ 500,000.00
X Personal Injury
X Advertising Injury General Aggregate $ 1,000,000.00
Product - Completed $ 1,000,000.00
Operations Aggregate
Policy Period BODILY INJURY AND PROPERTY DAMAGE
Policy Number EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit)
❑ Umbrella Each Occurrence $
❑ Other Aggregate $
Policy Period
Effective Date ! Expiration Date Part I - Workers Compensation - Statutory
Workers' Compensation Part II - Employers Liability
and Employers Liability Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
Policy Period Limits of Liability
Policy Number Type of Insurance Effective Date Expiration Date (at beginning of policy period)
500.00 DEDUCTIBLE
ANNUAL PREMIUM $465.00
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certification Holder If any of the described policies are canceled before
their expiration date, State Farm 9) will try to mail a
ADDL INSURED - SECTION II written notice to the certificate holder 30 days
before cancellation. If we fail to mail such notice, no
CITY OF ASHLAND obligation or liability will be imposed on State Farm or
ITS OFFICERS & EMPLOYEES its agents or representatives.
20 E MAIN ST
ASHLAND OR 97520-1814
Signature of Authorized Representative
FINANCIAL SERVICES REP 01/07/16
Title Date
BRIAN CONRAD
Agent Name
Telephone Number (541) 482-8470
Agent's Code Stamp
Agent Code 37-2155
AFO Code F-472
1001260 106399.10 08-25-2009