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HomeMy WebLinkAboutInsurance Certificate: Paddington Station 9PADDST OP ID: PB 2016Y) ACORL7 CERTIFICATE OF LIABILITY INSURANCE 0 D2108/ /2016 02/08 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). CONTACT AME, PRODUCER Phone: 541-779-4232 N Hart Insurance PHONE FAX 1123 Royal Ave. Fax: 541-772-3963 A/c No, Extl:___ Medford, OR 97504 E-MAIL -r Hart Insurance / Medford ADDRESS: INSURER S) AFFORDING COVERAGE NAIC # INSURER A : Hanover American Ins Co INSURED Hammond Family Corporation INSURER B dba: Paddington Station dba: Paddington Jewel Box INSURER C : 125 E Main Street INSURER D Ashland, OR 97520-1830 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED bELOVV 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. OLICY I R TYPE OF INSURANCE ADDL~SUBR POLICY NUMBER MM DDIYEYYY MM/DDIYYYY LIMITS LT R GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( A X -1.- - _ COMMERCIAL GENERAL LIABILITY OZ29884959 03/26/2016 03/26/2017 PREMISES ENTED (Ea occurrence $ $00,00 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG S 2,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ - r NON-OWNED PROPERTY DAMAGE ~ HIRED AUTOS ;AUTOS (Per accident) - $ 1000,00 X EUMBRELLA XCESS AB IAB X OCCUR - EACH OCCURRENCE _ _L__J 00 A DED RETENTION $ CLAIMS MADE OZ29884959 03/2612016 03/26/2017 1 AGGREGATE 000, - is I WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I N TORY LIMITS_` ANY PROPRIETOR/PARTNER/EXECUTIVE E .L EACH ACCIDENT is OFFICER/MEMBER EXCLUDED' - - i (Mandatory in NH) N/ A E ,L DISEASE E a EMPLOYEE. S If yes de=scribe under DESCRIPTION OF OPERATIONS below I E.L. UIStASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Jodi Vizzini 20 E. Main Ctroot AUTHORIZED REPRESENTATIVE r Ashland, OR 97520 Hart Ins ®r/ nice / edf d G ~~4L/ ©1988-2010 ACOR ORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD