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HomeMy WebLinkAboutInsurance Certificate: Lively Up LLC LIVEL-1 OP ID: KF1 Y) CERTIFICATE OF LIABILITY INSURANCE 01 / DATE ( 1MM/3!22016 016 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 Phone: 925-798-3334 CONTACT NAME: EPIC/James C Jenkins Ins Srvc - License No. 0545478 Fax: 925-609-5381 PHHONN Exc);-- FAX P.O. Box 5668 E-MAIL Concord, CA 94524 ADDRESS---_ Chris Parker INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Nova Casualty Company '.42552 INSURED Lively Up LLC INSURERS dba: Party Place - David & Beverly Lively INSURER C; 924 Chevy Way INSURER D : Medford, OR 97501 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 ADDLISUBR POLICY E_ - POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE S 1,000,00 I- A X COMMERCIAL GENERAL LIABILITY IRNTCLOD103433 U1122/21U16; , 01122/2017 DA E ENTED ~ PREMISEEa occurrencej__15 300,00 - - - _ CLAIMS-MADE E OCCUR MED EXP (Any one person) 5 10,00 PERSONAL & ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT AP PLIES PER PRODUCTS - COMP/OP AGG S 2,000,00 POLICY n PRO- n LOC j Emp Ben. S 1,000,00 JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,00 A X ! ANY AUTO 'SRN TCL00103433 01122/2016 01/22/2017 BODILY INJURY (Per person) $ r _ t - ALL OWNED SCHEDULED - I - AUTOS S ~ AUTOS BODILY INJURY (Per accident) I $ NON-OWNED P~RO~PERTY DAMAGE --T X HIRED AUTOS I X AUTOS Per accdent _ i S I X HAPD rX S1000 Ded ~L is j UMBRELLA LIAB OCCUR I EACH OCCURRENCE 5 1,000,00 A EXCESS LIAB CLAIMS- H ;.RNTUM00101993 01/22/2016 01/22/2017 I AGGREGATE $ 1,000,00 DED I X RETENTIONS 10,000 S WORKERS COMPENSATION I I I WC STATU- OTH-I AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ j I E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A. (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE S If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. jDISEASE - POLICY LIMIT S Equipment Floater 'RNTCL00103433 A I~ 0112212016 0112212017 Spec Form 325,00 Repl Cost $2500 Ded I I i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of Coverage ONLY. CERTIFICATE HOLDER CANCELLATION ASHLAND The City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD