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HomeMy WebLinkAboutInsurance Certificate: Noble Coffee Roasting 9NOBLCO OP ID: PB CERTIFICATE OF LIABILITY INSURANCE F03/23(MM/DDIYYY-Y) D!2016 2016THIS 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 PRODUCER Phone: 541-779-4232 NAME. E,d : Fax Hart Insurance Fax: 541-772-3963 PHONE No): 1123 Royal Ave. E-MAIL Medford, OR 97504 ADDRESS: Hart Insurance / Medford INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : American Hallmark Ins Co of TX 43494 INSURED Noble Coffee Roasting LLC INSURER B : SAIF Corp dba Noble Coffee Roasting INSURER C : 281 Fourth Street Ashland, OR 97520 INSURER D : 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDY/YYEFF YY MML LTR DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 44P6463752 04/1312016 04/13/2017 DAMAGE TO RENTED 100,00 A X COMMERCIAL GENERAL LIABILITY X PREMISES Ea occurrence $ CLAIMS-MADE 41 OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 X POLICY PRO- LOC $ F COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER /N I B ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ 776066 01/01/2016 01/01/2017 E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N/A 500,00 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is additional insured per attached CBP045 CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E. Main Street AUTHORIZED RESENTATIVE Ashland, OR 97520 Hart Insu a ce / dfo ©1988-2010 ACORD C PORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL ADVANTAGE POLICY CBP 045 03 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL ADVANTAGE POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara- tions. The following is added to Paragraph C. Who Is An Insured in Section II - Liability : 4. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injur/' caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongo- ing operations or in connection with your premises owned by or rented to you. CBP 045 03 05 Includes copyrighted material of Insurance Services Office., Inc., Page 1 of 1 with its permission