Loading...
HomeMy WebLinkAboutInsurance Certificate: Liquid Assets Wine Bar ® DATE (MMIDDNYYY) AC"R° CERTIFICATE OF LIABILITY INSURANCE 6/7/2016 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 CONTACT NAME: Marcene Forney Ashland Insurance Inc PAH/oNN t . (541) 857-0679 A/C No): (541) 857-9883 801 O'Hare Parkway, Ste 101 ADDRESS:marcenef@ashlandinsurance.com INSURERS AFFORDING COVERAGE NAIC # Medford OR 97504 INSURER A:Montere Insurance Co 23540 INSURED INSURER B : Reliable Resources Inc DBA Liquid Assets Wine Bar INSURER C: 96 N Main #201 INSURER D INSURER E Ashland OR 97520 INSURER F : COVERAGES CERTIFICATE NUMBER:16 17 GL Master 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 POLICY ADDLSUBR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD/YYYY MM LTR / D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 300 , 000 DAMAGE TO RENTED 75,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ X 27SSA31326012 6/1/2016 6/1/2017 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 300 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600 , 000 X POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 300 , 000 JECT OTHER: Liquor Liability $ 300 , 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 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 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STA,rUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is listed as Additional Insured for General Liability per attached form CG20120798. This form is subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Its Employees and Officers ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Kimberly Edwards/KIM ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: 27-SSA-3--1325012 COMMERCIAL GENERAL LIABILITY CG 20 12 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: City of Ashland its Employees and Officers (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section 11 Who 1s An Insured is amended to 2. This insurance does not apply to: include as an insured any state or political subdivi- a. Bodily injury, »property damage or sion shown in the Schedule, subject to the following "personal and advertising injury" arising out provisions: of operations performed for the state or mu- 1. This insurance applies only with respect to op- nicipality; or erations performed by you or on your behalf for b. "Bodily injury" or "property damage" included which the state or political subdivision has issued within the "products-completed operations a permit. hazard". CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑