HomeMy WebLinkAboutInsurance Certificate: Brother's Restaurant
Certificate of Insurance This Certificate is issued as a matter of information only and confers no rights upon the
certificate holder. This certificate does not amend, extend or alter the coverage
ISSUE DATE 09/02/16 afforded by the policies below.
RETAIL PRODUCER ISSUING CARRIER PRIMARY POLICY
Ashland Insurance, Inc. United Specialty Insurance Company
PO Box 880 465 Cleveland Avenue
Ashland , OR 97520 Westerville, OH 43802
Phone: 541-482-0831 Fax: 541-488-5851
INSURED ISSUED BY:
Brother's Restaurant Anchor Bay Insurance Managers, Inc
Durant Newton Enterprises, Inc. dba: Post Office Box # 2510
642 Sutton Place Silverdale, WA 98383
Ashland, OR 97520
COVERAGES
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.
Effective Expiration
Type of Insurance Policy number Date Date Limits
Building(s) Not Covered
Tenant's Improvements & Betterments Not Covered
Commercial Property USA4131433 9/4/2016 9/4/2017 Business Personal Property $165,000
Business Income including $600,000
Extra Expense
Tenant Glass Not Covered
General Aggregate $2,000,000
Products and Completed Ops Aggregate $2,000,000
Commercial General Liability USA4131433 9/4/'2016 9/4/2017 Personal & Advertising Injury $1,000,000
& Liquor Liability Each Occurrence $1,000,000
Damage to Premises Rented to You $100,000
Medical Payments (each person) $5,000
Liquor Legal (each common cause) $1,000,000
Liquor Legal (annual aggregate) $1,000,000
Non-owned & Hired Auto Liability $1,000,000/$1,000,000
Employee Benefits Liability Not Covered
Excess Liability Not Covered
Comments:
RE: Sidewalk Permit
Equipment Breakdown Enhancement Endorsement & Property Enhancement Endorsement are both included.
Certificate Holder is added as Additional Insured per: ISO form CG 2012 0509.
Location Address: 95 N Main Street Ashland, OR 97520
Certificate Holder Cancellation:
Should any of the above described policies be canceled before the expiration date
City of Ashland thereof, the issuing company will endeavor to mail 30* days written notice to the
20 E Main Street certificate holder named to the left, but failure to mail such notice shall impose no
Ashland, OR 97520 obligation or liability of any kind upon the company, its agents or representatives.
*10 days for non-payment of premium.
"THIS IS EVIDENCE OF INSURANCE PROCURED AND DEVELOPED Authorized Representative
UNDER THE OREGON SURPLUS LINES LAWS. IT IS NOT
COVERED BY THE PROVISIONS OF ORS.734.510 TO 734.710
RELATING TO THE OREGON INSURANCE GUARANTY
ASSOCIATION. IF THE INSURER ISSUING THIS INSURANCE /
BECOMES INSOLVENT, THE OREGON INSURANCE GUARANTY
ASSOCIATION HAS NO OBLIGATION TO PAY CLAIMS UNDER THIS
EVIDENCE OF INSURANCE."