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HomeMy WebLinkAboutInsurance Certificate: DJ Hope Pure Sound Entertainment BUSINESSOWNERS BP 12 01 08 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS POLICY CHANGES THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY AUTHORIZED REPRESENTATIVE BOP1021592 110/26/2016 RLI Insurance Company NAMED INSURED DJ Hope Pure Sound Entertainment, LLC CHANGES • Named insured has changed from: Hope Caster to: DJ Hope Pure Sound Entertainment, LLC • Insured type has changed from: Individual to: Limited Liability Company 11/312016 Insurance Association Svcs./34688 Insurance Marketplace, Inc./39607 BP 12 01 08 10 © Insurance Services Office, Inc., 2009 Page 1 of 2 1st Addntl Ins Copy BUSINESSOWNERS BP 12 01 08 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS POLICY CHANGES THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY BOP1021592 10/26/16 RLI Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE DJ HOPE PURE SOUND DBA PURE SOUND ENTERTAINMENT CHANGES * Named insured has changed from: HOPE CASTER to: DJ HOPE PURE SOUND * Mailing address has changed from: 148 S. Haskell #C to: ENTERTAINMENT, LLC CENTRAL POINT, OR 97502 148 S. HASKELL #C CENTRAL POINT, OR 97502 * Insured type has changed from: INDIVIDUAL to: LIMITED LIABILITY COMPANY 11/03/16 Insurance Association Svcs./34688 insurance Marketplace, Inc./39607 BP 12 01 0810 © Insurance Services Office, Inc., 2009 Page 1 of 2 PURES-1 OP ID: DR 01 6Y) ACORO` CERTIFICATE OF LIABILITY INSURANCE 1 D1 1 101 /033/ /22016 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: 541-779-0177 NAME CT Insurance Marketplace, Inc. PHONE I FAX 1998 Skypark Dr Suite 100 Fax: FAX 772-8235 A/c No Ext : A/C, No : Medford, OR 97504 E-MAIL ADDRESS: R. Scott Weaver, CIC INSURERS AFFORDING COVERAGE NAIC # INSURER A : RLI INSURED DJ Hope-Pure Sound INSURER B Entertainment LLC INSURER C Hope Smith 148 S. Haskell #C INSURER D : Central Point, OR 97502 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. ADDL UBR' POLICY EFF POLICY EXP ILTR I TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY ! MM/DDIYYYY ! LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ 300,00 DAMA E T RENTED A COMMERCIAL GENERAL LIABILITY X ~BOP1021592 10/26/2016 10/2612017 PREMISES Ea occurrence $ 50,000 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5:000 j X ( Business Owners I; PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 600,000 PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY' PRO- LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO ! BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) ! $ i AUTOS AUTOS j NON-OWNED ;PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR i EACH OCCURRENCE ! $ EXCESS LIAB AGGREGATE CLAIMS-MADE DED RETENTION $ $ WORKERS COMPENSATION TORY LIM ITS i OER I AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YF-7 E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u i N' A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEEI $ If At describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ (PROPERTY 6,08 l DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) add'1 insd per attached CERTIFICATE HOLDER CANCELLATION 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. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE R. Scott Weaver, CIC © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD Policy Number: BOP1021592 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM Section II - Liability is amended as follows: This insurance does not apply to: A. The following is added to Paragraph C. Who Is An 1. Any "occurrence" that takes place after you cease Insured: to be a tenant in the premises described in the Schedule. 3. The person(s) or organization(s) shown in the demo- Schedule is also an additional insured, but only 2. Structural alterations, new construction or demo- of the owner- lition operations performed by or for the person(s) with respect to liability arising out or organization( ship, maintenance or use of that part of the prem- ises leased to you and shown in the Schedule. C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Paragraph D. However: Liability And Medical Expenses Limits Of Insurance: a. The insurance afforded to such additional insured only applies to the extent permitted by If coverage provided to the additional insured is re- law; and quired by a contract or agreement, the most we will pay on behalf of the additional insured is the amount b. If coverage provided to the additional insured of insurance: is required by a contract or agreement, the insurance afforded to such additional insured 1. Required by the contract or agreement; or will not be broader than that which you are required by the contract or agreement to 2. Available under the applicable Limits Of provide for such additional insured. Insurance shown in the Declarations; B. With respect to the insurance afforded to these whichever is less. additional insureds the following additional exclusions apply: This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): City Of Ashland 20 East Main St Ashland, OR 97520 BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES - Cont'd. Additional Premium: $ 20 Information required to complete this Schedule, if not shown above. will be shown in the Declarations. BP 04 02 07 13 O Insurance Services Office, Inc., 2012 Page 2 of 2