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Home My WebLink AboutInsurance Certificate: Stories Alive NEW United States Liability Insurance Company Direct Bill Policy Renewal of Number 1190 Devon Park Drive, Wayne, Pennsylvania 19087 POLICY DECLARATIONS A Member Company of United States Liability Insurance Group No. NPP1572374 NAMED INSURED AND ADDRESS: Stories Alive 800 Ashland Street Ashland, OR 97520 POLICY PERIOD: (MO. DAY YR.) From: 09/14/2016 To: 09/14/2017 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE FORM OF BUSINESS: Non-Profit Corporation BUSINESS DESCRIPTION: Performing Art IN RETURN FOR THE PAYMENT • TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH • TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Liability Coverage Part $300.00 TOTAL: $300.00 Coverage Form(s) and Endorsement(s) made a part of this policy at time of issue See Endorsement EOD (1/95) Agent: LOCKTON AFFINITY, LLC. (2241) Issued: 09/19/2016 1:46 PM 7300 College Boulevard, Suite 500 Overland Park, KS 66210 By' Authorized Represe ati e THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, UPD (08-07) COVERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. EXTENSION OF DECLARATIONS Policy No. NPP1572374 Effective Date: 09/14/2016 12:01 AM STANDARD TIME FORMS AND ENDORSEMENTS The following forms apply to the Commercial Liability coverage part Endt# Revised Description of Endorsements CG0001 12/07 Commercial General Liability Coverage Form CGO068 05/09 Recording And Distribution Of Material Or Information In Violation Of Law Exclusion CG2107 05/14 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability - Limited Bodily Injury Exception Not Included CG2136 03/05 Exclusion - New Entities CG2139 10/93 Contractual Liability Limitation CG2147 12/07 Employment-Related Practices Exclusion CG2173 01/15 Exclusion Of Certified Acts Of Terrorism IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Liability Exclusion Endorsement IL0142 09/08 Oregon Changes - Domestic Partnership IL0279 09/08 Oregon Changes - Cancellation And Nonrenewal L 703 10/14 Molestation Or Abuse Insurance L-224 10/10 Punitive Or Exemplary Damages Exclusion L-232s 09/05 Classification Limitation Endorsement L-278 03/14 Independent Contractors/Subcontractors Exclusion L-367 02/11 Minimum Earned Premium Endorsement L-472 07/08 Exclusion - Injury To Performers Or Entertainers L-500 02/11 Bodily Injury Exclusion - All Employees, Volunteer Workers, Temporary Workers, Casual Laborers, Contractors, And Subcontractors L-536 09/09 Exclusion - Participation In Athletic Activity, Physical Activity Or Sports L-549 12/07 Absolute Professional Liability Exclusion L-581 02/11 Certain Animal Exclusion L-599 10/12 Absolute Exclusion for Pollution, Organic Pathogen, Silica, Asbestos and Lead with a Hostile Fire Exception L-610 11/04 Expanded Definition Of Bodily Injury L-618B 01/09 Amendment Of Premium Audit Conditions L-631 02/11 Event Vendor/Exhibitor & Contractor - Exclusion L-686 10/12 Absolute Exclusion for Liquor and Other Related Liability L-744NPP 06/10 Blanket Additional Insured Endorsement L-767 NPP 11/11 Exclusion - Bleacher Collapse LLQ100 07/06 Amendatory Endorsement LLQ368 08/10 Separation Of Insureds Clarification Endorsement TRIADN 02/15 Policyholder Disclosure Notice of Terrorism Insurance Coverage NPP Jacket 09/10 Non Profit Package Policy Jacket EOD (01/95) All other terms and conditions remain unchanged. Page 1 of 1 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy No. NPP1572374 Effective Date: 09/14/2016 12:01 AM STANDARD TIME LIMITS OF INSURANCE Each Occurrence Limit $1,000,000 Personal & Advertising Injury Limit (Any One Person/Organization) $1,000,000 Medical Expense Limit (Any One Person) $5,000 Damages To Premises Rented To You (Any One Premises) $100,000 Products/Completed Operations Aggregate Limit Included General Aggregate Limit $2,000,000 Abuse And Molestation Liability Each Occurrence $100,000 Abuse And Molestation Liability Aggregate $300,000 LIABILITY DEDUCTIBLE $0 LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY Location Address Territory 1 800 Ashland St, Ashland, OR 97520 002 PREMIUM COMPUTATION Rate Advance Premium Loc Classification Code No. Premium Basis Pr/Co All Other Pr/Co All Other 1 Theaters - Not-For-Profit only 49185 1,500 Per 1,000 Included 75.577 Included $113 Admissions 1 Abuse and Molestation Liability - Performing Arts 41795 Flat Included 0.000 Included Included 1 Blanket Additional Insured - Non-Profit Package 49950 1 Flat Included 100.000 Included $100 MINIMUM PREMIUM FOR GENERAL LIABILITY COVERAGE PART: $300 TOTAL PREMIUM FOR GENERAL LIABILITY COVERAGE PART: $300 MP (This Premium may be subject to adjustment.) MP - minimum premium Coverage Form(s)/Part(s) and Endorsement(s) made a part of this policy at time of issue: See Form EOD (01/95) THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. Includes copyrighted material of ISO Commercial Risk Services, Inc., with its permission. CL150 (101031 Convriaht. ISO Commercial Risk Services. Inc.. 1983. 1984. 1988 Paqe 1 Of 1