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HomeMy WebLinkAboutInsurance Certificate: Lively Up dba Party Place Pi2~,uuzxuuz /2017 Y) r A R" CERTIFICATE OF LIABILITY INSURANCE 0DATE1/2 00//2017 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 rv 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 LIC #CA LIC 1-925-798-3334 CONTACT NAME_ shakenah whiteside o Edgewood Partners Insurance Center (EPIC) - - - [Concord Programs Group - Branch 155581 ~cNo Ext):_ 925-822-9014 aC Nqy 925-609-5531 P.O. Box 5668 E-MAIL shakenah.whiteside@epicbrokers.com Concord, CA 94524 INSURERS AFFORDING COVERAGE NAIC # Chris Parker INSURER A : ARCH INS CO 11150 INSURED INSURER B Lively Up LLC dba: Party Place INSURERC: David & Beverly Lively 924 Chevy Way INSURER D Medford, OR 97501 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 48990160 REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF !NSURANCE 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 EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS A GENERAL LIABILITY TBD 01/22/1 01/22/18 EACH OCCURRENCE $1,000,000 - X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY - PREMISES (Ea occurrence $300,000 CLAIMS-MADE CX] OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY 1, 000, 000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 RO LOC $ - X POLICY PjECT A AUTOMOBILE LIABILITY TBD 01/22/1 01/22/18 COMBINED SINGLE LIMIT - Ea accident _ _ $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ X COMP $1000 X COLL $1000 HAPD $IInlimited A - UMBRELLALU►B X. OCCUR TBD 01/22/1 01/22/18 EACH OCCURRENCE $ 1,000,000 X EXCESS LU1B CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION $ 10, 000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LU►BILITY YIN - TOR LIMITS - - - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA - (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under - DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ A Eguipment Floater TBD Spec Form 325,000 Repl Cost 2,500Ded. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Evidence of Coverage Only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 L~~ G%GLu s USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SWhiteside 48990160 i ~ N>loou>souz Ldgewood Partners Insurance Center (EPIC) P.O. Box 5668 Concord, CA 94524 20 1 70 12~;120 Electronic Service Requested EBIX BPO w 0 ALL FOR AADC 975 2490 0.5234 AB 0.400 The City of Ashland 12 N 20 E MAIN ST ASHLAND, OR 97520-1814 uz This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, - please call EPIC at 800-234-6363 and ask for Shakenah Whiteside.- For new certificate requests or if you need changes made to an - existing certificate, please forward the- current certificate issued with requested changes via- E-Mail to: shakenah.whiteside@epicbrokers.com or Fax to: (925) - 609-5531- Please Note: All requests for new certificates or changes to - existing certificates must be requested by- the Named Insured.- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ContirmNet.com - 877.669.8600