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HomeMy WebLinkAboutInsurance Certificate: Tri-Con Productions AC" CERTIFICATE OF LIABILITY INSURANCE 1e/ D0/8/2o1IDD/Y2 Ilk.~ 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 Pam Donahue NAME: SGB-NIA Insurance Brokers PHA I C. No ONE . (818) 316-0999 IX No: (818)316-0990 License #0782466 E-MAIL )RESS. 21011 Warner Center Lane INSURERS AFFORDING COVERAGE NAIC ft Woodland Hill: CA 91367 INSURERA:Sentinel Ins. Co. , Limited 11000 INSURED INSURER B Tri-Con Productions, LLC, DBA: Jump! Creative INSURER C 13400 Riverside Dr. INSURER D : Suite 100 INSURER E: Sherman Oaks CA 91423 INSURER F COVERAGES CERTIFICATE NUMBER: 12-13 GL, AU, UMB 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. LTR IDD/YYYY LIMITS INSR TYPE OF INSURANCE INSR SUWVD ER POLICY NUMBER MM/DD/YYYY MM TR GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 300 000 X COMMERCIAL GFNERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE ❑X OCCUR X 72SBABO3835 7/25/2012 /25/2013 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 RGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4 , 000 , 000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 2,000,000 ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED SCHEDULED 2SBABO3835 7/25/2012 7/25/2013 BODILY INJURY (Per accident) $ AUTOS AUTOS NON PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS -OWNED Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 I DED RETENTION$ 72SBABO3835 /25/2012 7/25/2013 $ WORKERS COMPENSATION WC STATU- OTH-YIN I AND EMPLOYERS' LIABILITY ]MITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (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 I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Operations of the Named Insured for the Certificate Holder. Ashland Oregon is named Additional Insured per attached form SS0008 0405. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland Oregon 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Pam Donahue/PAM ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD CITY OF ASHLAND INDEMNITY AGREEMENT The undersigned, in exchange for being permitted to use the streets and public places of the City of Ashland for commercial purpose, and for the issuance of a license for such purposes, does hereby indemnify and agree to hold harmless the City of Ashland, its Officers, Agents and Employees against any and all loss, damage, costs and expenses, including but not limited to, attorney's fees and court costs that they may incur in litigation resulting from the activities of the undersigned, and the undersigned agrees to pay and discharge forthwith and on demand each and every debt, obligation or claim which may validly be asserted against the City of Ashland, its Agents, Officer and Employees. Dated this day of 2401'* Signature Printed Name P oduction Company Name