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HomeMy WebLinkAboutInsurance Certificate: Cieland Productions & Wild Films AC<?R1:? CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYW) llh.~ 9/30/2013 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 endorsements . PRODUCER CONTACT NAME: Stephanie Martel PHONE FAX Arthur J. Gallagher & Co. (Arc, No, Ext): 818 539-1404 A/C, No): 818 539-1704 Insurance Brokers of Cadfornia, Inc. ADDRESS: 505 N. Brand Blvd., Suite 600 E-MAIL ste hanie martel ajg.com _ Glendale, CA 91203-3944 PRODUCER License No. 0726293 CUSTOMER ID INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A : Hiscox Insurance Company 10200 Cleland Productions, Inc. & Films, Inc. INSURER B : Praetorian Insurance Company 37257 Wild Wild BOX 900 INSURER C : U.S. Specialty Insurance Company 29599 Bever) Hills, CA 90213 INSURER D 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 CONDI FIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM1DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY USUEN2671649.13 08/22/2013 08/22/2014 PREMISES (Ea occurrence) $ 1,000,000 CLAIMS-MADE M OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIM T APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000 PRO- POLICY POLICY JECT LOC $ COMBINED SINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) ANY AUTO X BODILY INJURY (Per person) $ USUEN2671649.13 08122(2013 08/22/2014 ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTO:; PROPERTY DAMAGE HIRED AUTOS (Per accident) $ X X NON-OWNED AUTO 3 U-13/7003442 06/30/2013 06/30/2014 $ C X PHYSICAL DAMAGE PHYSICAL DAMAGE $ INCL. IN MISC EQUIP A X UMBRELLA LIAB X OCCUR X USUEN2671649.13 08/2212013 08/22/2014 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIDN WC S ER AND EMPLOYERS' LABIL'TY Y 1 N X TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE N OWC4001161 (Cleland 0812212013 08/22/2014 E.L. EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? NIA Productions, Inc.) (Mandatory In NH) 08/2212013 08/22/2014 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under OWC4001160 (Wild Films, Inc.) DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 THIRD PARTY PROPERTY DAMAGE Limit: $3,000,000 C MISCELLANEOUS EQUIPMENT U-13/7003442 06/30/2013 06/30/2014 Limit: $3,000,000 PROPS/SETS/WARDROBE Limit: $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate Holder is included as an Additional Insured as required by written contract as per blanket Additional Insured endorsement CG D4 11 04 08 and as Loss Payee as their interest may appear, as respects locations, premises, vehicles and/or equipment leased and/or rented by the Named Insured while used in connection with the production entitled: "Wild". CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE t Contact: Diana 002 Phone: 541-488-6002 G,~w © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD CITY OF 71'XISHLAND 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 ' o 1, y-,Y J:) 20 ,J', ' 1F SignatU~e F tF Al, PriAted Name 'b CLL o" Production Company Name