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HomeMy WebLinkAboutInsurance Certificate: Agave AC40R°I CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/22/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE 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 R 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 condi ions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in ieu of such endorsement(s). PRODUCER CONTACT NAME: Sheri Hamilton Brown & Brown N rthwest PHONE (541) 772-1111 FAX (541)772-3785 A/C No Ext : A/C No - 3256 Hillcrest ;ark Drive E-MAIL ADDRESS: shami1ton@bbnw.com INSURER(S) AFFORDING COVERAGE NAIC # Medford OR 97504 INSURER A.Monterey Insurance Co 23540 INSURED INSURER B : OCAT Inc, DBA: 4gave INSURER C : 380 Avery Street INSURER D: INSURER E Ashland OR 97 520 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1722249408 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. NOTWIT STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY B 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED A CLAIMS-MACE OCCUR PREM SES (Ea occurrence) $ 75, 000 27SSA31319381 2/21/2017 2/21/2018 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 11000,000 GEN'L AGGREGATE LI IT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F PELOT D LOC PRODUCTS - COMP/OP AGG $ 11 000, 000 OTHER: Liquor Liability- Each $ 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RET NTION $ s $ WORKERS COMPENSA ION PER 10 AND EMPLOYERS' LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPE ATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIC NS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Refer to attached endorsement CG2026 11/85. Subject to signed written contract, policy terms, conditions, and exclusions. CERTIFICATE HOLDtR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of AI'shland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Sheri Hamilton/SHERHA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)1 The ACORD name and logo are registered marks of ACORD INS025 (201401) I POLICY N MBER: 27-SSA-3-1319381 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endon: ement modifies insurance provided under the following: COMMI,_RCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Pjerson or Organization: City of Ashland (If no entry 'appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN1 INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule a$ an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 11' 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ 1