HomeMy WebLinkAboutInsurance Certificate: Draperies N Things Miniblinds & More
Apr 05 2017 11:09:53 Himensional Tech Page 002
DATE (MM/DDIYYYY)
Ac"R"b CERTIFICATE, OF LIABILITY INSURANCE 04/05/20,11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DUES 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 have ADDITIONAL INSURED provisions or 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 dogs not confer ri hts to they certificates holder in lieu of such endorsement s).
PRODUCER
Hex xneuzance A enc NAME:•.. Misty... D...WhAx...x...
sox 9240 .......(..54~.>........... .779-4232 (.54..1.).........77.2..-3963
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EMAIL
Gre.nh:a $ano OR 97528 A.yP~..~~.~..................
INSURER(S) AFFORDING COVERAGE
INSURERA' SAAXF Corvora,tion 351.96
INURED C1) "la,5w2790 INSURER B: C)h~o fJecur1,ty e.ur. ance fbao an 24082
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Draperies 'N Things Miniblinds & More
Reeves Peeves Inn, IN 4URER C"
205 N P..hoeri, X Road INSU~i F7 f1
Phoenix Ott 97535 INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: c*rt iD 2.5og REVISION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CI RTIFICATiW MAY BE ISS(JFD OR MAY PERTAIN, TI-AF IN$URANCE AFFORC)C;q BY THIF PC)I.,.ICIIrS DE$CRIBFD HEREIN I$ :OBJECT TO AIA, THE I-FRMS,
EXCLUSIONS AND CONDITIONS OF St,1CH POI.JC;IE a, LIMITS SHOWN MAY HAVE BFFN REDUrED BY PAID CLAIMS,
. . . .
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LTR TYPE OF INSURANCE INSO: w POLICYNUMBER PAwbvYYYY MCvUbbYYYY LlMlrs
H X COMMERCIALGENERAL LIABILITY
Ff.ACNC7C(:%IIFtF~f::NC:£:.. 1 , 000, OQO
CLAIM5 MAC)L X C:r(7CC.IT@ l3Ft956A23561 12/02/2016;13/02/2017 1,000,000
Fk~ 141r , x Sri nta
MED EXEC (Any nri (9e mw))
. . 1 , 00
E ERcr 'ONAt, 4~ ADV INJURY 5 11000,000
;~f;N'6, leC;iC:3f~Qi'3/ATt",. C,IA~I'?' AfsFyl,.lf;`? f'EiF3' eiiFiNfml'21A6, / it;al+'1'li. 2,000,000
.
{>C:?LILY A?Pt',).. a........~ ...............t ....................ti.....
F ft''C)C UCI'5 OMP/0I',.1 Ar•.C, ~11 2,000,000
(:~'f F1 E~.F2:
AVIOMAAILAI..IAI~II,ITv I,, IV1E3W iyt) INC3L,F ,,IIV{I 1,000,000
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ANY AUTO E BAS56423581 01/01/2017; 01/01/201B 60?ILY INJURY (Pcff,pEi,wn)
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OWN I'r:L1 ` C=FiF:.I?l.ll.la:)
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i AUTOS BODILY INJURY (hr.t $jce S.,••••....•••••...•••••....••••••...••••••••..•••.......••••...
Ai_Ii"CJ ONLY
HIRED N0N-0WW'.(.) PROPERTY DAMAGE
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m~ UMBRELLA LIAS XErSO56423581 101/01/2017!01/01/2018 E"'At:;EIC>(.'::I..11~RE.NI:'T." 7.,0[JO,OOo
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EXCESS LfAB
t I,AIN1
F. O l? d . ..p..n
f.1FG/ X ! Flf.f7,NT1()Ni 10,000' I'
WORKERS COMPENSATION EMIR 01'I1.
A AND EMPLOYERS' LIABILITY YIN 776023 01/01/?.017:07./U1/Z01Q', :(i.19.?.!!.)..t t
aN'Yr hC'JF''RIF'r'C;)F~/F'AN'7"NF;' FlFtt ~Ciic;a.l ll~~F E. L. E:AC IA A1CCIIDE:NT ' 500, 000
QF'IICFRIMFM(-• R EXC;L1.1l;tE07 N/A...........
(Mimctatoryin NH) Y'" - )I;;>; n MF> C 500,000
II yam, de"°,t;fihr. undB1 ;
0171,4RATIONS bclcnrr LIMIT S00,000
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Addillonm Renwi'At~ 8che~elula, mi)y t>e ima, hrju it mom 6Piaees N requlr®u)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICF- WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 Ramt Main street AWHO)ZIZEI)REPIRK-$LNTATIVE
Aehzand OR 97520 L5• FMS
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