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HomeMy WebLinkAboutInsurance Certificate: Livey Up LLC dba: Party Place PiN-24-2 AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) F01/22/2018 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 CA LIC OB29370 1-925-798-3334 CONTACT NAME: Rayla Fritzberg Edgewood Partners Insurance Center (EPIC) PHONE - FAX (Concord Programs Group - Branch 15558] (AIC, No, EXt): 1 (AJC.N°I: 925-609-5531 P.O. Box 5668 ADDRESS: kayla.fritzbergCaepicbrokers.com Z - - - - - - - - - LL: Concord, CA 94524 INSURERRAS) AFFORDING_ COVERAGE NAIC N Chris Parker INSURER A: ARCH INS CO 11150 INSURED INSURER B : Lively Up LLC dba: Party Place David 4 Beverly Lively -INSURER C___ 924 Chevy Way INSURER D: _ Medford, OR 97501 INSURER E: - - - INSURER F : COVERAGES CERTIFICATE NUMBER: 51932564 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 [HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER I MMIDDIYYYY MM DDYYYYY LIMITS LTR A GENERAL LIABILITY PRPKG0014601 01/22/1 01/22/19 EACH OCCURRENCE f 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY _PREMISES _tEa-occurrence - - f 300,000 CLAIMS-MADE I_X ]OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE _ $ 2.000,000 i GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 - X POLICY PRO LOC $ A AUTOMOBILE LIABILITY PPPKGO014601 01/22/1 01/22/19 COMBINED SINGLE LIMIT 1,000,000 Ea accident) X_ _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ % NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS Per accident - _ iX COMP $2000 X COLL $2000 HAPD $ unlimited A UMBRELLA LIAB X OCCUR PRPXS0009301 01/22/1 01/22/19 EACH OCCURRENCE f 1,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED 1 HE fENTION$ f WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN _ TORY LIMITS EB ANY PHOPRIETOWPAH I NEWEXECU TIVE E.L. EACH ACCIDENT S OFFICEWMEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes. descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT f __617TTM_'~1/22/ 325000 A Equipment P or*_er PRPRG _ Species Form , Repl Cost 5,00ODed DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more spats 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 r 1 Ashland, OR 97520// USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SamStuart 51932564