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HomeMy WebLinkAboutInsurance Certificate: Ashland Eatery, Inc. CERTIFICATE OF LIABILITY INSURANCE 04 /2 DATE DDY0/zD18 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 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 does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michael Miller Hart Insurance Agency PHONE FAX PO Box 1240 (541) 779-4232 AIC Not: (541) 772-3963 , Skit E-MAIL Grants Pass OR 97528 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC9 INSURERA: American Hallmark Insurance Co 43494 INSURED (541) 890-5391 INSURER B: Ashland Eatery, Inc, dha Harvey's Place INSURERC: 50 E Main Street INSURER D: Ashland OR 97520 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: Cert ID 7235 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. INSR TYPE OF INSURANCE J=ADDL SUER POLICYNUMBER MMIDOYYYYFY POLICY UP LIMITS LTR A X COMMERCUILGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR Y 44PH479851 06/06/2018 06/06/2019 PREMISES Ea occu ence $ 300,000 MED EXP(Myerne person) $ 5,000 PERSONALaADVINJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 2,000,000 X POLICY ❑ JEI° El LOG PRODUCTS -COMPIOP AGG $ 2,000,000 OTHER: Liquor Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident ANYAUTO BODILY INJURY (Per Person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per aaident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSUAB CLAIMS-MADE AGGREGATE $ DELI RETENTIONS It WORT ERSCOMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETORAPARTNERrUECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICEPoMEMSEREXCLUDEDi (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ In g, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) The City, Parks Commission, it-9 officers, employees and agents are named as Additional Insured per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Public Worke Dept. 20 E Main Street AUTHORRED REPRESENTATIVE Ashland OR 97520 v ~'✓/~l. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1