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HomeMy WebLinkAboutInsurance CertificateL Oregon Hood Cleaning ACO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/Y /YY) 06/07/2018 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 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). CONTACTAME: PRODUCER N A/C No ISHAM & SPRAGUE INSURANCE INC PHONE FAX PO BOX 110 E-MAIL ADDRESS: INSURER S) AFFORDING COVERAGE NAIC 0 LINCOLN CITY OR 97367 lNSUREan _-NAUTILUS INSURANCE COMPANY _ . INSURED INSURER B OREGON HOOD CLEANING, LLC INSURERC: PO BOX 12851 INSURER D : INSURER E : SALEM OR 97309 INSURER F : 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - _ ADOL SU6R POLICY EH POLJCY EXP ILTR TYPE OF INSURANCE JIM wvn POLICY NUMBER MM/DD (MWDDIYYYYI LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 3,000,000- r~ AMAMTO tENTED - 100,000 CLAIMS-MADE U OCCUR PREMISES Ea occurrence) MED EXP (Arty one person) $ 5,000 A NN925681 06/08/2018 06/06/2019 PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY ❑ JE6 ~ LOC PRODUCTS -COMP/OP AGG $ INCLUDED OTHER: AUTOMOBILE LIABILITY CO accent) aE~D1iSINGLE LIMIT $ (Ea ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS -R- -DAMAGE $ HIRED NON-OWNED PROPE. AUTOS ONLY AUTOS ONLY Per acid I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ _ $ WORKERS COMPENSATION STATUTE ER AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTNE ❑ N / A E.L. EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory in NH) _E.L. DISEASE - EA EMPLOYEE If yes describe under E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RESTAURANT HOOD & DUCT CLEANING 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, OR ACCORDANCE WITH THE POLICY PROVISIONS. 20 E MAIN STREET AUTHORIZED REPRESENTATIVE ASHLAND OR 97520 09f wL-~ ©1988-2016 Ab6RD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD