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HomeMy WebLinkAboutInsurance Certificate: Beam Consulting & Ventures LLC / 7 ® DATE (MMIDD/YYYY) A`Z o CERTIFICATE OF LIABILITY INSURANCE 04/02/2018 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). PRODUCER CONTACT NAME: Michael Miller Hart Insurance Agency - Medford PHONE FAX PO Box 1240 (AIC. N Ex : (541) 779-4232 A/C No: E-MAIL Grants Pass OR 97528 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURER A:SAIF Corporation 36196 INSURED (541) 482-0119 INSURER B: Mutual of Enumclaw Insurance C 14761 Beam Consulting & Ventures LLC Sesame Asian Kitchen INSURER C 21 Winburn Way INSURER D: Ashland OR 97520 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 6993 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 ADDL SUER POLICY NUMBER MPOLICY EFF POLICY EXP MI D/YYYY MMI D/YYYY LIMITS LTR B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED CLAIMS-MADE FxIOCCUR y BOP001598200 05/18/2018 05/18/2019 PREMISES aoccurrence) $ 100,000 MED EXP (Any one person) $ 10 , 000 PERSONAL B ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 JECT OTHER: Liquor Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 g ANY AUTO BAP000535400 05/18/2018 05/18/2019 BODILY INJURY (Per person) $ OWNED X AUTOS SCHEDULED AUTOS ONLY BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accitlenl $ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKER ER - A AND EMPS LOYYERSERS''L LSAIABILIT LITY YIN 776045 01/01/2018 01/01/2019 X STATUTE EERH AND EMP ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑Y N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 , 000 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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. 20 E Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1