Loading...
HomeMy WebLinkAboutInsurance Certificate: Nobel CoffeeDATE (MM/DD/YYYY) ,4�oRo� CERTIFICATE OF LIABILITY INSURANCE O1/02/2020 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: Kristin Wick _ Hart Insurance Agency - Medford FAX PHONE 1123 Royal Ave (541) 779-4232 A/C No: E-MAIL Medford OR 97528 ___dc—pbell@hartinsurance.com dcbell@hartinsurance.com INSURER A:Alimerica Financial Benefit Ins. 41840 INSURED (541) 326-1383 INSURERS: Hanover American Insurance Co 36064 Noble Coffee Roasting LLC INSURERC:SAIF Corporation 36196 291 4th St INSURERD: Ashland OR 97520 INSURERE: CnVFRA[.FS CFRTIFICATE NUMRER-Cart ID 14540 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD LIMITS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 7XI OCCUR Y OZ2D20474201 04/13/2019 04/13/2020 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 51000 _ PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 21000,000 K POLICY E jECT F7 LOC PRODUCTS -COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY EO aBINED1SINGLE LIMIT $ 11000,000 BODILY INJURY (Per person) $ B ANY AUTO AW2D20476900 04/13/2019 04/13/2020 OWNED % SCHEDULED AUTOS ONLY AUTOS $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident HIRED NON -OWNED % AUTOS ONLY % AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/NH ANYPROPRIETOR/PARTNER/EXECUTIVE 776066 01/01/2020 01/01/2021 % STATUTE ER E.L. EACH ACCIDENT $ 11000,000 OFFICER/MEMBEREXCLUDED? (Mandatory In NH) NIA E.L. DISEASE -EA EMPLOYEE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 If yes describe under DESCRIPTION OF OPERATIONS below $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is additional insured per attached 391-1006 CERTIFICATE HOLDER CANCELLATION City of Ashland 20 E Main St Ashland OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©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