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HomeMy WebLinkAboutInsurance Certficate: Noble CoffeeA`oRo� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDY 12/26/201919 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 PHONE FAX E-MAIL 1123 Royal Ave (541) 779-4232 A/C No: Medford OR 97528 ADDRESS: dcam be llihartinsurance.com INSURERA:Allmerica Financial Benefit Ina. 41840 INSURED (541) 326-1383 INSURER B:HanOVer American Insurance CO 36064 Noble Coffee Roasting LLC INSURERC:3AIF Corporation 36196 281 4th St INSURERD: Ashland OR 97520 INSURERE: COVFROGFS CFRTIFICOTE NUMRFR- cart ID 14493 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 UBR POLICY NUMBER MMLICY EFF DD/YYYY MMLICY EXP DD/YYYY LIMBS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FXIOCCUR Y OZ2D20474201 04/13/2019 04/13/2020 DAMAGE TRENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 51000 PERSONAL SADVINJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 % POLICY PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ g ANY AUTO AW2D20476900 04/13/2019 04/13/2020 OWNED S SCHEDULED AUTOS ONLY AUTOS $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident HIRED NON -OWNED % AUTOS ONLY X AUTOS ONLY $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR $ DED I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE 776066 01/01/2020 01/01/2021 OT % STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? El (Mandatory In NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000.000 $ $ DESCRIPTION OF OPERATIONS / 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 UERI1FIGAIL HULULK GANGLLLAIIUN 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 St 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