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HomeMy WebLinkAboutInsurance Certificate: Pasta PiattiA DATE (MMIDD YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/26/2019 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 flick Hart Insurance Agency - Medford PHONE FAX PO Box 1240 Ex : (541) 779-4232 A/C No: E-MAIL ADDRESS: dcampb ll@hartinsurance.com Grants Pass OR 97528 ___.. INSURED Pasta Piatti Inc 358 E Main St Ashland OR 97520 -5493 INSURER E Mutual of Enumclaw Insurance Co. 114761 SAIF Corporation 136196 rnviceAnCC /`CDTICV`ATC KIIIIUIQCD-f'--r Tn 1AAOA RFVICInN NIIMRFR- 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 MMIDDIYYYYI POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS -MADE � OCCUR Y BOP0014578 09/10/2019 09/10/2020 PRREMSES(Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 K POLICY PRO- ❑ LOC JECT ILiquor Liability $ 1,0001000 OTHER: AUTOMOBILE LIABILITY OEaMBINED accidentSINGLE LIMIT (CEO, $ 11000,000 BODILY INJURY (Per person) $ g ANY AUTO BAP0005078 09/10/2019 09/10/2020 BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY K AUTOS HIRED NON -OWNED AUTOS ONLY R AUTOS ONLY I PROPERTY DAMAGE Per accident $ a UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DIED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? I1r (Mandatory In NH) NIA 776005 01/01/2020 01/01/2021 ITH- % STATUTE I I ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E. L. DISEASE -POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OFDPE.RATIONS below_ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is additional insured per attached BP0402 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 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