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HomeMy WebLinkAboutInsurance Certificate: Louie's Bar & GrillAC r1a DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/26/2019Y 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 PO Box 1240 AIC No Ex : (541) 779-4232 A/C No: E-MAIL ADDRESS: mmiller@hartinsurance.com Grants Pass OR 97528 INSURED Louie's Bar & Grill LLC 41 N Main St. Ashland OR 97520 (541) 301-4068 INSURER E : INSURERS AFFORDING COVERAGE NAIC p American Hallmark Insurance Co o 43494 SAIF Corporation 36196 nnVFRArFR CFRTIFICATF NHMRFR- Cart ID 14492 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 MMLICY EFF DD/YYYY POLICY EXP MM/DD/YYYY LIMITS B g COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR Y 44PB500406 09/01/2019 09/01/2020 DAMAGE TO TE PREMISES (Ea olccurence $ 100,000 IVIED EXP (Any one person) $ 5,000 RADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: -PERSONAL GENERAL AGGREGATE $ 2,000,000 PRO - K POLICY PRO ❑ JECTLOC PRODUCTS - COMP/OPAGG $ 2,000,000 Liquor $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) ANY AUTO $ OWNED SCHEDULED AUTOS ONLY AUTOS $ BODILY INJURY (Per accident) PROPERTYDAMAGE Per accident _. $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY P I $ UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE _LtOCCUR DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE 766283 01/01/2020 01/01/2021 R STATUTE ERH E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland is an Additional Insured per the attached CBP047 03/05 in regards to the outside seating area. 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