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HomeMy WebLinkAboutInsurance Certificate: Flavor the Restaurant LLC AD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°D/YYYv) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONI 5ATE L ER. r. .'.1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI _.; J BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR ` , ' 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 HUB International Northwest, LLC NAME: Katie Schnetzky PO Box 10167 PHONE I FAX (Arc,No.Ext):541-687-1117 (A/c,No):541-342-8280 Eugene OR 97440 ADDRESS: katie.schnetzky@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwriters Ins Co 13037 INSURED FLAVTHE-01 Flavor the Restaurant LLC, INSURER B: DBA:Oberon's Restaurant&Bar INSURER C: 45 N. Main St. INSURER D: Ashland OR 97520-2725 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2007587388 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y CSU 0114156 5/15/2023 5/15/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED — — PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $EXCLUDED PERSONAL 8 ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO" GENERAL AGGREGATE $2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ — OWNED BODILY INJURY(Per person) $ SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAB _ OCCUR EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY I STATUTE I I ERH Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Liquor Liability Y CSU 0114156 5/15/2023 5/15/2024 Each Common Cause: $1,000,000 Aggregate: $1,000,000 Deductible: $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds with respects to the general liability as required by written contract per attached endorsements.Subject to policy limits,terms,conditions and exclusions. 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 St. AUTHORIZED REPRESENTATIVE Ashland OR 97520-1814 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILIT' CSGA 434 11 a l '�• THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSURED - SPECIFIED RELATIONSHIPS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is formed by or on behalf of such addi- amended to include as an insured any person tional insured. or organization described in Paragraph B. below (hereinafter referred to as additional in- 2. Any person or organization from which sured) whom you are required to add as an you lease equipment with whom you additional insured under this Coverage Part have agreed per Paragraph A. above to by reason of a written contract or agreement provide insurance. However, this insur- is an insured, provided: ance does not apply to any "occurrence" which takes place after the equipment 1. The written contract or agreement is: lease expires. a. Currently in effect or becomes effec- 3. Any state or political subdivision with tive during the policy period; and which you have agreed per Paragraph A. b. Executed prior to an "occurrence" or above to provide insurance, subject to offense to which this insurance the following additional provision: would apply;and This insurance applies only with respect 2. They are not specifically named as an to the following hazards for which the state or political subdivision has issued a additional insured under any other provi- sion of, or endorsement added to, this permit in connection with premises you Coverage Part. own, rent or control and to which this in- surance applies: B. Only the following persons or organizations are additional insureds under this endorse- a. The existence, maintenance, repair, ment, but only with respect to liability caused, construction, erection, or removal of in whole or in part, by your acts or omissions advertising signs, awnings, cano- pies,or the acts or omissions of those acting on cellar entrances, coal holes, your behalf. Insurance coverage provided to driveways, manholes, marquees, such additional insureds is limited as provided hoist away openings, sidewalk herein: vaults, street banners, or decorations and similar exposures; or 1. The manager or lessor of a premises b. The construction, erection, or re- leased to you with whom you have agreed per Paragraph A. above to pro- moval of elevators;or vide insurance, but only with respect to c. The ownership, maintenance, or use the ownership, maintenance or use of of any elevators covered by this in- that part of a premises leased to you, surance. subject to the following additional exclu- sions: C. With respect to the insurance afforded to these additional insureds, SECTION III - LIM- This insurance does not apply to: ITS OF INSURANCE is amended to include: a. Any "occurrence" which takes place The limits applicable to the additional insured after you cease to be a tenant in that are those specified in the written contract or premises, agreement or in the Declarations of this Cov- b. Structural alterations, new construc- erage Part, whichever is less. If no limits are tion toro demolatio operations per- specified in the written contract or agreement, the limits applicable to the additional insured are those specified in the Declarations of this Includes copyrighted material of ISO CSGA 434 11 08 Properties, Inc.,with its permission. Page 1 of 2 ❑ Coverage Part. The limits of insurance are in- available to the additional insured whether elusive of and not in addition to the limits of primary, excess, contingent or on any other .•V•''v insurance shown in the Declarations. basis unless you have agreed in a written ?7cr9•:. contract or written agreement executed prior ••J•• • D. With respect to the insurance afforded to these additional insureds, SECTION IV - to any loss that this insurance will be primary. This insurance will be noncontributory only if COMMERCIAL GENERAL LIABILITY CON- you have so agreed in a written contract or DITIONS, 4. Other Insurance is amended to include: written agreement executed prior to any loss and this coverage is determined to be pri- Any coverage provided herein will be excess maty. over any other valid and collectible insurance Includes copyrighted material of ISO CSGA 434 11 08 Properties, Inc.,with its permission. Page 2 of 2 0 HUB INTERNATIONAL NORTHWEST LLC PO BOX 10167 EUGENE OR 97440-2167 7 L� :i "iZ CITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1814