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HomeMy WebLinkAboutInsurance Certificate: Flavor the Restaurant LLC dba Oberon's Restaurant & Bar -;eco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �✓ 5/11/2022 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 HUB International Northwest LLC PHONE Katie Schnetzky FAX • P.O. Box 10167 (AIC.No.Ext1:541-687-1117 (AIC,No):541-342-8280 , Eugene-OR 97440-2167 ADDRESS: katie.schnetzky@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwriters Ins Co 13037 INSURED FLAN/THE-01 INSURER B Flavor the Restaurant LLC, DBA:Oberon's Restaurant&Bar INSURER C: 45 N.Main St. INSURER D: Ashland OR 97520-2725- INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:980922126 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP./Y ,LIMITS LTR ,INSD WVD, POLICY NUMBER ,(MM/DDYYY) IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY CSU 0114156 5/15/2022 5/15/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $EXCLUDED PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES,PER: GENERAL AGGREGATE $2,000,000 POLICY PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 X JECT _ OTHER: • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? I I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Liquor Liability CSU 0114156 5/15/2022 5/15/2023 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 ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E.Main-St: Ashland OR-97520-.1814 AUTHORIZED REPRESENTATIVE Vit ©1988-2015 ACORD CORPORATION. All rights reserved. .CORD 25.(2016/03) The ACORD,name_and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CSGA 43411 08 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. above to provide insurance, subject to b. Executed prior to an "occurrence" or the following additional provision: offense to which this insurance would apply; and This insurance applies only with respect •2. They are not specifically named as an to the following hazards for which the additional insured under anyother provi- state or political subdivision has issued a permit in connection with premises you sion of, or endorsement added to, this own, rent or control and to which this in- Coverage Part. surance applies: B. Only the following persons or organizations a. The existence, maintenance, repair, are additional insureds under this endorse- construction, erection, or removal of ment, but only with respect to liability caused, advertising signs, awnings, cano- in whole or in part, by your acts or omissions pies, cellar entrances, coal holes, or the actsor omissions of those acting on driveways, manholes, marquees, your behalf. Insurance coverage provided to hoist away openings, sidewalk such additional insureds is limited as provided vaults,street banners, or decorations herein: 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 moval of elevators;or agreed per Paragraph A. above to pro- 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 b. Structural alterations, new construc- Cov- erage Part, whichever is less. If no limits are specified in the written contract or agreement, tion or demolition operations per- the limits applicable to the additional insured are those specified in the Declarations of this Includes copyrighted material of ISO CSGA 43411 08 Properties,Inc.,with its permission. Page 1 of 2 ❑ : Coverage Part. The limits of insurance are in- available to the additional insured whether clusive of and not in addition to the limits of primary, excess, contingent or on any other insurance shown in the Declarations. basis unless you have agreed in a written contract or written agreement executed prior D. With respect to the insurance afforded to to any loss that this insurance will be primary. these additional insureds, SECTION IV - 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 written agreement executed prior to any loss include: 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