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HomeMy WebLinkAboutInsurance Certificate: Pasta Piatti Inc ?ACc,RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/28/2021 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 Hart Insurance Agency PHONE Misty Whorley FAX PO Box 1240 (A/C.No.Ext): (541) 779-4232 (A/C,No): E-MAIL Grants Pass OR 97528 ADDRESS: mwhorley@hartinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:SAIF Corporation 36196 INSURED (541) 488-5493 INSURER B:Mutual of Enumclaw Insurance C 14761 Pasta Piatti Inc INSURERC:Artisan & Truckers Casualty Co 10194 358 E Main Street INSURERD: Ashland OR 97520 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 20043 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 EXPD/ LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DYYYY) B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR Y BOP0014578 09/10/2021 09/10/2022 PREMSa PREMISES rrence) $ 100,000 MED FRCP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 PRO- JECT _ OTHER: Liquor Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) C ANY AUTO 02607290-0 09/10/2021 09/10/2022 BODILY INJURY(Per person) $ OWNED r— 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$ $ A WORKERS EMPLOYERS' Y/N 776005 01/01/2021 01/01/2022 X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNERIEXECUTIVE N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? Y (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE-$ 500,000 if yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 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 POLICY NUMBER: BUSINESSOWNERS BP 04 02 0713 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Designation Of Premises(Part Leased To You): Name Of Person(s)Or Organization(s) (Additional Insured): Additional Premium: $ Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II—Liability is amended as follows: 2. Structural alterations, new construction or A. The following is added to Paragraph C.Who Is An demolition operations performed by or for the Insured: person(s) or organization(s) designated in the Schedule. 3. The person(s) or organization(s) shown in the C. With respect to the insurance afforded to these Schedule is also an additional insured, but only additional insureds, the following is added to with respect to liability arising out of the ownership, maintenance or use of that part of Paragraph D. Liability And Medical Expenses the premises leased to you and shown in the Limits Of Insurance: Schedule. If coverage provided to the additional insured is However: required by a contract or agreement, the most we will pay on behalf of the additional insured is the a. The insurance afforded to such additional amount-of insurance: insured only applies to the extent permitted by law; and 1. Required by the contract or agreement; or b. If coverage provided to the additional 2. Available under the applicable Limits Of insured is required by a contract or Insurance shown in the Declarations; agreement, the insurance afforded to such whichever is less. additional insured will not be broader than. This endorsement shall not increase the that which you are required by the contract applicable Limits Of Insurance shown in the or agreement to provide for such additional Declarations. insured. B. With respect to the insurance afforded to these additional insureds the following additional exclusions apply: This insurance does not apply to: 1. Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Schedule. BP 04 02 07 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1