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HomeMy WebLinkAboutInsurance Certificate: Ballet Folklorico Ritmo ALegre .�c�i►sr CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �.,.... 07/18/2021 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(les) must be endorsed. If SUBROGATIONIS 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 PENFOLD-LEAVITT INS AGCY INC/PHS -� 57110454 PHONE (866)467-8730 FAX (888)443-6112 (NC,No,Ext): (ac,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Sentinel Insurance Company Ltd. 11000 BALLET FOLKLORICO RITMO ALEGRE INSURER B: Twin City Fire Insurance Company 29459 PO BOX 8225 INSURER C: MEDFORD OR 97501-0525 — — INSURER D: INSURER E: INSURER F: N - N COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: sr THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD o INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS G 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 ADM SLIM POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDDIYYYY) (MM/DD/Y YYY) , COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED. $1,000,000 PREMISES(Ea occurrence) X General LIabil ty MED EXP(Any one person) $10,000 A — X 57 SBM RI3047 09/09/2021 09/09/2022 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $4,000,000 POLICY 0 PRO' ❑LOC PRODUCTS-COMP/OP AGG $4,000,000 —_ JECT X OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) — ALL OWNED SCHEDULED — —AUTOS _AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION XIPR EI0 " AND EMPLOYERS'LIABILITY I PATUTE T ANY YIN .E.L.EACH ACCIDENT $500,000 B PROPRIETOR/PARTNER/EXECUTIVE — NIA ' 57 WEC AD6KC1 08/16/2021 08/16/2022 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory In NH) It yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 •_,SCRI- •. • 0- -ATIONSbe• DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Those usual to the Insured's Operations,City of Ashland,It's officers,agents,and employees are listedas an additional Insured per the Business Liability Coverage Form SS0008 attached to this policy,RE:Grant funding for a 2019-20 Economic,Cultural,Tourism,Sustainability Grant from the City of Ashland, CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 20 E MAIN ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED ASHLAND OR 97520-1814 IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE sae Coat ru > ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Pry THE HARTFORD ' BUSINESS SERVICE CENTER THE "' 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 July 18, 2021 MB 01 000274 58223 H 2 A IIIiiIiIiit,IIiiIIlIntiiiu 1111ilIlinn!iiuIIIIIIiiuIIii"IIII ; City of Ashland 20 E MAIN ST ASHLAND OR 97520-1814 0 0 Account Information: %Q Contact Us `a BALLET FOLKLORICO RITMO Policy Holder Details : • Business Service Center MIME MIEN ALEGRE Business Hours: Monday- Friday. (7AM -7PM Central Standard Time) Phone: (866)467-8.730 Fax: (888)443-6112 Email: aaencv.services@thehartford.com Website: https://business.thehartford.com Enclosed pleasefind a Certificate Of.Insurancefor the,above.referenced Policyholder. Please contact us-if-you have any . questions or concerns. Sincerely, Your Hartford Service Team W LTR005