HomeMy WebLinkAboutInsurance Certificate: Pangea Ashland LLC l ® DATE(MMIDDIYYYY)
AC40R" CERTIFICATE OF LIABILITY INSURANCE
05/22/2026
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: Mist Whorle
Hart Insurance Agency PHONE FAX
PO Box 1240 A/C No Ext: (541) 779-4232 A/C No:(541) 772-3963
E-MAIL
ADDRESS: mwhorley@hartinsurance.com
Grants Pass OR 97528
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Monterey Insurance Company 23540
INSURED INSURER B:
Pangea Ashland LLC
Dba: Pangea Grills and Wraps INSURERC:
199 E Main Street INSURER D:
Ashland OR 97520 INSURER E:
(541) 625-9471 INSURERF:
COVERAGES IF CERTIFICATE NUMBER:Cert ID 35214 (7) 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 ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER MM%DO
LT EFF MM(DIIYYYY LIMITS
R
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
RENTE
CLAIMS-MADE �OCCUR Y 27SOP3070034366 06/01/2026 06/01/2027 pREM SES�a occur ence $ 1,000,000
MED EXP(Any one person} $ 5,000
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000
X JECT
OTHER: Liquor Liability $ 1,000,000
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 PROPERTYDAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION IPER 4TH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED? ❑ NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
$
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
RE: 272 East Main Street, Ashland, OR
Certificate holder is listed as additional insured where required by written contract. Policy
contains 30-day notice of cancellation and 10-day notice of cancellation for non-payment of premium.
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.
Public Works
51 Winburn Way AUTHORIZED REPRESENTATIVE
Ashland OR 97520
I
Q 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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