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ACORo'M CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODNYYY)
11/22/2006
PRODUCER (541) 772-1111 FAX: (541) 772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Security Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
707 Murphy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 RECEIVEC INSURERS AFFORDING COVERAGE NAIC#
INSURED NOV 3 0 2006 INSURER A Amer i can Hallmark Ins Co 43494
Brothers Restaurant And Deli INSURER B:
95 North Main Street ACCOUNTS PAYA~ !lN~RER C
'~~lJRER D
Ashland OR 97520 INSURER E:
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.
N"I RFf.:ATi= LIMITS SHOWN MAY HAVF RFFN RFnllr.ED BY PAID r.1 AIMS.
II~~: ~o.,~~ TYPE OF INSURANCE POLICY NUMBER P~}+~~~~~6g~F Pg~lfll~~~t~N LIMITS
GENERAL LIABILITY EN~H Or.r.IIRRENCE $ 500,000
- ~~~~~~~?F~';,~~~~enCA\
X COMMERCIAL GENERAL LIABILITY $ 100,000
A I CLAIMS MADE [i] OCCUR 44CL40244810 11/30/2006 11/30/2007 MED EXP IAnv one oerson\ $ 5,000
PERSONAL & ADV INIIIRY $ 500,000
GENERAL AGGREGATE $ 1,000,000
GEN'LAGGREGATE LIMIT AAES PER pRonllr.TS - COMP/OP N:;r, $ 1,000,000
rxl . n PRO- 500,000
X POLICY 'Ii:r-r LOC LIQUOR LIABILITY
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- (Ea accident) $
I-- ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
f-- (Per person)
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=i ANY AUTO OTHER THAN FAAr.r. $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY FAr.H $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ . $
WORKERS COMPENSATION AND I T~~n'i]Hs I OJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is Additional Insured
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
20 E Main Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Ashland, OR 97520 -
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~7~
IKim Edwards/KIMED /
ACORD 25 (2001/08)
INS025 (0108).08 AMS
13'-1 ™ Wolters Kluwer Financial Services
@ ACORD CORPORATION 1988
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