HomeMy WebLinkAboutInsurance Certificate: Sesame Asian Kitchen w/Reinstmt
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CERTIFICATE OF LIABILITY INSURANCE
OP 10 AS I DATE (MMIDD/YYYY)
9SESAAS 03/26/09
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA TIO,",
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
PRODUCER
Hart Insurance
3389 Crater Lake Hwy
Medford OR 97504
Phone: 541-779-4232
Fax:541-772-3963
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
dba: Sesame Asian Kitchen
Beam Consulting & Ventures LLC
400 Liberty Street
Ashland OR 97520-3043
INSURER A
INSURER B:
INSURER C:
I INSURER D
INSURER E
American Hallmark Ins Co of TX
COVERAGES
fHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE It~SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREME.NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, TYE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SlJCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRlmDT~~--- I POLICY NUMBER r'D<}f~jri~r6~~tXE PgktCEY(~*ltbRDAJ~~N LIMITS
L TR INSRO TYPE OF INSURANCE
xl ~~L LIABILITY I I EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY I 44 PB4 58664 I 03/25/09 03/25/10 UJ-\IV\A\.:>C I v ~CI~ I CU $ 300, 000
PREMISES (Ea occurence)
I I . -----.-J ~:Lt~IMS MADE ~ OCCUR I MED EXP (Anyone person) $5,000
~Liquor Liability --
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
~'L AGGREGATE LIMIT APPLIES PER PRODUCTS. COMP/OP AGG $2,000,000
n PRO- n
I X POLICY JECT , LOC
l_~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
i ANY AUTO (Ea accident)
----- I C-------- c------------
ALL OWNED AUTOS
f-- BODILY INJURY $
SCHEDULED AUTOS I (Per person)
- ----
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==l ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y- AGG $
EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
F $
=1 DEDUCTIBLE $
RETENTION $ I $
WORKERS COMPENSATION AND I I Tb'~/LI~IIT~ I IUJ~-
EMPLOYERS' LIABILITY E.L EACH ACCIDENT 1$
I ANY PROPRIETOR/PARTNERfEXECUTIVE I
OFFICER/MEMBER EXCLUDED? E.L DISEASE" EA EMPLOYE~ $
If yes, describe under E.L DISEASE - POLICY LIMIT I $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: 21 Winburn Way, Ashland, OR. 97520
CERTIFICATE HOLDER CANCELLATION
CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Ashland
20 E. Main Street
Ashland OR 97520
ACORD 25 (2001/08)
AMERICAN HALLMARK (....' ._
INSURANCE COMPANY OF TEXAS 'tW1'<<.
PO BOX 901089 'Kit
FORT WORTH TX 76101-2089'~fJ
.;.<-,li'!'"
Claims: (800) 426-5119 Phon~': 1888\ 271-5634
REINSTATEMENT NOTICE
44PB458664
I Statement Mailed To
v Tvne:---~-
I Businessowners I
I
I
'':':. Agent
Policv Effective I Policv Exniration
03/25/2009 I 03/25/2010
Phone: ',541-779-4232:' .'
..,.... .,.. .._,-,_........-----.. ,.......
CITY OF ASHLAND
20 E MAIN STREET
ASHLAND OR 97520
HART INSURANCE AGENCY
POBOX 1240
GRANTS PASS OR 97528
03792
Dear Lienholder:
We are pleased to inform you that this policy has been reinstated.
Policy Reinstatement Date is 08{19{2009 .
MF-B04
Keep this portion of the statement for your records.
IMPORTANT: Detach and return the ~otice below, along with your payment, in the envelope provided.
Please be sure to incl:Jde your policy number on your check.
m_m mAMERICAN'HALLMARK (~. .m....
:;6S~~~~~:i,i90MP ANY OF TEXASmmmm.."'~'I'
}'ORT WORTH TX 76101-2089,,&17
Claims: 800 426-5119 Phone: 888) 271-5634
REINSTATEMENT NOTICE
:Ari1tN#tEIlcl()s~(l::_ :,gaY#14~{I~~ebate
44PB458664
PleaseftltrralllOllntendoled.
44PB458664
Reinstatement notice sent by:
Policyholder:
AMERICAN HALLMARK'INSURANCE COMPANY OF TEXAS
PO BOX 901089
FORT WORTH TX 76101-2089
SESAME ASIAN KITCHEN
BEAM CONSULTING & VENTURES LLC DBA
21 WINBURN WAY
ASHLAND OR 97520
08/10/2009
A6M Add'l Interest