Loading...
HomeMy WebLinkAboutInsurance Certificate: Sesame Asian Kitchen w/Reinstmt I ACQ}jD... 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