HomeMy WebLinkAboutInsurance Certificate: Lithia Arts
ACORD CERTIFICATE OF LIABILITY INSURANCE J DATE (MMIDDIYYYY)
TM 0511512009
PRODUCER Phone: 503.365-7001 Fax: 503-365-7354 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MID VALLEY GENERAL AGENCY LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4305 RIVER ROAD N ~~;~:~. .!HIS CERTlFICA TE DOE~ ~~r.... ~!!,:~;...~T~~?, ~R
KEIZER OR 97303
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: SCOTTSDALE INSURANCE COMPANY 41297
UTHIA ARTS GUILD OF OREGON INC INSURER B:
DBA: BRISCOE ARTWING INSURER C:
PO BOX 3194
ASHLAND OR 97520 INSURER 0:
INSURER E:
COVERAGES
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 IMTH RESPECT TOWHICH 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. AGGREGATE LIMITS SHCMN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS~I:~DO\. TYPE OF INSURANCE POLICY NUMBER ~~y~~~ ~~ii~:~N LIMITS
LTR INSR
~NERAL LIABILITY CLS1330620 05117109 05117110 EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAl LIABILITY DAMAGE TO RENTED S 100,000
PREMISES (Eaoccul'Mce)
I CLAIMS MADE 0 OCCUR MED. EXP (Anyone person) S 5,000
A 1- PERSONAL & ADV INJURY S 1,000,000
f.-- GENERAL AGGREGATE S 2,000,000
h'l AGGREn L~~~APPn:ER: PRODUCTS-COMPfOP AGG. S 2,000,000
POLICY JECT LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) S
I--
I-- AlL OWNED AUTOS BODILY INJURY
(Per person) S
I-- SCHEDULED AUTOS ,
I-- HIRED AUTOS BODILY INJURY
S
NON-OWNED AUTOS (Peraccidenl)
I--
I-- rp~~~~~~AMAGE S
RGE LIABILITY AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC I
AUTO ONLY: AGG I
OESS I UMBRELLA LIABILITY EACH OCCURRENCE I
OCCUR 0 CLAIMS MADE AGGREGATE S
I
~DEDUCTIBLE I
RETENTION $ S
WORKERS COMPENSATION AND I",,,.r,). I I,
TORY LIMITS OTHER
EMPLOYERS' LIABILITY
AWf PROPRIETOFtlPARTNERlEXECUTIVE E.L EACH ACCIDENT I
OFFICER/MEMBER EXCLUDED? E.L, DISEASE-EA EMPLOYEE S
lty.., d..crlbll unlHr E.L DISEASE.pOLICY LIMIT
SPECIAl PROVISIONS billow S
OTHER:
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
CITY OF ASHLAND, IT'S AGENTS, DIRECTORS, OFFICERS.. EMPLOYEES ARE INCLUDED AS AN ADDITIONAL INSURED PER CG201Q(7-ll4).
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLANO, IT'S AGENTS, DIRECTORS, OFFICERS & EMP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WIll ENDEAVOR TO MAil 30 DAYS
LOYEES WRITIEN NOTICE TO THE CERTlACATE HOLDER NAMED TO THE lEFT, BUT FAILURE TO
20 E. MAIN STREET 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS
ASHLAND, OR 97520 AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATlVE
MID VAlLEY GENERAl AGENCY \-l Un.'
LlC ~"C "I ~
Attention: Herman R Deiss
ACORD 25 (2001/08)
Certificate #
41316
@ ACORD CORPORATION 1988
. ~ '.
."....
POLICY NUMBER: CLS1330620
L1THIA ARTS GUILD OF OREGON INe
DBA: BRISCOE ARTWING
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
eOMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Locationlsl Of Covered Ooerations
Or Oraanizationlsl: .
elTY OF ASHLAND, IT'S AGENTS, DIRECTORS, , ,
OFFICERS & EMPLOYEES " .'....:...1, ",',.
20 E. MAIN STREET ;,!
ASHLAND, OR 97520
POLICY PERIOD: 05-15-2009 TO 05-15-2010
Information reouired to comolete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above.
,CG 20 10 07 04
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf of
the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to ~s in-
tended use by any person or organization other
than another contractor or subcontractor en-
gaged in performing operations for a principal
as a part of the same project.
@ISO Properties, Inc" 2004
o
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