HomeMy WebLinkAboutInsurance Certificate: Ashland Spring Hotel
~
OP 10: NR
ACORD' CERTIFICATE OF LIABILITY INSURANCE r DATE (MMlDDfYYYY)
~ 11/09/10
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 pollcy(les) must 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 541-245-1111 ~2~1~CT Nikki Russell
United Risk Solutions, Inc. 541-245-1112 wgNJ. ...,,541-245-1111 I r~ No', 541-245-1112
PO Box 936 ~~D~~SS: nikkl.russell@unitedrisk.com
Medford, OR 9750HI067 ~n~~~~~= 10 #: ASHL08C
Michelle M. Savage
INSURER!SI AFFORDING COVERAGE HAle"
INSURED The Ashland Springs Hotel INSURER' ,New Hampshire Insurance Co
Mark Antony Historic INSURER B: National Union Fire Insurance
Property, LLC INSURER C :
212 E. Main St.
Ashland" OR 97520-1829 INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEO 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 DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER I f,:sM%rv~~, I /:3Mc;,~~V1 l..IMITS
LTR
~NERAl UABILlTY EACH OCCURRENCE . l,OOO,OO~
A X COMMERCIAL GENERAlllABIUTY X 01 LX0196580772 11/17/10 11/17/11 D~~~t:.Il!_Rt::NIt::LJ . 300,000
PREMISES Ea occurrence
I CLAIMS-MADE [!] OCCUR MED EXP (Anyone person) . 5,00~
~ PERSONAL & AOV INJURY . 1,OOO,00~
e- GENERAL AGGREGATE . 2,OOO,OOC
~'l AGG:EnE LIMIT APnS PER: . PRODUCTS - COMP/OP AGG . 2,000,00
X POLICY P~.9.; lOC .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT .
- (EaaCCidenl)
- ANY AUTO BODilY INJURY (Per person) .
'--- All OWNED AUTOS BOOll Y INJURY (Per accident) $
- SCHEDULED AUTOS PROPERTY DAMAGE
.
- HIRED AUTOS (Peraccidenl)
NON-OWNED AUTOS .
-
.
UMBRELLA LIAS ~ OCCUR EACH OCCURRENCE . 5,000,00~
-
EXCESS LIAS CLAIMS-MADE AGGREGATE . 5,OOO,00~
B 29UD0158456522_ 11/17/10. 11/17/11
- DEDUCTIBLE .
X RETENTION . 10,000 .
WORKERS COMPENSATION I T~g~T ~I,~~ I I OJ~'
AND EMPLOYERS' LIABILITY V,"
ANY PROPRIETORIPARTNER/EXECUTIVE D N" E.L. EACH ACCIDENT .
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.l. DISEASE POLICY LIMIT .
DESCRIPTION OF OPERATIONS below
A liquor liability 01LX0196580772 11/17/10 11/17/11 1,000,000 Urnl
A Employee Benefits 01 LX0196580772 11/17/10 11/17/11 1,000,000 Urnl
DESCRIPTION OF OPERATlONS /lOCATlONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
The Imagine Project, The City of Ashland, its officers, and employees are
Additional Insured as respects operations of the named insured
CERTIFICATE HOLDER
CANCELLATION
CITASOl
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
The Imagine Project
20 E, Main St. AUTHORIZED REPRESENTATIVE
Ashland, OR 97520-1814 ~~,^",,'Q
,
ACORD 25 (2009/09)
@1988.2009ACORDCORPORATlON. All rights reserved.
The ACORD name and logo are registered marks of ACORD