Sam Hill Entertainment: Insurance

Sam Hill Entertainment Insurance Information and COI

Upon request, Sam Hill Entertainment can provide general liability insurance coverage for the performer

you have booked ($1MM/occurrence; $2MM aggregate). If you, your organization or your venue require

the performer to carry insurance, please notify us no later than 30 days prior to your event.

Our Certificate of General Liability Insurance is included on the last two pages of this document. If you

need specific language represented on the certificate, please contact us at [email protected].

ADDITIONAL INSURANCE INFORMATION

GENERAL LIABILITY POLICY

The certificate Sam Hill Entertainment can provide is for a general liability policy ($1MM/occurrence;

$2MM aggregate). Our policy is valid for one year and renews on January 1st of each year.

Included in the policy:

● Blanket Additional Insured - Managers or Lessors of Premises: automatically covers the venue as

additional insured

● Blanket Waiver of Subrogation

NOT included in the policy:

● Primary/non-contributory language needs to be approved by our insurance provider. Supporting

documentation sent from the requester will be needed by our insurance provider to approve.

AUTOMOTIVE

Upon request, performers can provide proof of personal automotive coverage for any vehicle that will be

on-site at your event. Limits will be in the amount that is required by law for personal policies.

● Additional insured, waiver of subrogation, primary/non-contributory language cannot be added

to personal policies.

BODILY INJURY AND PROPERTY DAMAGE

The General Liability Policy provides coverage for Bodily Injury and Property Damage.

● The policy does contain exclusions so it is not “All Risks”. The policy will provide coverage for

property damage that the performer is legally liable for based on their operations.

BLANKET CONTRACTUAL

Our policy includes Contractual Liability under the standard General Liability form CG0001. The policy

does not limit the Contractual Liability to any specific contract.

CROSS LIABILITY

This exclusion does not apply to a person or organization that would not be an insured under this policy

except for an endorsement to this policy adding them as an additional insured. Please email

[email protected] if you need a copy of this endorsement.

SAM HILL ENTERTAINMENT AND OUR PERFORMERS CANNOT PROVIDE:

COMMERCIAL AUTOMOTIVE

We are unable to guarantee that our performers can provide Commercial Automotive Liability coverage

or excess amounts above a personal policy. In some cases, our performers have been able to secure a

policy above a personal limit. Please notify us if this is requested.

WORKERS’ COMPENSATION

Workers’ Compensation/employer’s liability isn’t covered. Each musician is considered an independent

contractor, not an employee. This request is generally waived because it is not a requirement by law

given musicians’ employment status.

● Workers' Compensation by State

EMPLOYER’S LIABILITY INSURANCE

Not included in the General Liability Policy.

UMBRELLA OR EXCESS LIABILITY

Not included in the General Liability Policy.

PROFESSIONAL LIABILITY

Not included in the General Liability Policy.

PROPERTY COVERAGE

Not included in the General Liability Policy.

LICENSED AND BONDED

Neither Sam Hill Entertainment nor our performers are required to be licensed or bonded. This is

common for tradespeople who need a state-issued license to operate (like an ABC license). We can

provide our general liability insurance instead upon request.

E-VERIFY

Our performers are federally exempt from signing the E-Verify form for the following reasons:

● Each musician is considered an independent contractor, not an employee.

● The contract of services is for fewer than 120 days.

● It is valued at less than the simplified acquisition threshold.

● E-Verify exemption page.

BMI & ASCAP

Is not a certificate we provide.

BUSINESS INTERRUPTION INSURANCE

Specific facts surrounding a loss will determine what is covered under a General Liability policy.

NOTICE OF CANCELLATION

Our carrier is not able to provide 30 days’ notice of cancellation.

03/15/2021

GFH Insurance Agency, Inc.

4807 Radford Ave, Ste 104

Richmond, VA 23230

c/o Sam Hill Entertainment (see addt'l remarks)

200 Garrett St Ste I

Charlottesville, VA 22902

Gerald Hemphill - Agent

Auto Owners Insurance Company

various *see page 2

01/01/2021

01/01/2022

1000000

300000

10000

1000000

2000000

See scheduled list of bands on page 2

Coverage is primary and non-contributory.

FOR INFORMATIONAL PURPOSES ONLY

Printed by RMB on March 15, 2021 at 11:17AM

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR

ADDL SUBR

LTR

INSD WVD

DATE (MM/DD/YYYY)

PRODUCER

CONTACT

NAME:

FAX

PHONE

(A/C, No):

(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS

(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTED

CLAIMS-MADE OCCUR $

PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-

POLICY LOC PRODUCTS - COMP/OP AGG $

JECT

OTHER:

COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO

BODILY INJURY (Per person) $

OWNED SCHEDULED

BODILY INJURY (Per accident) $

AUTOS ONLY AUTOS

HIRED

NON-OWNED

PROPERTY DAMAGE

AUTOS ONLY AUTOS ONLY

(Per accident)

OCCUR

EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $

DESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A

(Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

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 policy(ies) must have ADDITIONAL INSURED provisions or 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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

GFH Insurance Agency, Inc.

Various

Auto Owners Insurance Company

c/o Sam Hill Entertainment

200 Garrett St Ste I

Charlottesville, VA 22902

01/01/2021

Insured Bands

One Round Roof Productions LLC dba A Town A list, The Free, The Big Beyond 43669382

BS&M Entertainment Inc dba Attraction 43669391

Joshua N Bias dba The New Royals 43669386

The Jangling Reinharts LLC/Little Known Legends 43044126

Andy Ware dba The Finns, The Bridge Brothers 43171052

Affirmative Groove LLC 4317088

Power 2 Party LLC 43171100

Lotos Bean LLC dba Adrian Duke Project, Adrian Duke's Jazztet 43171117

1st Generation Band LLC 43171127

Noble Guest dba Queen City Band 43171193

Nate King Co. LLC dba Lucky Pockett 43171144

Rich Gunderlock dba The Retreat 43171157

Dickens Events LLC dba The Dickens 431711164

Gloria Burton dba Eight Past Mid Night, Seven Til Sunrise 43171179

Soul Expressions LLC 43136893

The After Party Experience LLC dba Block Party Experience 43171221

Crystal Clear Band LLC 43136895

Kevin Pryor dba Another Level 43136897

Timothy McCloud dba Hipshack 43171261

Ryan Philips dba The Whiskey Rebellion 43171277

Young Hearts LLC 43171308

10 Spot 43171312

Mark Ingraham Jr. dba Dance Candy 43171343

Perter Richardson dba Alegria 43171354

Scott Amone dba Tidewater Drive 43171376

Danny Stevens dba The Life Atlantic 43172336

Andre Eglevsky dba Blue Tips Rhythm Revue 43172338

Charles Arthur dba The Bellevue Rhythmaires 43172407

Cameron Owen dba The Radio Sparks 43172341

Jeffrey Decker dba Jeff Decker Band 43136991

Justin Presley dba RadioJacks 43172345

Andrew Waldeck LLC dba E3 43172355

Travis Rinehart dba Jackson Flats, Jackass Flats 43136993

Gallatin Canyon LLC 43172368

Adam Long dba The Lone Rangers, Dowstairs Mixtapes 43172376

Mark Goldstein dba Bent Mountain Trio 43172380

Ryan Link dba No Charge 43172385

Stage 39 Atlants Inc dba Revel Radio, Revel Arcade 43137201

Rogue Services Inc 38302461

Printed by RMB on March 15, 2021 at 11:17AM

AGENCY NAMED INSURED

POLICY NUMBER

CARRIER NAIC CODE

EFFECTIVE DATE:

AGENCY CUSTOMER ID:

LOC #:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

The ACORD name and logo are registered marks of ACORD

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ADDITIONAL REMARKS SCHEDULE