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HomeMy WebLinkAboutInsurance Certificate: Jackson County Fire District #3 ,acoR°® CERTIFICATE OF LIABILITY INSURANCE D2116IDD/YVVV) � 12n6/2 D11 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 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 CONTACT Dona Holmes, CISR NAME: WHA Insurance PHI ONE (800)852-6140 FAC (541)392-3786 IA C 2930 Chad Drive E-MAIL .dholmes @whainsurance.com PO BOX 1421 INSURERS)AFFORDING COVERAGE NAIC# Eugene OR 97440-1421 INSURER A:S ecial Districts Assoc of OR INSURED INSURER B:Genesis Insurance Company Jackson County Fire District #3 INSURER C: 8333 Agate Road INSURER D: INSURER E: White C'it OR 97503 INSURER F: COVERAGES CERTIFICATE NUMBER:2012 GL/AU/EX REVISION NUMBER: 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. INSR TYPE OF INSURANCE POLICY NUMBER MM DDNYYY MMIDDNYYP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea NI ED occurrence) $ A CLAIMS-MADE [K] OCCUR X 27P52299 /1/2012 /1/2013 MED EXP Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ None GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ X POLICY PRO LOC $ JFCT A LIABILITY EOMaBM�Dt SINGLE LIMIT 500,000 NY AUTO BODILY INJURY(Par person) $ A LL OED SCHEDULED 7P52299 /1/2012 /1/2013 UTOX AUTOS X BODILY INJURY(Per accitlent) $ IREDAUTOS X AUTOS PROPERTY DAMAGE $ NonownetllHired $ 500,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 9,500,000 B X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ X 27P52299 /1/2012 /1/2013 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is an additional participant and loss payee in respects to participant's use of Mobile Fire Training Unit, but only with respects to negligence claims for Bodily Injury, Property Damage or Personal Injury where the Named Participant is deemed to have liability. In no event shall coverage extend to any party for any Claim, Suit or Action, however or whenever asserted, arising out of such party's sole negligence or for any Claim, Suit or Action which occurs prior to the execution of the contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Ashland Fire 6 Rescue 455 Siskiyou Boulevard AUTHORIZED REPRESENTATIVE Ashland, OR 97520 s Jeffrey Gri££in/ASB ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD