Loading...
HomeMy WebLinkAboutInsurance Certificate: Ashland Community Theatre (3) A�® DATE(MM oorvrrr) CERTIFICATE OF LIABILITY INSURANCE 12/2/2011 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 poliey(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 - CON M NATACT E: Y Rust Poehner Gales Creek Insurance Services PHONE . (503)977-5632 FAX .(503)977-5832 AIC 5727 SW Macadam Ave. E-SiAIL ADDRESS. com PO BOX 69508 INSURERS AFFORDING COVERAGE NMCN Portland OR 97239 INSURER A:Rlve ort Insurance Company INSURED - INSURER B:Berkley Life & Health Insurance Ashland Community Theatre INSURER C: PO BOX 3284 INSURER D: NSURER E: Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:CL11122 0 7 2 9 5 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. IR TYPE OF INSURANCE A DL POLICY NUMBER MMMCY EFF POLICY P LT LIMITS LTR GENERAL UABILTTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMI ET E a occurrercel $ 300,000 RENTED A CLAIMS41ADE FO OCCUR X 152699-00 2/4/2011 2/4/2012 MED EXP(My one psmon $ 5,000 PERSONAL B ADV INJURY S 11000,000 X incl Host Liquor GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP,OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILT Y COMBINED SINGLE LIMIT Ea acaden ANY AUTO BODILY INJURY(Per person) $ ALL OVMED SCHEDULED BODILY INJURY(Per accitlenl) E AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per a ci ertI S UMBRELLA UAB OCCUR - EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA E.L.EACH ACCIDENT $ IM OFRCEREMBER EXCLUDED? (Mandatary In NH) E.L.DISEASE-EA EMPLOYE $ 9 yes,descrihe under DESCRIPTION OF OPERATIONS below - EL DISEASE-POLICY LIMB S B Volunteer/Participant PA L00226817-001 2/4/2011 2/4/2012 Metlical payments $15,000 Accident ]EXCESS my - $0 DED ADaD $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addiflonal Remarks Schedule,M mom space Is m9ulmd) The City of Ashland and its officers, employees, and agents are included as Additional Insureds with respect to the operations of the Named Insured. I CERTIFICATE HOLDER CANCELLATION (541) 552-2059 rossann.grimm@ashland.or.0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland attln: Rossann Grimm 20 H Main St AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Rusty Poehner/RUSTY - ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).D1 The ACORD name and logo are registered marks of ACORD