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HomeMy WebLinkAboutInsurance Certificate: Rogue Farm Corps ACC CERTIFICATE OF LIABILITY INSURANCE GATE(MM OD YYYY) `/ CERTIFICATE /2012 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 NAME: Dyan Bates Evergreen Insurance Managers Inc PNHONN Ext_ (503)616-7900 Arc No: (503)259-3065 5293 NE Elam Young Pkwy Ste 160 ADDRESS: dbates @evergreeninsmgrs.com INSURER(S)AFFOROING COVERAGE NAICA Hillsboro OR 97124 INSURER A: American Alternative Insurance Corporation INSURED INSURER B: Rogue Farm Corps INSURER C: PO Box 533 INSURER2! INSURER E Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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. LTR TYPE OF INSURANCE INSR WVD POLICYNUMSER MM/DD/YYYY MM/DDIVYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocwnence S 100,000 CLAIMS-MADE I ^I OCCUR MED EXP(Any one person) $ 5,000 A Y 2CA2GL000001101 06/09/2012 06/0912013 PERSONAL S ADV INJURY S 1,000,000 GENERALAGGREGATE S 1,000,000. GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS COMPIOP AGG S 1,000.000 X POLICY P'0. LOC S AUTOMOBILE LIABILfTY COMBINED SINGLE LIMIT _ a accident ANYAUTO BODILY INJURY(Per person) S ALLOWNEO SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) 5 NON-OWNED PROPERTYDAMAGE S HIREDAUTOS AUTOS Pere en s UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTME❑ NIA E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE4 S If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Ashland,its officers and employees THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Finance Dept,Attn: DL Tuneberg,Director ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD