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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Manor Community SRVCs o° CERTIFICATE OF LIABILITY INSURANCE DA 01/0312012) PRODUCER {..,� _ THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Caring Communities Sharetl Seryices LTD' - ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1850 W.W1dchester Road-D"`arz HOLDER. THIS CERTIFICATE .DOES NOT AMEND, EXTEND OR I Suite 109 .14_ -,w" '•:w.: I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Libertyville ' �5 >, ::.F IL ! 60048 INSURERS AFFORDING COVERAGE NAIC S > INSURED Pacific Retirement Services Inc. ' t INSURER A. Caring Communities,A Reciprocal RRG-`` 12373 ----- n 6 Rogue Valley Manor Community Services Inc INSURER B: . J ...,.L.9 7. 1045 Ellendale Drive •, • ..I-• ,,r•,,,•^ • ,�-.N._ ,; INSURER G ,. . . .,.. -- � � - ' ' '` • Medford OR 97504 INSURER D: INSURER E: ;�.r•r "- l I COVERAGES - • - - I 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS 1 LM INSR DATE MMIDOIYYYY DATE tM=DIYYYYI GENERAL LIABILITY CCRRRG-0015-12 01/01/2012 0110112013 DAMAGE OCCURRENCE E 1000000.00 A X X COMMERCIAL GENERAL LWBIUTY DAMAGE TO RENTED E 1 PREMISES Et occunenm X CLAIMS MADE ❑ OCCUR MED EXP (Arc/one parson) E _ X Professional Liability PERSONAL 6 ADV INJURY E 1,000,000.00 X1 Retro Date 011012002 GENERAL AGGREGATE $ 3,000,000.00 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP,OPAGG E Ind X POLICY R PRO- S AUTOMOBILE LIABUTY COMBINED SINGLE LIMIT s y -.. (Eaarmmrt) d ANY AUTO' .. ALLCMEDAUTOS - BODILY INJURY - SCHEDULperson) EDAUTOS - (Per p S - - •i HIREDAUTOS - BODILY INJURY r NON-CANED AUTOS - - (PeracddeN) $ PROPERTY DAMAGE E (Per eoddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT E ANY AUTO OTHER THAN EA ACC S AUTO ONLY: ADD $ EXCESS I UMBRELLA LIABILm CCRRRG-0015-12 0110112012 01/0112013 EACH OCCURRENCE E 10000000.00 A X OCCUR Fx1 CLAIMS MADE AGGREGATE $ 1$000 000.00 S S DEDUCTIBLE S RETENTION $ S -WM KERS COMPENSATION AND WC STATU OTH- EMPLOYERS'LIABILITY TORY OMITS ER ANY PROPRIETOR/PARTNERr ECUTNI — E.L.EACH ACCIDENT Is OFFICER/MEMBER EXCLUDED? (Mandatory In NMI E.L.DISEASE-EA EMPLOYE E Il yes,dasvibe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT E A MOTHER $2,000,000 EACH OCCURRENCE ESS PROFESSIONAL CCRRRG-0015-12 01/012012 01/01/2013 $2,000,000 AGGREGATE LIABILITY FL,LA,AR SUBLIMIT (INCLUDED IN EXCESS LMTS ABOVE) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 01/03/2012 14:33:41 The Certificate Holder is included as an Additional INSURED under this POLICY but only with respect to liability arising out of services rendered by the Named INSURED as outlined within the terms and conditions or the contractual agreement for the Foster Grandparent Program beM'een the City of Ashland and the Named INSURED. CERTIFICATE HOLD CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City Of Ashl DATE THEREOF, THE ISSUING INSURER HALL ENDEAVOR TO MAIL 30 DAYS WRITTEN 20 East Main St t AN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2012 Ashland JAN — 9 OR 20 IMPOSE NO OBLIGATION OR LIABILITY OF Y IONO UPON THE INSURER,ITS AGENTS OR REPRESENTATNES. AUTHORIZED REPRESENTATIVE .ACORD 25(200910 ©1988-2009 ACORD CORPORATION. All rights reserved. e ACORD name and logo are registered marks of ACORD