HomeMy WebLinkAboutInsurance Certificate: Rogue Farm Corps (2) ,acoRD° CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDO rrvr)
05/2112012
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: N 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). -
COW CT
PRODUCER NAME, Dan Bates
Evergreen Insurance Managers Inc PHONE 503 616-7900 NC,No: 503 259-3065
9 9 uc No EXt: ( ) ( )
5293 NE Elam Young Pkwy Ste 160 ADDRESS: dbates ever reeninsm m.com -
INSURERSAFFORDINGCOVERAGE NAICe
Hillsboro OR 97124 INSURERA: American Alternative Insurance Corporation
INSURED INSURER B:
Rogue Farm Corps INSURER C:
PO Box 533 INSURER 0:
INSURER E:
Ashland OR 97520 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FORTHE 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 $ POLICY NUMBER MMIDOM" MMIDD LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000
X COMMERCIAL GENERAL LIABILITY PREMISES EaErourmnce $ 100,000
CLAIMS-MADE 1�1 OCCUR MED EXP(Any one Person) $ 5.000
A Y 2CA2GL000001101 0610912012 06109/2013 PERSONAL B ADV INJURY $ -1,000,000
GENERALAGGREGATE f .-1,000,000'
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ - 1.000,000
X POLICY PRO- LOC $
AUTOMOBILE UABILT' COMBINED SINGLE LIMIT
Ea accident) S
ANY AUTO BODILY INJURY(Per Person) $
ALLOWNED r7 SCHEDULED BODILY INJURY(Per amdenl) $
AUTOS AUTOS
HIREDAUTOS AUTOSWNED P.,..tlenl AMAGE $
$
UMBRELLA UAB OCCUR EACH OCCURRENCE S
EXCESS DAB CLAIMS-MADE AGGREGATE $
DED I I RETENTIONS $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETORIPARTNEWEXECUTIVE❑ NIA E.LEACHACCIOENT $
OFFICEMMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
If yes, crib
dese under
OE SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB 1$
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addi tonal Remaft Schedule,If more space is required)) D FMAY Q V F.
2 5 2012
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:OL Tuneberg,Director ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St AUTHORDED REPRESENTATIVE
Ashland OR 97520 � . J
'4�i A'
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD _