HomeMy WebLinkAboutInsurance Certficate: Casa of Jackson County WJ vv It vvz
ac`�oe CERTIFICATE OF LIABILITY INSURANCE os/3012012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THR
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLJCIE;
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the pollcy(les)moat be endorsed. If SUBROGATION IS WAIVED,subject to thI
tames and older in li of the policy, certain policies rosy require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such andolst:merd(s).
PRODUCER RORY WOLD STATE FARM INSURANCE INCZ!7!ftE:A CONTACT V WILD
2019 AERO WAY STE 101 laoa
Ne: 1-77 MEDFORD, OREGON 97504 Y�RORYWOLD.N ET INSURERISIAFFORDNG COVERAGE Noe0
te Farm Firc and Casualty ComDanY INSURED CASA OF JACKSON COUNTY 613 MARKET STREET
MEDFORD, OREGON 97504 NwaER O:
INSURER E:
NSURlR F: -• �
COVERAGES CERTIFICATE NUMBER: 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. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VLTTH 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 SHONM MAY HAVE BEEN REDUCED BY PAID CWM&
NSh TYPE OF INauRAxcs pMm yv Mq' YexP ..__.
POLICY NUMBER LIMITS
GENERAL uAe1DrY 97-ES-523B-8 06101/2012 08101/7013 EACH OCCURRENCE i 1.0aD,o00
x COMMERCIALGENERALLIA&I •—
PREMISES _ i
CWMSMADE ED OCCUR MED EXP(Any arb Prsml i
PERSONAL A AOV INJURY 6
GENERAL AGGREGATE s _ 2.000.000
GEN'L AGGREGATE LIMIT APPLIES PIER-
POLICY PROOIX:TS-COMP/OP AGG E 2.000,000
PR6 ..
LOC
s
AUTfMpNLE LIABa1IY NG LW
ectideH _ i
ANY AUTO
CANED BONLYINIURY(Pwr e ) i
ALL OV.NED SCHEDULED BODILY INJURY(PWII d )
AUTOS AUTOS -
HIREDAVTOS NOpj�ED PRb s ...._
_M ecddeM) E
UNOREaue OCCUR I EACH OCCURRENCE S
D(CE94
me EACH
AGGREGATE i
LIED RETENTIONS "'
MRNERS COMPENSATION a
AND ENPLOYEW LIAeaITY VC - OTM.
ANY PROPRIETORp,,Y ERERECUnVE Y/N
OFFIC&MEMBER EXCLUDED? ❑ NIA E.L.EACH ACGDENr i
(Mandatary M MH
NecMe )
Ol
Ir Yee. der EL DISEASE.EA EMPLOYE f
EL OLSFASE-POLICYLMfi s
DESCRIPTION OF OPERATIONS I LOCATIONS I VENICUM (Afud,ACORD IN.moth teal Re"Ala ached"Nman 11"—4 MWIM)
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N
20 E MAIN STREET ACCORDANCE WITH THE POLICY PROVISION&
ASHLAND,OREGON 97520
AUTHORIZED T
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ACORD 26(2010/05) The ACORD name and logo am registered marks of ACORD 10014ss 132849.7 03.01-2012