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Home My WebLink AboutInsurance Certificate: Mediation Works Jun 12 12 01:47p JON SNOWDEN STATE FARM 5414824957 p.1 Policy Number DECLARATIONS PAGE COVERAGE SUMMARY a 97-BG-9222-6 JUN 8 2012 Sl'A"E FARM FIRE AND CASUALTY COMPANY F O BOX 5000, DUPONT WA 98327-5000 A STOCK(COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Named Insured and Mailing Ac dress 15-3A13-F473 1 MEDIATION WORKS, A COMP 1UNITY DISPUTE RESOLUTION CEM'ER 33 N CENTRAL AVE STE 21 9 MEDFORDOR 97501-SSKI Cov A-Inflation Coverage Index: N/A BUSINESS POLICY-SPECIAL FORI13 Gov B - Consumer Price Index:226.9 AUTOMATIC RENEWAL - If the POLI :Y PERIOD is shown as 12 MONTHS, this olicy will be renewed automatioally subject to the premiums, rules and for ns in effect for each succeedingg policy peric . If this policy is terminated, we wi give you and tFte Mortgagee/Lienholde-written notice in compliance wdh the policy provisions or as required by law. Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time at the Effective Date: MAR 31 2012 premises location. Expiration Dane: MAR 31 2013 Named Insured: Corporation Location of Covered Premises: 33 N CENTRAL AVE STE 219 MEDFORDOR 975 01-593 9 Coverages S Property Limits of Insurance Section I A Buildings Excluded B Business Personal Property $ 29 500 C Loss of Income - 12 Months $ Actual toss Section II Deductibles-Section 1 L Business Liability $ 1 000 000 M Medical Payments $ 5,D00 $ 500 Basic Products-Completed Operations Excluded (POO) Aggregate General Aggregate(Other $ 2,000,000 Than PCO In case of loss under this policy, the deductible will be applied to each occurrence and wall be deducted from the amount of the lose. Other deductibles may apply - refer to policy. Policy Premium $ 375.00 Forms Options, and Endorsements Minimum Premium Speciar Form 3 FP-6103 Policy Endorsement- Business FE-6851 Discounts Applied: Amendatory Collapse FE-6573.1 Renewal Year Fungus (Including Mold) Excl FE-6566 Years in Business Building Coverage for Tenants FE-6859 Claim Record Policy Endorsement- Business FE-6610 Policy Endorsement FE-6656 Continued on Reverse Side of Page Pre pared OTHER umr'S AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY iUN 08 2012 Cc tersi d 16 899.2C MITM By n y1 Agent 'our olio consists of this e a endlor:ements JO OWDEN policy Pa9 r any (541)482.2461 nd the policy form.PLEASE KEEP THESE 100 ETHER. (01 @ 172b) Jun 12 12 01:47p JON SNOWDEN STATE FARM 5414824957 p.2 Policy Number 97-BG-9222.6 CONTINUED FROM FRONT SIDE 3USIN ESS POLICY-SPECIAL FORD 13 Forms,0ptions,and Endorsements Products/Operations Liab Exol FE-6312 Amendatory Endorsement FE-6237.1 Inc Cost and Demolition Gov FE-6587 Business Policy Endorsement FE-6464 Terrorism Insurance Cov Notice FE-6999.1 Personal Injury Exclusion FE-6346 Dist Mat Volat Statues Excl FE-6655 Subcontractor Pd Exclusion FE-6598 Designated Premises Limitation FE-6351 Tree Debris Removal FE-6451 Mandatory Reportng Endorsement FE-5801 Registered Domestic Partnrship FE-6858 Advertising Injury Excl FE-6345 31ass Deductible Deletion FE-6538.1 Additional Insured Endorsement FE-6494 Section II Additional Insured FE-6609 3repared IUN 08 2012 (OM175a) Jun 12 12 01:47p JON SNOWDEN,STATE FARM 5414824957 p.3 FE-6609 Page 1 of 1 SEC rION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 97-BG-9222-6 Named Insured: MEDIATION WORKS, A CON1M UNITY s DISPUTE RESOLUTION CENT:R 33 N CENTRAL AVE STE 219 MEDFORD OR 97501.5939 Additional Insured (include adc ress): CITY OF ASHLAND ITS OFFICERS, EMPLOYEES &AGENTS 20 E MAIN ST ASHLAND OR 97520-1850 WHO IS AN INSURED, under S =CTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, iut only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that P dditional Insured shown above. Any insurance provided to the A iditional Insured shall only apply with respect to a claim made or suit brought for damages for which you are provid,!d coverage. The Primary Insurance coverage t elow applies only when there Is an "X' in the box. ❑ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other provisions of the policy at ply. FE-6605