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HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Child ACC)°e CERTIFICATE OF LIABILITY INSURANCE 6/27/ 12 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(les)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 CONTACT Dana Rheault JD Fulwiler B Co. Insurance, Inc. - PNONE (503)293-8325 FAX .IS031 ass-sue SELL 5727 SW Macadam Ave E-MAI ,drheault®jdfulwiler.com PO BOX 69508 INSURERS AFFORDING COVERAGE NAIC0 Portland OR 97239 INSURER A Alliance of Nonprofits for Ins INSURED INSURERB:Saif Corporation Family Solutions, DBA: Southern Oregon Child INSURER C: 1836 Fremont St INSURER D: INSURER E: Ashland OR 97520 1 INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 GL,AL,DM,PL,WC 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH 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. INSR TYPE OF INSURANCE ADO SUBR POLICY NUMBER PAILpCY EFF POLICDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES TE $ 500,000 A CLAIMS-MADE 510CCUR X 201221304 /1/2012 /1/2013 MED EXP(Any one person) $ 20,000 PERSONAL B ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 X POLICY PRO, LOC $ IFCT AUTOMOBILE LIABILITY M.d. SINGLE LIMIT adINED 11000,000 X ANY AUTO BODILY INJURY(Per person) 5 A ALL OWNED SCHEDULED 201221304 /1/2012 /1/2013 BODILY INJURY(Peracciden) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Paraccidenl Undennsured motonst S 1 000 000 UMBRELLA DAB HOCCUR EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE AGGREGATE $ DELI I 'Y I RETENTIONS 10,00 01221304DM8 /1/2012 /1/2013 $ B WORKERS COMPENSATION - WC STATU- GTH- AND EMPLOYERS'UAIN ITY ANY PROPRIETOR/PARTNERIFXECUTIVE� NIA E.L.EACH ACCIDENT $ SOO OOO OFFICERIMEMBER EXCLUDED? 98536 /1/2012 /1/2013 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 U yea,desoMSe.ncar DESCRIPTION OF OPERATIONS helo E.L.DISEASE-POLICY LIMIT S 500,000 A Professional Liability 01221304 /1/2012 /1/2013 O."Ince $1,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD101,AdtllUonal Remark.Schedule,K more space is required) Certificate Holder is hereby added as an Additional Insured, as their interest may appear to the operations of the named insured, subjet to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION campost®ashland.or.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Dana Rheault/DANA ACORD 25(2010/05) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025,minnsi n1 Thu Ar()Gr1 namu an,1 Inn.aru r.niatnrurl m.rYc.F Ar nion