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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Farm to School ACIIe CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YY) �/ 0710912012 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(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 endorsements. PRODUCER CONTACT Reinholdt&O'Harra Insurance PHONE Allison ward FaX 518 Washington St EMAIL (541)482-1921 INC.No:(541)488-0458 Ashland, OR 97520 A- s: award@reinholdtins.com License#: 800442 INSURERL)AFFORDINGCOVERAGE NAIC0 INSURERA: Montpelier US Insurance CO. INSURED INSURER B Rogue Valley Farm to School Tracy Harding INSURER C: P.O. Box 898 INSURER D Ashland, OR 97520 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: 00014506-122017 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AWL gum POLICY EFF POLICY UP LTR 1 POLICY NUMBER MMIDDIYYYY nfmIDDIYYW l LIMITS A GENERAL LIABILITY Y N MP0046003000650 07/05,2012 0710512013 EACHOCCURRENCE S 1,000,000 X COMMERCIALGENERALUABIUTY DAMAG TO EN ED PREMISES occum nce $ 50 gg� CLAIMS-WDE OCCUR MEDEXP(An orre n) $ Excluded PERSONAL S ADV IWURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL All EGATELIMIT APPLIESPER: PRODUCTS AGG $ Included X POLICY PRO LDU S AUTOMOBILE LIABILITY COMBINED SINGLE UMIT �tlmt ANYAUTO BODILY INJURY(Par person) $ ALLOWNED SCHEDULED BODILYIWURY(Paracadert) S AUTOS AUTOS NON-0 EO PROPERTYDAMAGE $ HIREOAUTOS AUTOS par arndom UMBRELLAUIS OCCUR EACH OCCURRENCE $ EXCESS LIAR CIAIM'MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION V.0 STATU- OE T& AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWE%ECUTNE EL EACH ACCIDENT S OFFICERAtEMBER EXCLUDED? NIA (Maulato,y in NH) EL DISEASE-EA EMPLOYEE S if ye tleavunder ihe under DESCRI PTION OF OPERATIONS ml. E DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD tat,Additional Remorse Schedule,if more space is required) The City of Ashland and all other governmental bodies having jurisdiction in the area,their officers and employees are included as additional insureds. Event:Siskiyou Challenge 2012 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. MAIN STREET ASHLAND,OR 97520 AUTHORIZED REPRESENTATIVE S ALI ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Printed by ALI on July 09,2012 at 03:07PM