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Q AC R° Im CERTIFICATE OF LIABILITY INSURANCE 16/i2"2
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 sr LL
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER p
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. N 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 andomemen s.
PROORRER 1-303-773-9999 CONTACT Anita Bruner
Arthur J. Gallagher Risk Mamgamsnt Services, Inc. PHONE FAX
Na.Ent 303-889-2574 IAIC.NOT 303-089-2575
6399 S. Fiddlers green Cir EA p ES ; anita_brunereajq.com z,
Suite 200 w
Green ood Village, CO 80111 INSURER(51 AFFOROINS COVERAGE NNCe
Karen Graham INSURERA: UNIT® EDUCATORS INS RRG INC 10020
INSURED
INSURER B:
Southern Oregon University
INSURER C
1250 Slskyou Blvd INSURER O:
Ashland, OR 97520 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 283=4462 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 REGUIREMENT,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.
IN9R TYPE OF INSURANCE POLICY EFF POLICY UP
LTR POLICY NUMBER M YM D LIMITS
• GENERAL UAaARY BLX201200468800 07/01/1 07/01/13 EACIOCCURRENCE f 500,000
Z COMMERCIALGENERA.UABILITY DAMAG T(Ea ED 500,000
PREMISE Ee oc.mnc f
CLAIMS-MADE O OCCUR MEDEXP".Pelson $Rx:cluded
Z $500,000 Self Insured 500,000
PERSONALAADV INJURY i
Z Retention GENERALAGGREGATE f 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO Slncl.Above
POLICY PRO- E LOC $
• AWOMOIN ELIABILITY BLX201200468800 COMBINED SINGLE LIMIT
Ecdcddem i Incl.Above
Z ANY AUTO BODILY INJURY(Pw peaon) S
ALL OWNED SCHEWLED BODRYINJURY(P.. t) $
AUTOa AUTOS
NON-0WNED PROPERTY DAMAGE
Z HIRED AUTOS Z AUTOS P.acdd. f
S
A UMBRELLA LUR Z OCCUR OL1201200468000 07/01/1 07/01/13 EACH OCCURRENCE f 5,000,000
Z EXCESS IJAB CLAIMS NUDE AGGREAITE $5,000,000
DEO I I RETENTION $
YORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LUBILOY YIN
ANYPROPRIETORIPARTNEREXECUDVE E.LrACHACCIDENT S
OFFICERIMEMBER EXCWDEDi ❑ NIA
(Mmdda'In NH) E.L.DISEASE-EA EMPLOYE f
Il yyeeaa 6ne UM.
DESCRIPTION OF OPERATIONS OeLw EL DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AUACN ACORD 101,AddltNnM RrineNS SCAOduM,O b r ue )
Evidence of insurance for pezmenent university street pennants. The certificate holder is mmed AN -Additional insured-
with respect to their interests, to the eztent USE can indemnify the certificate holder, subject to Article XI, Section
7 of the Oregon Comtitution, the Oregon Tort Claima Act (ORS 30.260-30.300), and ORE 351.086, but only with respect to
liability arising out of the negligent or wrongful acts or omissions of the State of Oregon, acting by and through the
State Board of Higher Education, on behalf of the Dreg= University System (DUE).
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland, its agents THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
directors, officers, e.Vloyeas and volunteers ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Mein Street AUTHORIZED REPRESENTATNE / `'
Ashland, of 97520 `—{
08A --CL
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
prabbasden
28314462
PtEtlUENMIt
Arthur.l.Gullagher Risk Dfanagernent Services,Inc. _
6399 S.Fiddlers Green Cir
Suite 200
Grcenwraxl Village,CO 80111
21112117171124
Electronic Service Requested EBIX BPO
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ALL FOR AADC 970
24614 0.5234 AB 0.371
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City of Ashlantl, its ag9ents `r
DIRECTORS, OFFICERS, Ef7PL0YEES AND VOLUNi63 ?
20 EAST WAIN STREET z
ASHLAND, OR 97520-1614 w
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