HomeMy WebLinkAboutInsurance Certificate: Ashland School Dist 5 GL-AL Certificate Summary Certificate Page 1 of 2
—••��GENERAL LTABILSTY word Atrl0 L74BILXTY ADDITIONAL PARTICIPANT CERTIFICATE t
AGENCY/AC MT-ISSUING CERTIFICATE Does,7/12/1012 Print!:
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Beadier C UUM Io%WKrod ONLY AND CONFER4 NO RIGNTS UPON THE CERTIFICATE MOLDER
AgerrcyItmfwd OTHER T1um TH05•PROVIOEO W THE COVERAGE OOCVMENTS.
/MOSafad OR 97� THIS CERTIFICATE DOES NOT AMEND,EYIEHO ORALTER THE
Sandy Orr COVERAGE AFFORDED BY THE COVERAGE OOCOMEIrM OUSTED
(541)772-1111 HEREIN.THIS CERTIFICATE DOES NOT CONSTJNE A CONTRACT
BETWEEN ANY OF THE FOLLOWING PARTIES:THE AGENCY,NAMEDI
PARAW CEInF=31!MOLOEA AND/OR COKP"W3
AFFORDINGCOVERAGE. 7
MANED PARTICIPANT/MEMBER-REQUESF W
ING CERTIFICATE ORGANIZATIONS AFFOROG COVERAGE
US SlW sabot bw des rcmaw,V A ReoerM caRrdt,rernepe Fde Edublbn(PACE)
uSand0ym eoubvam
Ashland,Olt 97520.2197 Cwmwm B-GerN-JO ftln ame Come , 1
Anita Obdam
(SAS)981.2811 7
CO V ERAOE9 .•».••••_w.w.r«�«._..V.�..��
Mk k m awry Pat CoM Deamewa estsd ha tv ebem ba d b Po Nwned PwtWl hwakw zee Vw Covwage Ponca tdubd Nowova Ndsq wry i
nquranml tatmw rondum cram cmb'W w m1w docam m Nth remml b atom ea wtm,,,a aay W h1uM w me/fn1aL Ua zoruepe dlwdod by tl+e 1
Wen to&DOabnmb GwA seb N MAcom, h Udws refs w XvM and esckNM2 of oxh COVma9e 0oaPmnO.AgWe"umlb Ntam wa ms n mm he+e !(
4mradrotdby pest Co me rmao ;to Thenkerduenred utda TM Of Cwmeoe as touted solely fw c 010Ca drdralt9 aM mill rat be sbemedmf
vim way b wM w alram av1 prwawY6 b ravmr bey eabro. 77
OR/CO of Cave CoromBe ENplmtion s
LTN TY� Document Effective Data Date Llmna 1
""».w .w.w,..._.._w.._....„w..«......_.ww.w.».........._ «..»..
w..w,........._... ...«...«...».......«. ......«..w»...«... .« «.»«»...wow..
General U^a�abry .`�+ Wrery AOmarw iarJAU,OW:
% Team dra dWeal,
% �rWCONdak OIU1M ianaadss•Ida 2/wolz
' A % llAwha
% xC[Nes.ran Een dmaeKl �tlo.00d•Um
EmpbymMCA,elSlma DOdcm"110c F50.W0 3
w Hb D*dtmbWAfA:St4aeo
Gerard U0t1v OadGOVAIR:SSDAM i
Pz v to MaAdaymMt lambcow. rwb,w 1/PACE w atnwm kOd cwvmel k not mnw4ed ( 7
s
Automobile Liability
urcea APp.P.w tmAOO.eoo
x edadad.ww
a i
A x Twee AVm eaemov,Nd loon IS1Fe005iIK >/Vaoli zlVtota
ww«i._»«wwww.ww»ww. ww.«.�w.j CM Uwn•ae NV.OW,W I
Y ierenmw Fa.e
x ibaaewr/AA:uo.00, i
Ra,w,ka:W tl..erpA W LY mr)w�W W M aLL vwunsuw rMW 4 a,aAlalrwlµ,YUVae w ieypye IV Us,l UT tlwl ralelpe Lwt wM aW,layaaia W:aurypnN
de4ro Iw Bed4Y NIMy,Ptromh Dendea w Pmaond)n}ry vha¢tM tNrRy Pmltbem b deemed b bore eeb8ty.In rM scam Oav cwmspe o.laid b mr pMy
b my Claim,Sun w AdHm,hwesya a vAw ¢VU agmted,Emma wa d me cookout h~A oche nadeer”w for any OM ,Sun w Amu I'mOe01a prp-b
tla atCUOm dllM matador a7ammL
•rNammM 9 NmA(od A, ftM Ml,mMa Hfil NA onep ,00d"I av M wit l+.*dvt Mdvn
Cartiftmts Molder•RoqueeMnBCerMRCeto GNCEUA17ON:Shedd any of the Cammga DOmmentl harem be CenWOed blk.am
Oty of Athlm 1,a dflcwe 6 mployaa alPbaaul debt Owned.PACE MU eadwwr to provide rues In a¢oName adtr the PACE
20 Eat Man Slow Germ+at UabBay COVwepa Document pmvhba.FaRUZe to mall such mdoe Shill Unpma
Ashland,OR 47520 no oUgatbn an Uab@ry deny land upon PACE,Be agents
ar
dmtrmrmwm.. rgVIN OWD-e.nRb b91w
�enmdRgwmmroavedNamedPartWpant: /Ill//iL
G1,AL Certificate Summary Certificate Page 2 of 2
Applicable Coverage Document Donnitiore�� 'RT�� Vw�•u~_��� Y_
The rmlawing definitions am p:ovNed solely for convenience of reference and shall not be deemed in any way to limit or affect the plown;Ww to which E(
0107 ralab0.IortomplsCa detods m theta., cumdaiem and ash osi d apptabie COM"D Doemmrrts please Mar W the PACE Uabnty Gowe rage I
Document. E
Participant means:
L The Named Participant end each of the following whIleacting wghin the acne and scope of their dut m as such:
a. No be of the Board;
b. EseutIm OfUtsa;
Q Employees;
d. Volunteers and Agents;
a PAghtmad Students wham muse study Includes on-dw-Job training.but only while acting under directions and within thescopa ofthelr
aWNllm performed whUe In badning;
f. 54derq Organstatlo s6 Parent Teacher Organizations,Bocotar Cuba and Fnmdatlom under the Junsdukbn and supervision of the gonvnhg
board;and
g. Any person,misty army organization the Named Participant Is required by an Insured Crnaad to Include as a Participant.This coverage will be
UPOW o the ndentef mwaage and Ihmb of Uabday,required by the Insured Contract and will not hmense the BrNta stated In SECTION V.
Lgf1115 OF UABIL[fyor alter any or the eaten of coverage seabed In this Govern"Decu rmht The Desired Contract mart beeffacthe and
execumtl pror o a cow n Oamrssho9 or Wrongful Art in no event shall coverage under this Coverage Document aa1ems to say party(army
Calm honewm whenever assorted,arising out of suds party's sole negligence.(1)The bum Additmel insured'g used In an Insured Contract
shall be understood to mean the coma m Additional Participant
L With Impact o:
Marble"mentor soy Auto.any person Is a Participant whlo driving such Auto or Noah Equipment with a Named Partlnpentla pembsim.My
person,amNy,or organization rmyonslbie forlhe conduct of such person is also a 1Mtlpmt,but only with respectte eodity,Injury or Property Danage
�out of c am of the Aaaserr Wade fquiprnorht tawwwe,the owner manyma also lmm whom a Named PaNdpant hams or borrows an -
pant only It chat Auto is a trailer connlected to an Auer a Named PaltklpUht Owen.Nowaew ur,no person,entity,or organization is a
PertfdpeR under this paragraph 2.with reaped o:
a. Frapmq Damage to property owned by a Named Participant or the employer deny parson who Is a Participant under this provision;
b. My Auto a Named Padcipant hbm arto, ovn floor one of a Named PmticlpeatY Enooyces,.alunixem ar members of their households,it they
am the owned such Auto,unless acting within the sooI of their dutm on a gamed Perttlpmes behalf;
c. Any Nrb being used by a home employed In the business of selling,servicing.repairing,or parking Autrs unless they eta a Named PnNclpent's
Empbyem;or
d. The Movem9rt of pmperty to or from an Auto esfapL a Named ParlltlpmhL a Named Pert uripmes Empoyem,lessees or borrowers of such Auo,
and myeagoy"of the Names or borrowers.
Insured Camractrrans:
1.A ogaly anfaceeble conbac[that Includes one or all of the following:
a. A Ime of pmmism as It rides to lort Uabgltim msumod by the Named Pamcipantarising out of the lease,such assumption occurring In wring
prior to the data of Oaanronco; r
b. Aaldetmdtagreament; J
Q Any®mentor license agreement; .
d. An obligation,as required by and wc%to Indemnif y a Public Body;
a Msimmer mdneeanoo agreement;
I. That part of any atercontract or agrrmeht pertaining tithe Named PaNclped's operatlom(Including an Indemnification of a Public Body o i
connection with wort performed by or for a Public Body)under which the Named Participant ammo the bM lability d medic person or entity i _
to pay for Badly Injury,Property Damage or Pmamal Injury o a thW persom or organization,provided the Bodily injury,Property Damage err
Personal Injury o ccurs subsequent to the execution of the win toragmemenp and
g. Contracts forserWas with Public Btdlm. i
2.M Insured Goofed dom not Include met parcel mycontract a agreement: a
a. That lntlons; arch arrhlbsd,eaploeerar wrvayerawnq as an lntlependentcantrecSOr/or injury or Damages arlsIng outdprofessronalmron j
' oroMSSbrG•
b. Twit ademnifam any pennon or organization for Damages by Bra to premeds named or loaned to the Pamrlpint and
c Mat Involve the purdhme orsao of marl property or personal property.
.._ _..._................_...._........._.------.r.................«...._............._...«............_.__...�..__,.........._�...............�
Pass)