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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Farm to School (2) s►coizo® CERTIFICATE OF LIABILITY INSURANCE °A�`MM°"YY" �..._� 09/12/2012 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 endorsement(s). PRODUCER CONTACT NAME Reinhold[&O'Harra Insurance PHONE Allison Ward FAX 518 Washington St ELAIL J541)482-1921 Alc N 541 488-0456 Ashland,OR 97520 EZESS' award minholdtins.com Ashland, 89752 INSU 5AFFORDINGCONERAGE NAICa INSURERA: Montpelier US Insurance CO. INSURED INSURER B: Rogue Valley Farm to School Tracy Harding INSURER C: P.O. Box 898 INSURER O: Ashland, OR 97520 INSURER E: INSURERF COVERAGES CERTIFICATE NUMBER: 00014506-122017 REVISION NUMBER: 3 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 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. INSR TYPE OF INSURANCE SU POUCY EFF POLICY EXP Lm POLICY NUMBER MMIDDNYYY MWD UMITS A GENERALUABILITY Y N MP0046003000650 07105/2012 07/05/2013 EACH OCCURRENCE E 1,000,000 )t COMMFJiGALGENERALUABIIITY PREMI amrtv® E 50,000 CIAIMSMADE OCCUR Mm E% pne E Excluded PERSONAL 4AW INJURY E 1,000,000 GENERALAGGREGATE $ Z 000 000 GFNLAGGREGATELINTAPPUESPER: PROIXICTS-COMP/OPAGG E Included X POUCV PR,O- L� $ AUTOMOBILE MSILRY COMBINED SINGLE UMIT Ea.. ANYAM B LY INJURY(P person) S ALL ahNED SCHEWLED BIWURY CPB a..6. ) $ AIREI Np�OM�ED TY DAMAGE $ HIRED AUTOS AUTOS . $ UMBRELALMS OCCUR CCURRENCE E EXCESS MB CI-AMSMADE ATE E DIED RETENTION$ E MRKERS COMPENSATON STAT OTH-- AWEMPLOYERVI-001UTY YIN I FR ANY PROPRIEfORIPARTNDLE%ECUDVE❑ NIA ACCIDENT $ OFFICERIMEMBEREXCLUDBO? (MZn4ator,in NH) -EA EMPLOYE $ If yyes,descdW Under OESCRIPTIONOFOPERATIONSDeIpx E.L DISEASE-POLICY UMIT $ DE$CRIPTON OF OPERATONS I LOCATIONS I VEHICLES(AMcN ACORD 101,AEtl2gal Ra,ruMS$cM1 We,if n—a space is rpuinsd) 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 AUn10RIZED REPRESEfJIATiVE, ALI ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Printed by ALI on September 12,2012 at 04:OOPM