HomeMy WebLinkAboutInsurance Certificate: Childrens Advocacy Center
AC"Ra CERTIFICATE OF LIABILITY INSURANCE DATE (MM DO YYYY)
10/23/2012
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 pollcy(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 certlflcate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER NCONTACT ONE, Sandy Orr
FAX
IC No: (541)772-37e5
Beecher Carlson Insurance Agency LLC (541) 772-1111 A
707 Murphy Rd PROSE.sandy.orr@beechercarlson.com
INSURER 3 AFFORDING COVERAGE NAIC e
Medford OR 97504 INSURERA ?hiladel hia Indemnity Ins Co 8058
INSURED INSURERS:
Jackson County Child Abuse Task Force, DBA: INSURERC:
The Children's Advocacy Center INSURERO:
816 W 10th Street ISLSURERE:
Medford OR 97501 INCURLRF:
COVERAGES CERTIFICATE NUMBER:2012-13 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 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.
I TYPE OF INSURANCE POLICY NUMBER MMIICYEFF MMIICYE%P LIMITS J= JIM LM
TR
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERALL VBILITY PREMISESEeoavrrrice $ 100,000
A CLAIMSMADE aOCCUR PHPK931195 1/1/2012 1/1/2013 MED EXP Wry one person) E 5,000
PERSONAL SADV INJURY IT 1,000,000
GENERAL AGGREGATE S 3,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPMP AGG S 3,000,000
X POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
1,000,000
A MY ALTO BODILY WXRY(Per person) S
ALL X SCHEDULED PF@K931195 1/1/2012 1/1/2013 BODILY WJURY (Per ecciderp) E
AUTOS S AUTOS
X HIRED ALTOS X NJT SV.NED PPROPPEERd YMDAMAGE $
PIP-Basic IT
UMBRELLA LIAS OCCUR EACH OCCURRENCE S
EXCESS UAB DlA1MSMA0E AGGREGATE $
DEO RETENTIONa S
WORKERS COMPENSATION VIC STATU- OTH-TORY I IMITR FR
AND EMPLOYERS' LIABILITY YIN
ANY PRORLETORiPARTNERIEYEOUTIVEā¯‘ NIA E. L. EACH ACCIDENT S
ORFICER/MEh®EP El(CL(IDED7
(Mandatory in NH) E.L. DISEASE-EA EMPLOYE S
If yes, describe urN0
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LN11T S
A Professional Liability PHPK931195 1/1/2012 1/1/2013 Eecn Prot..,.nal incident $1,000,000
Aggregate Limit $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Adach ACORD 101, Additional Romania Schedule, It more span Is required)
Certificate holder is an additional insured per form CG2026 attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
its officers S employees
20 E Main Street AUTHORIZED REPRESENTATIVE
Ashland, OR 97520 I~
Sandy Orr/SANDOR )L_JQ.rI dhA_(/$. CV,
ACORD 25 (2010105) ®1888-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: PHPK931195 COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Persons Or Organization(s)
CITY OF ASHLAND, ITS OFFICERS AND
EMPLOYEES
Information required to complete this Schedule if not shown above will be shown in the Declarations.
Section II - Who Is An Insured is amended to in-
clude as an additional insured the person(s) or or-
ganization(s) shown in the Schedule, but only with
respect to liability for "bodily Injury", "property dam-
age" or "personal and advertising injury" caused, in
whole or in part, by your acts or omissions or the acts
or omissions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to YOU.
CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 O