HomeMy WebLinkAboutInsurance Certificate: Youth Symphony of SO
Rb® CERTIFICATE OF LIABILITY INSURANCE OPID TJ DATE(MMIDDIYYYY)
10/24/12
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: I the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. I 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
NAME: HO,
Liberty Northwest Insurance A/c,NO EXt: (ac, Na):
PO Box 188065 ADDRESS:
Fairfield OR 45018 cuSTOMERID#: YOUTH-3
Phone:800-289-0930 Fax:800-845-3666 INSURER(S) AFFORDING COVERAGE NAIC#
INSURED INSURER A: American States Insurance 19704
Youth Symphony of INSURER B:
Southern Oregon
PO BOX 4291 INSURER C:
Medford OR.97501
INSURER D :
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
LTR TYPE OF INSURANCE INSR WV POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) UNITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY 01CH65230460 11/24/12 11/24/13 PREMISES Ea occurrence $ 1000000
CLAIMS-MADE F-IOCCUR MED EXP(Any one person) $ 10000
PERSONAL B ADV INJURY $1000000
GENERAL AGGREGATE $ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 1000000
X POLICY PRO LOG $
ECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULEDAUTOS PROPERTY DAMAGE
A X HIRED AUTOS 01CH65230460 11/24/12 11/24/13 (Per accident) $
A X NON-OWNED AUTOS 01CH65230460 11/24/12 11/24/13 $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N TORY LIMITS ER
ANY PROPRIETORIPARTNERIEXECUTIVG~ E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? u IA
(Mandatory In NH) E.L. DISEASE- EA EMPLOYEE $
It yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITASH3
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland AUTHORIZED REPRESENTATIVE
Finance Department
20 East Main Street
Ashland OR 97520
IATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
Holder