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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Manor YYW) CERTIFICATE OF LIABILITY INSURANCE DATE(MIWIDDA 12//3131/20/2012 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Caring Communities Shared Services LTD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1850 W. Winchester Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR- Suite 109 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Libertyville - - - IL 60048 INSURERS AFFORDING COVERAGE - NAIC O INSURED Pacific Retirement Services Inc. INSURER A Caring Communities,',A" Reciprocal RRG 12373 i c' -nz I Rogue Valley Marrnor Community Services inc. i INSURER B: - ,,.l,..,..;. r . Medford Ellendale DnVer INSURER C O R I i SIT :`:-1.: OR 97504 I _ INSURER D: _ INSURER E: COVERAGES - 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL POUCYEFFECTIVE POUCYEXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYYYY DATE MMIDDIYYYY LIMITS GENERAL LIABILITY CCRRRG-0015-13 011012013 01/0112014 EACH DAMAGE TO OCCURRENCE RENTED $ 1000000.00 A X *Xpo"fessional MMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000.00 CLAIMS MADE ~ OCCUR MEDEXP (Anyone person) 5 Liability PERSONAL B AW INJURY IS 1,000,000.00 X Retro Date 01/01/1002 GENERAL AGGREGATE $ 3,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OPAGG S Ind X POLICY PRO- LOG S JECT AUTOMOBILE LIABILITY - - - COMBINED SINGLE LIMIT ANY AUTO (ED ecccent). - $ ` ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS HIREDAUTOS - - BODILY INJURY - NON-0Wm1EDAUTOS - - - (Per acddent) . $ PROPERTY DAMAGE (Per acdtlent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC IS AUTO ONLY AGG $ EXCESS I UMBRELLA LMBIUTY EACH OCCURRENCE $ 10000000.00 A X OCCUR ❑X CLAIMS MADE CCRRRG-0015-13 01/0112013 01/012014 AGGREGATE s 15,000,000.00 s a DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' UABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVED OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ Ifyas descnbe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER $2,000,000 EACH OCCURRENCE A EXCESS PROFESSIONAL CCRRRG-0015-13 01101/2013 01101/2014 $2,000,000 AGGREGATE LIABILITY FL, LA, AR SUBLIMIT (INCLUDED IN EXCESS LIMITS ABOVE) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 12/31/2012 12:31:23 The Certificate Holder is included as an Additional INSURED under this POLICY but only with respect to liability arising out of services rendered by the Named INSURED as outlined within the terms and conditions of the Contractual agreement for the Foster Grandparent program between the City of Ashland and the Named INSURED. CERTIFICATE HOLDER CANCELLATION EGEUVE 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Ashland D DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 20 East Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Ashland JAN -1°10139752 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. o are registered marks of ACORD