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il R CERTIFICATE OF LIABILITY INSURANCE o2naI22otaM~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON LYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
HIS 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 been domed. tSUBROGATION IS WANED, 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 GEICO Insurance Agency, Inc.
GEICO Insurance Agency, Inc. NAME'.
PHONE FAC
1 GEICO Blvd VVC.Na Ec) HUG, NH
Fredericksburg, VA 22412 E-MAIL
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: NATIONAL LIABILITY SFIRE INSURANCE 701152
THERESA BALDWIN INSURER B. COMPANY
1 CORRAL LN APT. 69 INSURERC
ASHLAND, OR 97520 INSURERD
NSURER E
NSUFERF-
InfLable.bNeal CERTIFICATE NUMBER: 111,479 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 OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR .NAY PERTAIN, THE 0,151 RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.ECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL BURR POLICY EFP POLICY EXP
LTR TYPE OF INSURANCE RED Wino POUCYNUMBER M1MDDM'Y MMDOMT LIMTS
GENERAL LABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
PREMISES (Ea omurrence)
CIAIMSMADE ā¯‘OCCUR
MED E%P (Arty one person) 8
PERSONAL a ADV INJURY $
GENERAL AGGREGATE $
GENTAGGREGATE UMITAPPUES PER FRODJCTS-CCMPgP ADS $
POLICY PRO, LDC $
JF~ AUTOMOBILE AUTHORITY COMBINED SINGLE LIMIT $ 580,DB8
(En
JANY AUTO mfil
BODILY INJURY (Per Person) $ NIA
A LTDOVWED X nu osuLED y 73APGO51203-01 02/2712013 02/27/2014 BODILY INJURY (Per abadir ll s NIA
IRED AUTOS X NON 0-C. PROPERTY DAMAGE $ NIA
AUTOS (Per br identl
uM"LU LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTCP1$ $
WORKERS COMPENSATION ACSTATLL OTH-
AND EMPLOYERS' LABILITY TORY LIMITS ER
ANY PROPRETORIPARTNEF/EXECUTIVE NIA E. L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? YIN
(Mandamr, in NHI EL.DISEASE - EA EMPLOYEE $
n yes, describe under
DESCRIPTION OF CPERAMMS below E. L. DISEASE-POLICYUMIT $
8
$
DESCRIPr10N OF OPERATIONS/ LOCATIONS /VEHICLES (ARiCh ACOR0101, Addolonal Rxnahe Scrod ll if more spate Is requirW)
CertlOcale Holder is named an Additional Insured on this policy.
Comp or Sifted PMs Dam
Year,MfIm MOdel,VM Col4srm Sec Caus. Anount Deducible
2011 KIA SOUL KNDJT2AllB7347474 Covered C 12,900 500/500
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
THE CITY OF ASHLAND EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
20 E MAIN ST POLICY PROVISIONS.
ASHLAND, OR 97520 AUTHORZED REPRESENTATIVE
ACORD 25 (2010)05) ® 1988.2010 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks ofACORD
M-5652 (11/2011) 0212&201312:32 C04496AC4650ABD9-887C-3BBE1DC34861