HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Symphony Assoc From:Terry Friend FaxID:541-772-1906 Page 1 of 1 Date:6252013 03:32 PM Page:1 of 1
OP ID:-TMF
(SAIMIDOM
CERTIFICATE OF LIABILITY INSURANCE 0 °6/25/2013
1
06!25/2013
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 terns 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 Phone: 541-773-5358 NCONTACT
AME: Ter Friend
Protectors Insurance, LLC
Pilot Rock Ins Agency LLC (CA) Fax: 541-772-1906 ac°N E,t: 541-773-5358 FAC Na: 541-772-1906
PO Box 4669 ADoREss: terryfo
rOteCtOrsins.COm
Medford, OR 97501
Terry Friend CUSTOMERID$: ROGUE27
INSURER(S) AFFORDING COVERAGE NAIC i
INSURED Rogue Valley Symphony Assoc INSURERA: American States Ins Company 19704
1250 Siskiyou Blvd INSURERS:
Ashland, OR 97520
INSURER C
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.
INSR
LTR TPEOFINSURANCE POUCYNUMBER MMIDD (MiMSODAn-M LIMITS
GENERAL LIABILITY EACH OCCURRENCE 4 1,000,00
A X COMMERCIAL. GENERAL LIABILITY X 0101252849 09101/2012 09101/2013 pREMISES Ezoccurrence) $ 1,000,00
CLAIMS-MADE 1-R-11 OCCUR MED EXP (Any one person) S 10,000
PERSONAL S ADV IN.AIRY $ 1,000,0001
GENERAL AGGREGATE $ 1,000,00
GENL AGGREGATE LIMIT APPLIES PER PROCUCTS-COMP/OP AGO $ 1,000,00
X POLICY PR
g
FrT
O 171LOC
AUTOMOBILE LUIBILRY COMBINED SINGLE LIMIT
ANY AUTO E. accident) $
BODILY IN,URY (Per pers..) g
ALL OWNED AUTOS
BODILY IN.LLRY (Per pccidonU $
SCHEDULED AUTOS
PROPERTY OPM4GE
HIRED AUTOS (P.... citlenq $
NON-OWNED AUTOS $
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LAB CLA.IMSMADF AGGREGATE $
DEDUCTIBLE
• E
RETENTION S $
WORKERSCOMPENSATION WC STATU- OT$~
AND EMPLOYERS' LIABILRY YIN TORYLIMITS R
ANY PROPRIETORPARTNERIEXECU VE E.L. EACH ACCIDENT
OFFICERIMEMBER EXCLUDED? N / A
(Mandatory in NH) EL DISEASE - EA EMPLOYEE $
If Yes describe under
DESCRIPTION OF OPERATIONS W. EL. DISEASE- POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonel Remarks Schedule, If more space Ie required)
CERTIFICATE HOLDER CANCELLATION
CITYAS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main Str
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
Terry Friend
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD