HomeMy WebLinkAboutInsurance Certificate: CASA of Jackson County
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State Farm Fire and Casualty Company
A Stock Company with Home Offices in Bloomington, Illinois
Herein called the Insurer
DECLARATIONS PAGE
NOT-FOR-PROFIT ORGANIZATION LIABILITY POLICY
INCLUDING EMPLOYMENT PRACTICES LIABILITY COVERAGE
Policy No: PS0000000306510
Renewal of Policy No: PS0000000306508
NOTICE: THIS IS A CLAIMS-MADE POLICY. THIS POLICY, SUBJECT TO ITS TERMS, APPLIES
CNLY TO CLAIMS FIRST MADE DURING THE POLICY,PERIOD OR ANY EXTENDED REPORTING
PERIOD THAT MAY APPLY.
This Declarations Page along with the completed and signed Application including attachments, and the
Policy Form and 'Endorsements listed in Item 6., shall constitute the contract between the Insureds and
the Insurer.
Item 1. Parent Organization: CASA of Jackson County, Inc.
Address: 613 Market Street
Medford, OR 97504
Item 2. Policy Period:
Effective Date: December 2, 2012 Expiration Date: December 2, 2013
(12:01 A.M. Standard Time at the Address stated in Item 1.)
Item 3. Limit of Liability: $1,000,000 in the Aggregate.
Item 4. Retention: $1,000 each Claim.
Item 5. Premium: $1,254.00
PSNP1000(07/01) Page 1 of2
Item 6. Policy Form and endorsements made part of this Policy at the time of issuance:
-t -
P1001(01/01) Not-For-Profit Organizati zation Liability Policy Including Employment Practices
PSN
I Liability Coverage
11 Certified Acts of Terrorism Endorsement
PS1039-01(03/08)
PSNP1008(01/01) Adoption or Foster Care Services Exclusion
PSNP1026OR(11/02) _j Oregon Amendatory Endorsement
Item 7. Notices to the Insurer - All notices to the Insurer pertaining to this Policy must be sent to:
State Farm Specialty Products
111 North Canal Street, Suite 940
Chicago, IL 60606-7201
Date of Issue: November 14, 2012 By:
Authorized Representati
PSNP1000(07/01) Page 2 of 2