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HomeMy WebLinkAboutInsurance Certificate: SO Child Study & Treatment Ctr CERTIFICATE OF LIABILITY INSURANCE 6/27/20113"' 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 policy(ies) must be endorsed. If 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 CONTACT Peggy MacMillan JD Fulwiler 6 Co. Insurance, Inc. PHORE ,.(503)293-8325 FA% N (503)293-5418 5727 SW Macadam Ave AEbmpAgLESS.pmaemillan@jdfulwiler.com PO BOX 69508 INSURERS AFFORDING COVERAGE RAID is Portland OR 97239 INSURER A Alliance of Nonprofits for Ins 10023 INSURED INSURERB:Saif Corporation Family Solutions, DBA: Southern Oregon Child INSURER C: Study 6 Treatment Center INSURER D: 1836 Fremont St INSURER E: Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:13/14 Gen Use 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 rypE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP POLICY NUMBER DD (MMIDDrYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES $ 500,000 A CLAIMS MADE OCCUR 01321304 /1/2013 /1/2014 MED EXP(Any one person) $ 20,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 3,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY EOMBINED IN LE LIMIT 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 01321304 /1/2013 /1/2014 BODILY INJURY(Per accitlen0 $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per Underinsured motorist $ 1 000 000 X UMBRELIALIAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTION 10100 013213041UMB /1/2013 /1/2014 $ B WORKERS COMPENSATION X WC STATt} OTF4 ANO EMPLOYERS'LIABILIry YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? NIA (Mandator, In NH) 98536 /1/2013 /1/2014 E.L. DISEASE-EA EMPLOYE $ 500,000 II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 000 A Professional Liability 01321304 /1/2013 /1/2014 Occurrence Limit $1,000,000 Social Services Aggregate Umit $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) The City of Ashland, its officers, and employees are included as additional insureds with regard to operations of the named insured in accordance with the policy terms, conditions, and exclusion. All operations of the named insured subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE P MacMillan/TMAYDA ~~.-J wwa&1ki1e11 ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 nmmm~ nt Tha Amen name and Innn era renictarad mnr4c of Ar.r1Rn Additional Named Insureds Other Named Insureds Josephine Child Resources . Southern Oregon Child Resources Southern Oregon Child Study 6 Treatment Center Doing Business As OFAPPINF (0212007) COPYRIGHT 2007, AMS SERVICES INC