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HomeMy WebLinkAboutInsurance Certificate: Ashland Supportive Housing 0710312013 13:41 Bliss Sequoia Insurance (FAX)503 364 5406 P.0011001 ACC)Rit 1 CERTIFICATE OF LIABILITY INSURANCE ;/3/201°3 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 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 CONTACT Wauneta Ohnmacht NAME: Bliss Sequoia Insurance PHONE (503) 364-5401 FAX P.O. Box 826 E-MwLSs: wauneta@blisainsurance. com E INSURER(S) AFFORDING COVERAGE NAIC9 Salem OR 97308 INSURERA:Philadel hia Indemni ins. Co. INSURED INSURERS Saif Corporation 36196 Ashland Supportive Housing INSURER C: S Ccome. unity Outreach INSURER D: PO Box 3536 INSURER E: Ashland OR 97520-0318 INSURER F: COVERAGES CERTIFICATE NUMBER: (13-14) Master 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 TYPE OF INSURANCE ADDL S POLICY EFF POLICY EXP UNITS LTR POLICY NUMBER MM/D MMIDDIYWV GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES E- cccUence$ 1,000,000 A CLAIMSHMADE FX] OCCUR PHPK973596 /1/2013 /1/2014 MED EXP(Any OPe parem) $ 20,000 PERSONAL S ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 3,000,000 1-1 POLICY PR IFCT X LOC $ AUTOMOBILE LIABILITY OMBINEDI SINGLE LIMB $ 1,000,000 A X ANY AUTO BODILY INJURY (Pmpmson) $ ALLONME❑ SCHEDULED HPK973596 /1/2013 /1/2014 BODILY INJURY(Per ocdde S AUTOS H AUTOS NON-0VdJEO PROPERTY DAMAGE HIRED AUTOS AUTOS PeraoodeM $ Urkem,sUmd mm nd S X UMBRELLA LIAR X OCCUR - EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB CLAIMSAAADE AGGREGATE $ 1,000,000 OED X RETENTIONS 10,00 HUB409923 /1/2013 /1/2014 S B WORKERS COMPENSATION V`C STATU- DTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR,PARTNERJEXECUTIVEENIA E.L EACH ACCIDENT $ 1 000 000 OFFICERIVEMSER EXCLUDED4 • 776721 /1/2013 /1/2013 (Mandatory in NN) E.L. DISEASE-EAEMPLOYE $ 1 000 00,000 If yes desoibeunder DESCRIPTION OF OPERATIONS Eelma E.L. DISEASE POLICY UM IT $ 1 000 00,000 A PROFESSIONAL LIABILITY HPK973596 /1/2013 /1/2014 1.000.000 PER OCCURRENCE 3,000,000 A ABUSE/MOLESTATION 1.000.000 PER OCCURRENCE 1,000,000 A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional RemsAs Schedule, 11 more space is required) The City of Ashland, its officers, and employees are additional insureds as respects work performed on its behalf by the named insured as required by contract. CERTIFICATE HOLDER CANCELLATION (541)552-2059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Lance Barnwell/NETA ACORD 25 (2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. The Annan r.~...n end I...... --ignif.-A -II M ACnDrl