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HomeMy WebLinkAboutInsurance Certificate: Youth Symphony of So OR ~Rb CERTIFICATE OF LIABILITY INSURANCE OP ID TJ DATE(MWDDIYYYYI 10/24/12 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: the certificate holder Is an ADDITIONAL INSURED, he po Icy(ies must be endorsed. I SUBROGATION 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 NAME: Liberty Northwest Insurance AIC,NO Eat: WC, NO): PO Box 188065 ADDRESS: Fairfield OH 45018 CUSTOMERIDa: YOUTH-3 Phone:800-289-0930 Fax:800-845-3666 INSURER(S) AFFORDING COVERAGE NAICY INSURED INSURER A: American States Insurance 19704 Youth Symghony of INSURERS: - Southern regon PO BOX 4291 INSURERC: Medford OR 97501 INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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. LTR TYPE OF INSURANCE INSR M POLICY NUMBER (MMIDD/YYYY) IMWDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 1A A' A X COMMERCIAL GENERAL LIABILITY 01CH65230460 11/24/12 11/24/13 P RE MISES(Eaoccunence) $ 1000000 CLAIMS-MADE ā¯‘OCCUR LED EXP(Any one person) $ 10000 PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE $ 1000000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/CP AGO $ 1000000 X POLICY PRO LOC $ ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 (Ea accident) ANY AUTO BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY IPeraccitlent E SCHEDULED AUTOS PROPERTY DAMAGE A X HIRED AUTOS 01CH65230460 11/24/12 11/24/13 (Per accident $ A X NON-OWNED AUTOS 01CH65230460 11/24/12 11/24/13 $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS OMPENSATION AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETORMARTNERIEXECUTIVG- IA EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEDT u (Mandatory In NH) E1 . DISEASE - EA EMPLOYEE S If yes, descries under DESCRIPTION OF OPERATIONS belay E.L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITASH3 THE EXPIRATION DATE THEREOF, NOTICEWILL BEDELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE Finance Department 20 East Main Street Ashland OR 97520 ©1988.2009 A RD CO ORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD