HomeMy WebLinkAboutInsurance Certificate: Community Health Center 11512013 1:15 PM From: Ashland Insurance Inc If 541-488-5851 To: 15418427640 2
4`~ °O® CERTIFICATE OF LIABILITY INSURANCE 7/15/ 013
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 poticy(les) 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 NAME: Julio Asher
Ashland Insurance Inc PHONE (541)482-0831 P No: 154114Be-9851
585'A Street Suite 1 Eo .jaeher@ashlandinaurance.com
P. 0. BOJC BBD INSURERS APPOROIND COYEWAOe NAICa
Ashland OR 97520 INSURERAMutual of Enumclaw 4761
INSURED INSURERS:
COhAIIJNITY HEALTH CENTER INC INSUrD=xc:
8385 DIVISION RD INSURER D:
INSURER E :
WHITE CITY OR 97503 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL737904286 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.
ILTR TYPE OF OlSURANCE up USH POLICY EFF POLICY NUMB tMMfDDn`YYYI ~nRP LIMITS
GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES ommmai S 300,000
A CLAMS-MADE M OCCUR X FF0006632 /1/2013 /1/2014 MED EXP(Arq one emn S 10,000
PERSONAL 6'ADV INJURY S 1,000,000
GENERAL AGGREGATE 9 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP AGG S 2,000,000
S
X POLICY T& n LOC
B COMBINED SING LIMA
AUTOMOSILELUIDTY a
ANY AUTO BODILY INJURY(Perpmm) S
AALLOO6EO SCHEDULED BODILY INJURY (Per ncJdeN) S AUTOS
NON-OWNED P -ROPERTY DAMAGE S
HIRED AUTOS AUTOS P e
• 5
UMeR u.ALJAS ODOUR EACH OCCURRENCE S
EXCESS LUa CLAIM&MADE AGGREGATE S
DED RETENTIONS S
WORKERS COMPENSATION WCSTATU- DTH-
LIM 51 AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECLmVE Y NIA EL EACH ACCIDENT S
OFPICERMEMBER EXCLUDEDT
(Mandatory In NH) EL DISEASE-EA EMPLOYE S
11 Y. deevme uMar
DE9GrRIPnON OF OPERATIONS bal. £L DISEASE - POLICY LMR S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Minch ACORD 101, Additional Rmarho Schodub, it mom space to mqulmd)
Certificate Holder Is an Additional Insured.
CERTIFICATE HOLDER CANCELLATION
campost@ashland.or.us 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.
Its Officers, Employees 6 Agents
Bryn Morrison ALRHORMED REPRESENT VE
20 E Main St
Ashland, OR 97520
Julie Ashe
ACORD 25 (2010105) 9,A988-2010 ACORD CORPORATION. All rights reserved.
INS02512mms).01 The ACORD name and logo are reglstere marks of ACORD