HomeMy WebLinkAboutInsurance Certificate: Jackson Cty Health & Human Srvcs
AUG/01/2013/THU 10:02 AM Legal Services Inc. FAX No.5417797308 P•002
AMERICAN ECONOMY INSURANCE COMPANY PACE 1
fNacLh tst- SEATTLE, WASHINGTON
ULTRA OFFICE POLICY
' NAMED CENTER FOR NON-PROFIT LEGAL RENEWAL DECLARATIONS
INSURED SERVICE, INC.
AND PO B08 1586 POLICY NUMBER 02-BP-574750-7
MAILING
ADDRESS MEDFORD, OR 97501 RENEWALOF 02-BP-574750-6 05-93
AGENT BEECHER CARLSON INS AGY LLC
NAME 707 MURPHY RD
POLICYPERIOD FROM 05-15-13 TO 05-15-14 12:01AM ADDRESS MEDFORD, OR 97504
STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE.
FORM OF 36-28302 --(-88) 451-8277
BUSINESS CORPORATION
THE TOTAL PREMIUM DUE FOR THE POLICY TERM IS $1,089.00,
YOU WILL BE BILLED THROUGH YOUR CUSTOMER ACCOUNT 4020-0585-291-01.
YOU NEED NOT PAY ANY PREMIUM AT THIS TIME. WE WILL SEND A BILLING
STATEMENT IN A SEPARATE MAILING.
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU
TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
ADDL INSD-DESIGNATED PERSON ADDL INSD-DESIGNATED PERSON
JACKSON COUNTY CITY OF ASHLAND
PREMISES 001 HEALTH & HUMAN SERVICES DEPT. PREMISES 001 CITY HALL
1005 E MAIN ASHLAND, OR 97520
MEDFORD, OR 97504
THE FOLLOWING FORMS CURRENTLY APPLY TO THIS POLICY:
BP8051(0702) WAIVER OF TRANSFER OF RIGA BP0003(0106) BUSINESSOWNERS SPECIAL COVER.
BP7076(0606) ULTRA PLUS BP7080,(0606) ORDINANCE OR LAW COVERAGE
BP8094(0606) NON-OWNED AUTO LIAB. AMEND. EN BP1203(0106) LOSS PAYABLE PROVISIONS
BP7057(0702) ADDT'L INSD-DESIG.PERSON OR OR BP7059(0105) COMMERCIAL FINE ARTS COV FOR!
_ BP0437(0702) EXCLUSION-PERSONAL & ADVERT. I BP8136(0108) EQUIPMENT BREAKDOWN ENDORSEAP
BP0523(0108) CAP ON LOSSES CERTIFIED ACTS O BP8206(0606) ID RECOVERY COV FOR DEFINE
BPO159(0808) WATER EXCLUSION ENDORSEMEN BP0601(0107) EXCL OF LOSS DUE TO VIRUS
IL7201(0392) COMPANY COMMON POL CONDITIONS BP8068(0702) EXCLUSION -ASBESTOS
_ BP8029(0702) AMENDMENT-AGGREGATE LIMITS OF BP0455(0106) BUSINESS LIAB COV - TENANT
- BP0441(0106) BUSINESS INCOME CHANGES - BP0417(0702) EMPLOYMENT RELATED PRACT. EX
BP0178(0108) OREGON CHANGES BP8128(0502) EMPLOYMENT PRACTICES LIABILI
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(DATE) BY (AUTHORIZED REPRMTATiVE)
9-BP(ti-8B)
t COMPANY USE ONLY
.Inorl~c.cr vq e¢TFEI TN TNCIIRPD MPY PREPARED 03-22-13 CS