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HomeMy WebLinkAboutInsurance Certificate: Mediation Works Av CERTIFICATE OF LIABILITY INSURANCE 008/01/2013 rrl 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(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)- PRGDuc' Jon Snowden State Farm Insurance NAME°CT Jon Snowden PHONE X 420 Bridge St fA&.No Eat)L(541 482-2461 FaC No: 541 482-4957 E-MAIL Ashland, OR 97520 ADDRESS: ion@jonsnowden.com a INSURER(S) AFFORDING COVERAGE NAIC a INSURER A : Slate Farm Fire and Casualty Company 25143 INS I URED MEDIATION WORKS, A COMMUNITY INSURER B: DISPUTE RESOLUTION CENTER INSURER C: 33 N CENTRAL AVE STE 219 INSURER D: MEDFORD OR 97501-5939 INSURERE: NSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMADD/YYYY LIMITS A GENERAL LIABILITY ❑ 97-BG-9222-6 03131/2013 03131/2014 EACHOCGURRENCE S 1,000,000 1-1 X COMMERCIAL GENERAL LIABILITY PREMISES E. omurrance 5 300,000 CLAIMS-MADE ~ I OCCUR MED EXP (Any one parson) E 5.000 PERSONAL B ADV INJURY S _ GENERAL AGGREGATE 5 2,000,000 GEN'L AGGREG~AT7E LIMIT APPLIES PER PRODUCTS-COMPIOP AGG 5 X POLICYr PRO- LOC I S AUTOMOBILE LIABILITY ❑ ❑ COMBrurnmL NGLE LIMIT - Ea accident 1 $ 1_000,000 ANY AUTO BODILY INJURY (Pm person) I $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aaitlanp S _ HIREDAUTOS NONOWNED PROPERTY DAMAGE AUTOS Per a.dent S 5 UMBRELLA LIAR OCCUR H~H EACH OCCURRENCE $ EXCESS LIAB CI-AIMS-MADE AGGREGATE $ _ OED RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN DRY LIMITS R ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEIMEMBER EXCLUDED? ❑NIA❑ E. L. EACH ACCIOENE S (Mandatary In NH) E. L. DISEASE - EA EMPLOYE S Ryes, describe under E. L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space is required) - Business - Office CERTIFICATE HOLDER CANCELLATION City of Ashland Its Officers, Employees & Agents SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012