HomeMy WebLinkAboutInsurance Certificate: Sustainable Valley Technology Group
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Et D PPS 04682178 02345338 M019880848-001-00001 ANNUAL
BRANCH ST BRANCH TBD - NC RENEWAL EFF 03/03/2013
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MARYLAND CASUALTY COMPANY
COMMON POLICY DECLARATIONS
PRECISION PREMIER
INSTITUTIONAL PROGRAM
This policy consists of the declarations as well as the coverage forms and endorsements
listed on the Forms and Endorsements Applicable List
NAME ANDSERVICING ADDRESS
NAMED INSURED AND MAILING ADDRESS AGENCY
SUSTAINABLE VALLEY TECHNOLOGY GROUP REINHOLDT 8 O HARRA INSURANCE
PO BOX 1075 518 WASHINGTON ST
MEDFORD OR 97501 ASHLAND OR 97520-1682
(541) 482-1921
BRANCH NAME AND SERVICING ADDRESS POLICY PERIOD
BRANCH TBD - NC FROM TO
PO Box 2248 03/03/2013 03/03/2014
_ Grand Rapids, NI 49501-2248 12:01 All 1201 A.M.
(800) 800-3907
Standard Time At Your Mailing Address Shown Above
BUSINESS ENTITY: NOT FOR PROFIT ORGANIZATION
BUSINESS DESCRIPTION: NONPROFIT OFFICE RISK - WITH EVENT SPONSORSHIP
POLICY PREMIUMS
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.
This policy consists of the following coverage parts for which a premium is indicated. This
premium may be subject to adjustment
PREMIUM
COMMERCIAL PROPERTY COVERAGE PART S 174.00
COMMERCIAL GENERAL LIABILITY COVERAGE PART $ 569.00
TERRORISM PREMIUM S 7.00
3 ' TOTAL ANNUAL PREMIUM $ 750.00
n
ry Countersigned by
Authorized Representative Date
Includes copyrighted mereria of ISO Properties, Inc., with its permission. 01 /27/201o
Copyright, ISO Properties, Inc., 2001
COMMON INSURED'S COPY U-a-D- t 00-A cw (06-era)