HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Manor Community SRVCs
A o® CERTIFICATE OF LIABILITY INSURANCE ° 12/1" /22013"
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
t ~TELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
tEPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. N SUBROGATION IS WANED, 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 I
certificate holder In lieu of such endomeme a .
PRODUCER ~E T Underwriting Associate
Caring Communities Shared Services LTD
FAX
1850 W. Winchester Road ;V.NN . EN: 847-549-8225 /qc, 44 847-549-8095
Suits 109 ADDRESS: Cerbfiwtes@cadngcomm.org
Libertyville IL 80048 NAIC#
INSURERS AFFORDING COVERAGE
INSURED Padfic Retirement Services Inc. INSURER A Cadng Communities, A Recipro al RRG 12373
Rogue Valley Manor Community Services Inc. INSURER B:
1045 Ellendale Drive INSURER C:
Medford OR 97504 INSURER tx
INSURER E
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 ADD'L SUBR POUCY NUMBER POUCYEFF POLICY EXP UMne
LTR IN9R YND MWO (MMODYYYY0
GENERAL LIAMI-n ! EACH OCCURRENCE f 1,000,00000
CCRRRG-0015-14 01/012014 01/01/2015 DNAAGE TO RENIFD
A X COMMERCUL GENERAL LIPBILRV X $ 300,000.00
PREMISED (lEs c.I,
X CI.VMSMADE ❑ OCCUR MED EXP (My caw pe.r) 3 -
X Professional Liability PERSONAL. S ALN INJURY s 1,000,000.00
X Retm Date 01/012002 GENERAL AGGREGATE $ 3,000,000.00
GENLAGGREGATEUMITAPFUESPER: PRODUCTS-COMPNP AGO f ind
X PpJCY PR0. LOC 3
COMBINEDSINGLEUMIT 3
AUTOMOBILE 1M1B611Y soddeM
ANVAIJIO BODILY INAIRY(Per penan) S
A.A. OWNED H SCHEDULED BODILY INJURY (PM ecJderlg 3
AUTOS AUIOS
NONOV0NED PROPERTY QAmGE 3
HIRED AlTTO3 AUTOS (Pet amd
s
EXCESS I ums LA UABIUly EACH OCCURRENCE f 10000000.00
A UMBRSUAUAS =UR X CCRRRG-0015-14 01/012014 01/01/2015 AGGREGATE $ 15,000,000.00
X EXCESS LIAR X CLAIMS MADE $
$
DEDLIc nBLE f
RETENTION 3 f
NroRNERS CGMPENSATIIXI me M STAT 0.L
EMPLOYERS. UABIRY YIN TORY UMns ER
ANY
OFFILEPROFRI(UMEMBERBER E XCLUDm USDE,Ei ACCI.XECUINE ❑ EL EACH DHTNT S.
m,orsNNNt EL DISEASE-EA EM0.0VFF i
0EeuMM
S PECOewlECUL PROVISIONS MIVA EL DISEASE-POLJCY l1MR f
OTHER 07/072074 $2,000,000 EACH OCCURRENCE
A EXCESS PROFESSIONAL X CCRRRG-0015-14 01/012015 $2000,000 AGGREGATE
LIABILITY FL, LA, AR SUBLIMIT (INCLUDED IN EXCESS LMTS ABOVE)
DESCRIPTION OF OPERATIONS I LOCAMNS /VEH1=5 I EXCLUSIONS AUDW BY ENDORSEMENT] SPECML PROVISIONS
12/1912013 20:17:46
The Certificate Holder is in duded as an Additional INSURED under Nis POLICY but only with respect to liability arising out of services tendered by the Named INSURED as
outlined within Ne terms and conditions of the contractual agreement for the Faster Grandparent program between the City of Ashland and the Named INSURED.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland OR 97520
AUmOR~D REPRESENTATIVE -
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