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HomeMy WebLinkAboutInsurance Certificate: Ashland Supportive Housing & Community Outreach D14" AcoRO® CERTIFICATE OF LIABILITY INSURANCE 1/2DATE,MM/D 9/2014 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). PRODUCER CONTACT Wauneta Ohnmacht NAME: Bliss Sequoia Insurance PHONE (503) 364-5401 FAX P.O. Sox 826 E-MAIL . wauneta0blissinsurance. cots INSURER(S) AFFORDING COVERAGE NAIL R Salem OR 97308 INSURER A:Philadel hia Indemnity Ins. Co. INSURED INSURERE:Saif Corporation 6196 Ashland Supportive INSURER C: Housing 6 Community Outreach INSURER D: PO BOX 3536 INSURER E: Ashland OR 97520-0318 INSURER F: COVERAGES CERTIFICATE NUMBER: (14-15) 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 INSURANCE ADDLSUSR POLICY NUMBER PM/LD ICYEFF POLICY UP LIMITS GENERAL LIABILITY EACH OCCURRENCE f 1,000,000 X: COMMERCIAL GENERAL LIABILITY DAMAGE TO R PREMISES lEa EN TED f 1,000,000 A CLAIMS-MADE ❑OCCUR X, HPK1125291 /1/2014 /1/2015 MED UP(Any we Person) f 20,000 PERSONAL S ADV INJURY E 1,000,000 GENERAL AGGREGATE E 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG E 3,000,000 F FC X LOC f 1-1 POLICY PRO AUTOMOBILE LIABILITY C (Ea OMBIN dEeD SINGLE LIMIT 1 000 000 A X. ANY AUTO BODILY INJURY (Per person) E ALL OMED SCHEDULED HPK1125291 /1/2014 /1/2015 BODILY INJURY (Per acciden) f AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per 'de Undere,surad motorist f X UMBRELLA UAB K OCCUR EACH OCCURRENCE E 1,000,000 A EXCESS LIAe CLAIMS-MADE AGGREGATE E 1,000,000 DED X RETENTIONf 10,00C I SUH447643 /1/2014 /1/2015 E B WORKERS COMPENSATION VYC STATU- OTM- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECU➢VE E.L. EACH ACCIDENT E 11000,000 OFFICEWMEMSER EXCLUDED? ~ N/A 76721 /1/2013 /1/2016 (Mandatory In NH) E.L. DISEASE- EA EMPLOYE E 1'000' 000 It yea, deernbe under DESCRIPTION OF OPERATIONS below E.L. DIEEABE-POLICY LIMIT E 1,000,000 A PROFESSIONAL LIABILITY HPK1125291 /1/2014 /1/2015 1,00),000 PER OCCURRENCE 3,000,000 AGG ABUSE/MOLESTATION 1,000,000 PER OCCURRENCE 1,000,000 A DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, N more space is required) The City of Ashland, its officers, and employees are additional insureds as respects work performed on its behalf by the named insured as required by contract. CERTIFICATE HOLDER CANCELLATION (541) 552-2059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORU:ED REPRESENTATIVE off ' Lance Barnwell/NETA ACORD 26 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD