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HomeMy WebLinkAboutInsurance Certificate: Pacific Retirement Services Inc 4 Rte' CERTIFICATE OF LIABILITY INSURANCE °"02/042° 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 pollcy(ies) must be endorsed. N 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 endorsementls). PRODUCER CONTACT NAME UOtleNJTIIlO9 Associate ' Caning Communities Shared Services LTD PHONE 1850 W. Winchester Road 'C Re E.) 847-549-8225 ac. No): 847-549-8095 Suite 109 E-MAIL Certificates Garin mmm.o ADDRESS: g rg Libertyville IL 60048 INSURERS AFFORDING COVERAGE NAIC # INSURED, Pacific Retirement Services Inc. INSURER A: Canng Communities, A Reciprocal RRG 12373 Community Volunteer Network INSURER 8'. 1045 Ellendale Drive INSURER C: Medford OR 97504 INSURER D. 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 POLICY NUMBER POLICYEFF POLICY UP LIMna LTR INSR were MMID MMIODIYYYY GENERALUABILITY EACH OCCURRENCE $ 1000000.00 CCRRRG-0015-14 01/01/2014 01101/2015 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY X PREMISES Es ocwrre,ce $ 300,000.00 X CLAIMS MADE F-1 OCCUR MEDEXP (Anyoneperson) $ X Professional Liability PERSONAL A ADV INJURY f 1,000,000.00 X Retro Date 01/0112002 GENERAL AGGREGATE s 3,000,000.00 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP ADD s Inc[ X POLICY PRO- LOC $ IFCT AUTO MOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY (Per person) S ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S HIREDAUTOS NON-0WNED PROPERTY DAMAGE $ AUTOS (Para dent S EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 01/01/2015 10000000.00 A UMBRELIALIAS OCCUR X CCRRRG-0015-14 01/01/2014 AGGREGATE $ 15 000 000.00 X EXCESS LIPS X CLAIMS MADE S f DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERa'DABIMTY YIN TORY LIMITS ER ANY PROPRIETOWPARTNERIEXECLITIVE ❑ OFFICERRAEMBER EXCLUDED? EL EACH ACCIDENT E (Manddre, In NH) EL DISEASE - EA EMPLOYEE S If yea, describe under SPECIAL PROVISIONS balm E. L. DISEASE - POLICY LIMIT $ OTHER $2,000,000 EACH OCCURRENCE A EXCESS PROFESSIONAL X CCRRRG-0015-14 01/01/2014 01/01/2015 $2000,000 AGGREGATE LIABILITY FL, LA, AR SUBLIMIT (INCLUDED IN EXCESS LMTS ABOVE) DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECLLL PROVISIONS 02/04/2014 14:04:00 The Certificate Holder is induded as an Additional INSURED under this POLICY but only with respect to liability arising out of services rendered by the Named INSURED as outlined within the terms and conditions of the conbadual agreement for the Foster 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 AUTHORIZEDREPRESEHTATIVE ACORD 25 (2010105) © 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD