HomeMy WebLinkAboutInsurance Certificate: Sustainable Valley Technology Group
BBL' POLICY NUMBER ' PRODUCER N1gIBER ; ..ACCOUNT NUMBER AUDfT PERIOD"
D PPS 04r.62179 02345338 F000746773-001-00001 ANNUAL
s BRANCH GR GRAND RAPIDS EFF 03/03/2014
FOREMOST
INSURANCE GROUP
FOREMOST SIGNATURE INSURANCE 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
NAMED INSURED AND MAILING ADDRESS AGENCY NAME AND SERVICING ADDRESS
SUSTAINABLE VALLEY TEOINOLOGY GROUP REINHOLDT 8 O'HARRA INSURANCE
PO BOX 1075 518 WASHINGTON ST
MEDFORD OR 97501 ASHLAND OR 97520-1682
(541) 482-1921
s_• BRANCH NAME AND SERVICING ADDRES POLICY PERIOD i'
GRAND RAPIDS FROM TO
PO Box 2248 03/03/2014 03/03/2015
Grand Rapids, MI 49501-2248 12:01 A.M. 1201 AM
Standard Time At Your Mailing Address Shown Above
U INES ENTITY: NOT FOR PROFIT ORGANIZATION
BUSINESS DESCRIPTION: NON-PROFIT OFFICE RISK - WITH EVENT SPONSORSHIP
POLICY PIEMIUMS
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 f 231.00
COMMERCIAL GENERAL LIABILITY COVERAGE PART $ 509.00
TERRORISM PREMIUM S 10.00
TOTAL ANNUAL PREMIUM E 750.00
Countersigned by
Authorized Representative Date
mcl,d- aopy,ighied material of ISO Propenks, Inc, -6 iU permission.
01/28/2014
Copyright ISO Properties, Inc., 2001
COMMON INSURED'S COPY U-CL-D-100-A Cw (06-D4)