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HomeMy WebLinkAboutInsurance Certificate: Multicultural Association of Southern Oregon MULTI-5 OP ID: JG CERTIFICATE OF LIABILITY INSURANCE 0 D512712011'Y) sn7/zola 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(ies) 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 Phone: 541-479-2667 CONTACT NAME: Redwoods Leavitt Ins. Agency Fax: PHONE FA% CA Lic #OC66788 A/C No EM : NC No 122 NE Beacon Dr. E-MAIL Grants Pass, OR 97526 ADDRESS: Samantha Fedosky INSURER $ AFFORDING COVERAGE NAIC a INSURER A: Philadelphia Insurance Company 18058 INSURED Multicultural Association INSURER B: of Southern Oregon PO Box 67 INSURER C: Medford, OR 97504 INSURER D: INSURER E : INSURER F: 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 ADDL SUER POLICY EFF POLICY UP POLICY NUMBER MWDDIYYri MM INSR -Mau LTR IDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PHPK1173585 0610112014 061011201$ NTED 100,00 PREMISES Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 6,00 PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NAUTOS ON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Pereccident $ UMBRELLA ME OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DEO RETENTIONS $ LIM WORKERS COMPENSATION WC STATU- OTH- ITORY _ AND EMPLOYERS'LULBILITY YIN... ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICERIVEMBER E%CLUDED7 (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes. da.oe under DESCRIPTION OF OPERATIONS Oeloer E1 . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) This certificate is issued as proof of coverage in regards to General Liability. Event: 4th of July Parade CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE j,~ ~,\wt1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD