HomeMy WebLinkAboutInsurance Certificate: Rogue Farm Corps
°RO® CERTIFICATE OF LIABILITY INSURANCE °"'E"M" WYYYY)
05I, 42014
014
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 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
certificate holder In lieu of such endorsemen s .
PRODUCER
NAME: Dan Bates Renewals
Evergreen Insurance Managers Inc - P NE 503 259 AJC
-3060 No : 503 259-3065
It MAIL
5293 NE Elam Young Pkwy Ste 160 A
uDRESS: .
INSURER(S) AFFORDING COVERAGE NAIC0
Hillsboro OR 97124 INSURERA: Acce lance Casual Insurance Company- 10349
INSURED
INSURER B
Rogue Farm Corps INSURER C:
PO Box 533 INSURER D :
INSURER E :
Ashland OR 97520 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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.
LTR TYPE OFINSURANCE POLICY NUMBER WDDNYYYI MWDDNYYYI LIMIT
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL UABIUTY PREMISES Ma ox,umIrml $ 100,000
CLAIMS-MADE 19 OCCUR MED EXP(Any one rson 5,000
A Y CLOO106470 06/0912014 06/09/2015 PERSONAL d ADV INJURY $ 1,000,000
GENERALAGGREGATE P 2,000,000
GEM AGGREGATE L!NIT APPLIES PER PRODUCTS - COMP,OP AGO 5 Included
X POLICY PRo- LOC S
I'm AUTOMOBILE LABILITY COMBINED SINGLE LIMIT
I P ANY AUTO BODILY INJURY (Pm person) $
ALL OWNED SCHEDULED BODILY INJURY (Px A nt) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIREOAUTOS AUTOS flPeremxIent)
S
UMBRELLAUAB~ EACH OCCURRENCE S
EXCESS WLB CIMMa-MADE AGGREGATE
DED RETENTIONS S
WORKERS COMPENSATION WC STATU- OTH-
ANDEMPLOYERS'LABIUTY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE❑NIA E.L. EACH ACCIDENT $
O
JM&ndatM FFICERRAEMB In N)o H)
EXClUOEDT E.L. DISEASE - EA EMPLOYE $
OFFIC IM
U yea, JIB9nJIEB urlmr
DESCRIPTION OF OPERATIONS neb E.L DISEASE - POLICY LIMIT S
-'DESCRIPTAHvFOFERATiO1JSl:OCATON&I VLNICLSS.1Ataeh ACODO ~D".,A22MOr..1 Rem:da 8<hedu~e, !!mom spots la mRUlradl _
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
The City of Ashland, its Officers and Employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Finance Dept Attn: DL Tuneberg, Director ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St AUTHORIZED REPRESENTATIVE
Ashland OR 97520
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