HomeMy WebLinkAboutInsurance Certificate: CASA of Jackson County (2)
StateFarm
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State Farm Fire and Casualty Company
A Stock Company with Home Offices in Bloomington, Illinois
Herein called the Insurer
DECLARATIONS PAGE
NOT-FOR-PROFIT ORGANIZATION LIABILITY POLICY
INCLUDING EMPLOYMENT PRACTICES LIABILITY COVERAGE
Policy No: PS0000000306511
Renewal of Policy No: PS0000000306510
NOTICE: THIS IS A CLAIMS-MADE POLICY. THIS POLICY, SUBJECT TO ITS TERMS, APPLIES
ONLY TO CLAIMS FIRST MADE DURING THE POLICY PERIOD OR ANY EXTENDED REPORTING
PERIOD THAT MAY APPLY.
This Declarations Page along with the completed and signed Application including attachments, and the
Policy Form and Endorsements listed in Item 6., shall constitute the contract between the Insureds and
the Insurer.
Item 1. Parent Organization: CASA of Jackson County, Inc.
Address: 613 Market Street
Medford, OR 97504
Item 2. Policy Period:
Effective Date: December 2, 2013 Expiration Date: December 2, 2014
(12:01 A.M. Standard Time at the Address stated in Item 1.)
Item 3. Limit of Liability: $2,000,000 in the Aggregate.
Item 4. Retention: $1,000 each Claim.
Item 5. Premium: $1,881.00
PSNP1000(07/01) Page 1 of 2
Item 6. Policy Form and endorsements made part of this Policy at the time of issuance:
PSNP1001(01/01) Not-For-Profit Organization Liability Policy Including Employment
Practices Liability Coverage
Certified Acts of Terrorism Endorsement
PSNP1008(01/01) Adoption or Foster Care Services Exclusion
1/02F71 Oregon Amendatory Endorsement
Item 7. Notices to the Insurer - All notices to the Insurer pertaining to this Policy must be sent to:
State Farm Specialty Products
111 North Canal Street, Suite 940
Chicago, IL 60606-7201
Date of Issue: October 2, 2013 By:
Authorized Represents
PSNP1000(07/01) Page 2 of 2