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HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Child ACOW& (MM I CERTIFICATE OF LIABILITY INSURANCE 6/25/ D/25/2m01D/Y4 4 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 CONTACT NAME: Peggy MacMillan JD Fulwiler S Co. Insurance, Inc. PHONE . (503)293-8325 FA% .(503)293-5918 5727 SW Macadam Ave AEpMpAg'ELSS.pmamillan@jdfulwiler.com PO Box 69508 INSURER(s) AFFORDING COVERAGE NAIC 0 Portland OR 97239 INSURER A'Alliance of Nonprofits for Ins 10023 INSURED INSURERB:Saif Corporation 6196 Family Solutions, DBA: Southern Oregon Child INSURERC: 1836 Fremont $t INSURER D: INSURER E Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:14/15 General Use 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 UB LTR TYPE OF INSURANCE POLICY NUMBER MM/DDYANNEFF Y IMMIDDfYYYYI DY EXP LIMITS NERAL LIABILITY PR MI ES Eaoccunn $ 500,000 ce) LAGGREGATE EACH OCCURRENCE $ 1,000,000 E ❑X OCCUR 01421304 /1/2014 /1/2015 MED EXP(Any one person $ 20,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 MIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3,000,000 O LOC $ LE LIABILITY EOMBINdEeDt INGLE LIMIT 1 OOO OOO A A NY AUTO BODILY INJURY(Par person) $ POMOBI ALL OWNED SCHEDULED 01421309 /1/2014 /1/2015 ( ) AUTOS AUTOS BODILY INJURY Per accident $ HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS _ P accident) $ X UMBRELLA LIAB $ Underinsured motorist S 1,000,0001 OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTIONS 10,00 0142130413M3 /1/2014 /1/2015 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LABILITY Y I N $ ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? MIA (Mandatory in NH) 998536 /1/2019 /1/2015 E.L. DISEASE - EA EMPLOYE $ 500,000 If yyes, descdb0 under - DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 A Professional Liability 01421304 /1/2014 /1/2015 Occurrence Lmit $1,000,000 Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ANach ACORD 101, Additional Remarks Schedule, If more apace la required) The City of Ashland, its officers, and employees are included as additional insureds with regard to operations of the named insured in accordance with the policy terms, conditions, and exclusion. All operations of the named insured subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORRED REPRESENTATIVE P MacMillan/TMAYDA ms=s-.G~a y'~~l ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).D1 The ACORD name and logo are registered marks of ACORD Additional Named Insureds other Named Insureds Josephine Child Resources Southern Oregon Child Resources Southern Oregon Child Study 6 Treatment Center (for Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC