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CERTIFICATE OF LIABILITY INSURANCE '7/11/2014 /YYYY)
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(les) 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 endorsements .
PRODUCER CONTACT Julie Asher
NAME:
Ashland Insurance Inc PHONEI . (541)482-0831 Fax .(541)488-5851 UVC 585 A Street Suite 1 - .jaeher@ashlandinsurance.com
P. 0. BOX 880 INSURERS AFFORDING COVERAGE NAICa
Ashland OR 97520 INSURERA.Mutual of Enumclaw 14761
INSURED
INSURER B:
COMMUNITY HEALTH CENTER INSURER C:
19 MYRTLE ST - INSURER D:
INSURER E
MEDFORD OR 97504 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL346404821 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.
ILTR TYPE OF INSURANCE ADDL U R POLICY EFF POLICY EXP
POLICY NUMBER MI UNITS
GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY 300,000
PREMISES aoavrmnce S
A CLAIMS-MADE a OCCUR X PP0006632 /1/2014 /1/2015
MED EXP me parson S 10,000
PERSONAL S ADV INJURY $ 1,000,000
GENERAL AGGREGATE S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO S 2,000,000
X POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accidentANY AUTO BODILY INJURY (Par person) S
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident$
X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000
A EXCESS LUIS CLAIMS-MADE AGGREGATE S
DED X RETENTIONS 10,00 0003488 /1/2014 /1/2015 S
WORKERS COMPENSATION W C STATU- OTH-
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER,EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. EACH ACCIDENT $
(Mandatory in NH) E.L. DISEASE- EA EMPLOYE $
If yes, desaibe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Renard, Schedule, if mom space is required)
Certificate Holder Is an Additional Insured.
CERTIFICATE HOLDER CANCELLATION
campost@ashland.or.us 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.
Its Officers, Employees 6 Agents
Bryn Morrison AUTHORIZED REPRESENTA E
20 E Main St
Ashland, OR 97520
VI-4-
Julia Asher v
ACORD 25 (2010105) 19"-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005) ,01 The ACORD name and logo are registered m s of ACORD