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HomeMy WebLinkAboutInsurance Certificate: Community Works Dn YYV, 711712 (MIND A`oRO® CERTIFICATE OF LIABILITY INSURANCE DAM 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(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 endorsement(s). PRODUCER Brown & Brown Northwest NAM Sandy L. Orr FAX INC. Md. ExUL_ 541-494.2687 INC Net; 541-494-2787 3256 Medford, Park Drive PHONE Medf, OR 97504 E-MAIL ADDRESS(-_-_Sprr®bbnw_com INSURER(S) AFFORDING COVERAGE NAIC# wwVi.bbnw.com _ INSURER A: Alliance of Nonprofits for Insurance INSURED INSURER B : Community Works 201 W Main, Suite 3D NSURER C: Medford OR 97504 INSURER O: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 20817157 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. _ INS I TYPEOFINSURANCE rAODLisUBR POLICY NUMBER MMIDDY EFF MM."DYIWYY LIMITS A COMMERCIAL GENERAL LIABILITY I' V 2014-19517 7/1/2014 711/2015 EACH OCCURRENCE $ 1,000,000 A N PREMI ES Ee oawranca S CLAIMS-MADE 5/1 OCCUR 100,000 ~~.Professional Liability _ _MEO ExP(Am we peson)_ Is 10,000 I~✓ J Abuse & Molestation _ PERSONAL S ADV INJURY I S 1,000,000 G~ATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 IG-EN,'L AGGREI" ECT I POLICY PRO LOC I PRODUCTS - COMP/OP AGG S 2,000,000 ~ I OTHER: I S A I AUTOMOBILE LIABILITY i 12014-19517 7112014 7/112015 EOM~BINd Dt SING LE LIMIT S 1,000,000 L,/ i ANY AUTO I BODILY INJURY (Par person) $ ALL OWNED SCHEDULED BODILY INJURY $ (Per accident, $ AUTOS AUTOS ( NON-OWNED I i PROPERTY ecade DAMAGE _I HIRED AUTOS i i AUTOS I i t S ;UMBRELLA LIAR I IOC CUR I I EACH OCCURRENCE $ I AGGREGATE S F EXCESS DAB CIAIMSMADE DED RETENTIONS I I $ (WORKERS COMPENSATON STATUTE 0H. 4 AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORFARTNER/EXECUTIVE I I E, L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED' NIA( (Mandatory in NH) I ( E.L. DISEASE - EA EMPLOYEE S (DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT I S I i • DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Addidonal Ramarka Schedule, may ba attached Ir mere apace le regelndI All operations of the Named Insured as provided under the policy terms, conditions & exclusions. General Liability coverage includes Blanket Additional Insured coverage as required by written contract per endl CG 20 26 07104 (Attached). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: FINANCE ACCORDANCE WITH THE POLICY PROVISIONS. 20 EAST MAIN STREET ASHLAND OR 97520 AUTHORIZED REPRESENTATIVE Sand L. Orr © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 20817157 Sandy L. Orr 7/~/3014 9:38:16 AN (PDT) Page 1 of 2 POLICY NUMBER: 2014-19517 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or ..personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 O CERT NO. 220811157 Sandy L. Orr 7/`/2014 9:29:16 Av, (PDT) Page 2 0- 2