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HomeMy WebLinkAboutInsurance Certificate: St Vincent de Paul andy Orr BBNW (2/4) 07/14/2014 02:13:40 PM -070C A OR°® CERTIFICATE OF LIABILITY INSURANCE 7/14/2014 .MMDNYYY) 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). rRODUCER NAME: C Sandy Orr qIC No: (Shc)TT2-3TB5 Brown t Brown Northwest PHC rNd r (541)772-1111 3256 Hillcrest Park Drive .sorr@bbnw.c0m INSURERS AFFORDING COVERAGE NAIDa Medford OR 97504 INSURERAPhiladel hia Indemnity Ins Co 18058 INSURED IN.DRE.R: Rogue Valley District Council St Vincent ]URR de Paul INSURERD: PO BOX 1663 INSURERE: Medford OR 97501 INallaaac COVERAGES CERTIFICATE NUMBER:14-15 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMMDlYYVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES aouovence $ 100,000 A CI-AIMS-MADE Fx~ OCCUR X EPKII87685 /1/2019 /1/2015 MED EXP(Any one Person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 2,000,000 X POLICY PRO- LOL $ AUTOMOBILE LIABNITY Es a¢Benl III LIMI 1,000,000 A X ANY AUTO P4DI Lr n+avn'r (rn PeramO a ALL OWNED SCHEDULED BPK1187685 /1/2014 /1/2015 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED IS HIRED AUTOS AUTOS Peraccidenl PIP-Bask $ X UMBRELLA UAB X nc- FACH nCCnPRFNCF $ 1,000,000 A EXCESSLIAB 'LAMS41AUt AGGREGAIt $ 1,000,000 DEO X RETENTIONS 10,00 BUB962'38tl /1/2019 /1/2010 $ WORHER]DO MrEN]ATON WC GTATU OTII- ANDEMPLOYERVUABIUTY YIN TORY LIMBS ER ANY PROFRIETORIPAATNERIEXECUTIVEā¯‘ NIA E.L. EACH ACCIDENT $ OFFIOERIMEMBER EXCLUDEO? (Mend MOry In NW) EL. DISEAV` EA EMPLOYE $ a s, desende under DESCRIPTION OF OPERATIONS below EL . DISEASE -POLICY LIMIT $ DGCCRPTON OF OPEMTO NC I LOCATONC 1 VGHICLGC lAeaah ACORD 101, Addi canal Romarka Cehodule, N more opaca Is npul red) The City of Ashlandr its officers, officials, agents, volunteers and employees are additional insureds as ra~pcu La General Liabili Ly wheu rcyuircd by wri LLeu ayree_IUCUL pec aLLnultnd cndurseuuettL. TIU. Lurlu is subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION (541)552-2059 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 E Main Street Ashland, OR 97502 AUTHORIZED REPRESENTATIVE Mikc M s1_zutti/SANDOR ACORD 25 (2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INSOis rtm+0os).01 The ACORD name and logo are registered marks of ACORD >andy Orr BBNW (3/4) 07/14/2014 02:14:37 PM -070( PI-GLD-HS (10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Ovmed Watc rcrak Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $Zu,uou b Medical Payments- Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments - Bail Bonds $5,000 5 Supplementary Poymcnt Loan of Eorningo $1,000 pcr day 6 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement -Janitorial Services Client Coverage $10,000 limit 8 Additional Insured - Newly Acquired Time Period Amended 6 Additional Insured - Medical Directors and Administrators Included 7 Additional Insured -Managers and Supervisors (with Fellow Included 7 Fm In ee Covp.ra a Additional Insured - Broadened-.Named Insured Included 7 Additionallnsured- Funding Source Included 7 Additionallnsured -Home Care Providers Included 7 Additional Insured - Managers, Landlords, or Lessors of Premises Included 7 Additional Insured - Lessor of Leased Equipment Included 7 Additionallnsured - Grantor of Permits Included 8 Additional Insured - Vendor Included 8 Additionallnsured-Franchisor Included g Additional Insured -When Required by Contract Included g Additional Insured - Owners, Lessees, or Contractors Included g Additional Insured - State or Political Subdivisions Included 10 . Page 1 of 12 ncludes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company Tandy Orr BBNW (4/4) 07/14/2014 02:15:26 PM -070C PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards - Included 10 Transfer of Rights of Recovery Against others To Us Clarlncatlon 10 Liberalization Included 11 Bodily Injury - includes Mental Anguish Included i I Personal and Advertising Injury - includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodiiy injury" or property daniadc" cxpeotcd or intended from the ctandpoint of the mcurcd. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I -COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim. we agree to indemnify the Diprnogl inA4`j Pr. t2gi0i0WIKZ.,s§ 1Pg,rlA!L1 ~QPJGacZ9L,~gT.eglp,Ol.I. o%!pc th@.rg&I only applies to rental lease agreements. This coverage is excess over any renters liability insurance of the client. C. Non-Owned Watercraft SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; iiIe!'use-ui-eroodier6_Zfl t- r111S' rr FYL71W1t; S C'i'I.cSS'i'lveT 7lt ryUu?ctI"GBii U"?li ii7 i,1)iiCt,'lRlic°^:~'~" insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I- COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance cervices Office, Inc., with its permission. n 2011 Philadelphia Indemnity Insurance Company