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HomeMy WebLinkAboutInsurance Certificate: Southern Oregon University A~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM ODYYY~ 7/14/2014 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 NAME: Anita Bruner Arthur J. Gallagher Risk Management Services, Inc. PHDNE 303 889-2574 FAX .303 889-2575 Ent, - WC - 6399 S. Fiddler's Green Cir., anitabruner@ajg.com Suite 200 E MaL Greenwood Village CO 80111-4949 INSURERS AFFORDING COVERAGE NAIC# INSURERA:United Educators Ins 10020 INSURED PUBLUN I-01 INSURERS: Southern Oregon University INSURERC: 1250 Siskyou Blvd Ashland, OR 97250 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1482765055 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIUD IMMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE 71OCCUR PREMISES Ea occurrence $ MED EXP (My one person S PERSONAL B ADV INJURY $ GEN-L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY PRO- JECT F-] LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE llA&LITY Ea accident $ ANY AUTO BODILY INJURY (Per Person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED DAMA $ HIRED AUTOS AUTOS Per accident S A UMBRELLA LIAR X OCCUR GLX20140D468800 11/2014 /1/2015 EACH OCCURRENCE $5.000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 OED X RETENTION$1,000,000 $ WORKERS COMPENSILTION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTNE ❑ M/11 E.L. EACH ACCIDENT $ OFHCERILIEMBER EXCLUDED? (Mandatory I. NH) E.L. DISEASE- EA EMPLOYE $ If yes, demob a under DESCRIPTION OF OPERATIONS We E.L. DISEASE - POLICY LIMIT $ DESCM"ON OF OPERATIONS I LOCATIONS / VENICLES (ACORD 101, Addltlaul Remarlu ScMdYM, maY M efmcMd if mare epees b requirp0 This certificate holder, its officers, directors, agents and employees is named as "additional insured" with respect to their interests, to the extent Public Universities Risk Management and Insurance Trust can indemnify the certificate holder, subject to Article XI, Section 7 of the Oregon Constitution, the Oregon Tort Claims Act (ORS 30.260-30.300), ORS 351.086, and ORS 352.138, but only with respect to liability arising out of the negligent or wrongful acts or omissions of the member institutions of the Public Universities Risk Management and Insurance Trust and their governing boards. Excess Liability includes General Liability, Liquor Liability and Auto Liability. See Attached... 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, its agents directors, officers, ACCORDANCE WITH THE POLICY PROVISION& employees and volunteers 20 East Main Street AUTHORIZEDREVRESOnATNE Ashland OR 97520 USA ~~/,.a•`.` XA~ O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 001307 AGENCY CUSTOMER ID: PUBLUNI-01 _ LOC '4 Q® ADDITIONAL REMARKS SCHEDULE Pagel of 1 AGENCY NAMEDINSURED Arthur J. Gallagher Risk Management Services, Inc. Southern Oregon University raucr NUrneER 1250 Siskyou Blvd Ashland, OR 97250 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Evidence of insurance for permanent university street pennants. ACORD 101 (2008101) m 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 001307 Version Date: 7-1-14 EVIDENCE OF SELF-INSURANCE ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Public Universities Risk Management and Insurance Trust CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT P.O. Box 751, PURMT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY Porlland,OR 97207 PUBLIC UNIVERSITIES RISK MANAGEMENT AND INSURANCE TRUST SELF-INSURANCE LIABILITY PROGRAM. COVERAGE AFFORDED BY PUBLIC UNIVERSITIES RISK MANAGEMENT AND INSURANCE TRUST INSURED: PUBLIC UNIVERSITIES RISK MANAGEMENT AND INSURANCE • Public Universities Risk Management - Portland State University TRUST IS SELF-INSURED FOR TORT LIABILITY UNDER and Insurance Trust - Southern Oregon Universty ORS 351.096 AND ORS 352107. ALL CLAIMS MUST BE - Oregon University System • University of Oregon FILED WITH PUBLIC UNIVERSITIES RISK MANAGEMENT AND • Eastem Oregon University • Western Oregon University • Oregon Institute of Technology INSURANCE TRUST FOR PROCESSING IN ACCORD WITH - Oregon State University STATUTORY REQUIREMENTS. • Oregon Universry System Chancellor's Office • University Shared Services Enterprise COVERAGE THIS IS TO CERTIFY THAT PUBLIC UNIVERSITIES RISK MANAGEMENT AND INSURANCE TRUST IS SELF-INSURED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF THE PROGRAM AND OREGON LAW. POLICY EFFECTIVE EXPIRATION LIMITS NUMBER DATE DATE GENERAL LIABILITY O General liability Self-Insured 7/1/2014 7/1/2015 $1,000,000 G) Occurrence AUTOMOBILE LIABILITY © Any Auto ❑ All Owned Autos Self-Insured 7/1/2014 7/112015 ❑ Scheduled Autos $1,000,000 © Hired Autos © Non-owned Autos OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLE/SPECIAL ITEMS: Please refer to attached certificate. EVIDENCE HOLDER: AUTHORIZED REPRESENTATIVE. Please refer to attached certificate. Public Universities Risk Management and Insurance Trust Ellen S. Hgfard. ARM. CIFO'- " Ad mesaatdr MaAR Refer to attached certificate Date Issued 001307 Arthur J. Gallagher Risk Management Services, Inc. 6399 S. Fiddlers Green Cir., #200 Greenwood Village CO 80111-4949 USA o City of Ashland, its agents directors, officers, employees and volunteers w 20 E Main St 0 Ashland OR 97520-1814