HomeMy WebLinkAboutInsurance Certificate: Mediation Works
A_ ROB CERTIFICATE OF LIABILITY INSURANCE °10102/20D a"'
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 C NTAC
Jon Snowden State Farm Insurance NAME• Jon Snowden
420 Bridge St PRONE No. EXIII, 541 482-2461 A/C No: 452 4957
aOORess: on Onsnourden.com
O Ashland, OR 97520
INSURERS AFFORDING COVERAGE NAIC>r
Li INSURER A : State Farm Fire and Casual Company 251143
INSURED MEDIATION WORKS, A COMMUNITY INSURER B:
DISPUTE RESOLUTION CENTER INSURE RC:
33 N CENTRAL AVE STE 219 INSURER D :
MEDFORD OR 97501-5939 INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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 OF-SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRA POLICY EFF POLICY EXP IAllTS
LTR TYPE OF INSURANCE POLICY NUMBER DD MMIDDi'YYYY
A GENERAL LIABILITY
Y 97-BG-9222-6 0313112014 03/31/2015 EACH OCCURRENCE S 1,000,000
DAMAGE r0_ff9IqTEI3_
X COMMERCIAL GENERAL LIABILITY PREMISES Eaocaxrence S 300,000
CLAIMS-MADE 7x 1 OCCUR MED EXP (Any one person) S 5,000
PERSONAL & ACV INJURY S
GENERAL AGGREGATE $ 2,000,000
GGEERL AGGREGATE LIMIT APPLIES PER'. f PRODUCTS - COMPIOP AGG S
X I POLICY PRO- LOC S
COMNED a accident IN LE LIMIT $
AUTOMOBILE LL481UTY ~ E
ANY AUTO BODILY INJURY (Per person) S
ALL OWNED SCHEDULED BODILY INJURY (Per acddent) $
AUTOS NAUTOS
ON OWNED PROPERTY DAMAGE S
HIRED AUTOS AUTOS Per ccident
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEC) RETENTIONS S
WORKERS COMPENSATION 1n S- ATU- TH-
AND EMPLOYERS' LJABILITY YIN IMT R
ANY PROPRIETOR/PARTNER/EXECUTIVE EACH ACCIDENT S
OFFICEIMEMBER EXCLUDED? NIA ❑
(mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
E L, DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONqbAlow DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (AttaM ACORD 101, Additional Remarks Schedule, If more space Is required)
Business - Office
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND ITS OFFICERS, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
EMPLOYEES & AGENTS ACCORDANCE WITH THE POLICY PROVISIONS.
20 E MAIN ST
AUTHORIZED RES
ASHLAND, OR 97520-1850
198 - 1 d ACORD CO PORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered arks f A RD 1001486 132849.7 03-01-2012