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HomeMy WebLinkAboutInsurance Certificate: Planned Parenthood of Southwestern ,4co CERTIFICATE OF LIABILIT F DATE /2015 YYYY) ~ Y INSURANCE 0,/02/20,5 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 CONTACT Marsh USA, Inc. NAME: 1166 Avenue of the Americas PHONE FAX A/C No New York, NY 10036 E-MAIL Attn: healthcare.accountscss@marsh.com Fax: 212-948-1307 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 109210-NIP-CAS-15-16 EUG,O GL INSURER A : New Hampshire Insurance Company 23841 INSURED INSURER 0: N/A N/A PLANNED PARENTHOOD OF SOUTHWESTERN OREGON, AN AFFILIATE OF PLANNED PARENTHOOD INSURER C : FEDERATION OF AMERICA, INC. INSURER D : 3579 FRANKLIN BLVD. EUGENE, OR 97403 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-006658311-05 REVISION NUMBER:3 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 AD ME SU8R LTR TYPE OF INSURANCE POLICY NUMBER MM DD/YYYY MM DD/YYYY LIMITS A GENERAL LIABILITY 082695195 01/0112015 01/0112016 EACH OCCURRENCE $ 1,000,000 X DAMAGE T RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000 CLAIMS-MADE 1~1 OCCUR MED EXP (Any one person) $ X SIR: $100,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _4ED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN IQBY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: PPSO'S ASHLAND HEALTH CENTER - THE GET YOURSELF TESTED! (GYT) PROGRAM WILL PROVIDE FREE SEXUALLY TRANSMITTED INFECTION (STI) TESTING, COUNSELING, AND TREATMENT COORDINATION FOR YOUTH AGES 25 AND UNDER AT PPSO'S ASHLAND HEALTH CENTER. TARGET GROUPS FOR THIS PROGRAM INCLUDE YOUTH AGES 20-25, MEN, AND LGBTQ YOUTH. CITY OF ASHLAND IS INCLUDED AS ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: DAVE KANNER, CITY ADMINISTRATOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Ricki Fitzsimmons f- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD