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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Council of Governments AC~ ® DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 1/8/2015 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 Marcy Baker NAME: y Ward Insurance Agency PHONE (541) 687-1117 FAX (541)342-8280 PO Box 10167 AE-pmpA'kss.marcy@wardinsurance.net INSURERS AFFORDING COVERAGE NAIC If Eugene OR 97440 INSURER A:S ecial Districts Assn. of Ore INSURED INSURER B : Rogue Valley Council of Governments INSURER C: PO BOX 3275 INSURER D: INSURER E : Central Point OR 97502-0011 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16-2 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 ADDLSUBR POLICY EFF POLICY EXP LIMBS LTR TYPE OF INSURANCE POLICY NUMBER MM DD Y MM DD GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMA E T RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ A CLAIMS-MADE ❑X OCCUR 0P44372-429 /1/2015 /1/2016 MEDEXP(Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 500,000 A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED 0P44372-429 /1/2015 /1/2016 BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acc dent Underinsured motorist $ 500,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION 0P44372-429 /1/2015 /1/2016 $ WORKERS COMPENSATION WC STATU- OTH-I TORY LIMITS I FR AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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, H more space is required) RE: USING PROPERTY FOR MEAL SITE. CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECTS TO WORK PERFORMED BY THE ROGUE VALLEY COG, SUBJECT TO TERMS & CONDITIONS. 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 ACCORDANCE WITH THE POLICY PROVISIONS. KATHY GRIFFIN CITY HALL AUTHORIZED REPRESENTATIVE ASHLAND, OR 97520 Paul Jensen/EMILY ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201006).01 The ACORD name and logo are registered marks of ACORD