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Home My WebLink AboutInsurance Certificate: Ashland Gallery Association (2) CAPITOL INDEMNITY CORPORATION COMMON POLICY DECLARATIONS P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT 000 POLICY NUMBER POLICY PERIOD AGENCY/PRODUCER CODE CP02215132-03 03/31/2015 - 03/3112016 07221 12:01 A.M. Standard Time at the address of the insured stated herein. NAMED INSURED AND ADDRESS AGENCYIPRODUCER Ashland Gallery Association HULL & COMPANY INC PO Box 241 RALEIGH WEST EXEC BLDG STE 350 Ashland, OR 97520-0009 6443 SW BEAVERTON-HILLSDALE HW Portland OR 97221 FORM OF BUSINESS: Association NO FLAT CANCELLATIONS BUSINESS DESCRIPTION: Art Association IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. Commercial Auto Coverage Part NOT COVERED Commercial Property Coverage Part NOT COVERED Commercial General Liability Coverage Part $ 278.00 Commercial Crime Coverage Part NOT COVERED Inland Marine Coverage Part NOT COVERED Umbrella Excess Coverage Part NOT COVERED Liquor Liability Coverage Part NOT COVERED Businessowners Coverage Part NOT COVERED Employment Practices Liability Coverage Part NOT COVERED Professional Liability Coverage Part NOT COVERED TOTAL ADVANCE PREMIUM $ 278.00 TERRORISM RISK INSURANCE ACT OF 2007 $ 0.00 Premium shown as payable: $ 278.00 THE LIABILITY PREMIUM BASIS OF THIS POLICY IS SUBJECT TO AN AUDIT. ADDITIONAL OR RETURN PREMIUMS MAY BE DUE. FORMS APPLICABLE TO ALL COVERAGE PARTS: See Attached Policy Coverage Part Form Schedule CICG 179 Countersigned 04/29/2015 By "(Authorized Representative) CICG 174 (04-11) Page 1 of 1 Capitol Indemnity Corporation ADDITIONAL INTEREST SCHEDULE P.O. Box 5900, Madison, WI 53705 POLICY NUMBER POLICY PERIOD AGENCYIPRODUCER CODE CP02215132 03/31/2015 - 03/31/2016 07221 12:01 A.M. Standard Time at the address of the insured stated herein. NAMED INSURED AND ADDRESS AGENCYIPRODUCER Ashland Gallery Association HULL & COMPANY INC PO Box 241 RALEIGH WEST EXEC BLDG STE 350 Ashland. OR 97520-0009 6443 SW BEAVERTON-HILLSDALE HW Portland OR 97221 SCHEDULE Name of Person or Organization: City of Ashland Address: 20 E Main St Ashland OR 97520-1814 Jackson Insured Item: $ 50.00 - Additional Insured Interest: CG 20 26 - Additional Insured Designated Person or Organization Interest Type: Name Of Additional Insured Persons Or Organizations Description: Countersigned 04129/2015 By Authorized Representative CGE 067 (08-03) Page 1 of 1 Capitol Indemnity Corporation POLICY COVERAGE PART FORM SCHEDULE P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT 000 POLICY NUMBER POLICY PERIOD AGENCY/PRODUCER CODE CP02215132-03 03/31/2015 - 0313112016 07221 92:01 A.M. Standard Time at the address - of the insured stated herein. NAMED INSURED AND ADDRESS AGENCY/PRODUCER Ashland Gallery Association HULL & COMPANY INC PO Box 241 RALEIGH WEST EXEC BLDG STE 350 Ashland. OR 97520-0009 6443 SW BEAVERTON-HILLSDALE HW Portland OR 97221 Forms and Endorsement apply to the Coverage Part and made a part of this policy at time of issue: FORMS APPLICABLE TO ALL PREMISES AND COVERAGES Form Description CICG 174 CIC 04 11 Common Policy Declarations CICG 176 06 11 Locations Schedule CGE 067 08 03 Additional Interest Schedule CGE 112 04 96 Important Notice CGE 215 04 96 Important Notice Non Payment Of Premium CGE 278 04 96 Policyholder Audit Information CGE 085 01 08 Policyholder Disclosure Notice Of Terrorism Insurance Coverage IL 00 17 11 98 Common Policy Conditions CG 21 73 01 08 Exclusion of Certified Acts of Terrorism IL 00 21 09 08 Nuclear Energy Liability Exclusion (Broad Form) IL 02 79 09 08 Oregon Changes Cancellation And Nonrenewal IL 01 42 09 08 Oregon Changes Domestic Partnership BJP 190 08 14 Signature Page Countersigned 04/29/2015 By Authorized Representative CICG 179 (02-09) Page 1 of 1 Capitol Indemnity Corporation LOCATIONS SCHEDULE P.O. Box 5900, Madison, WI 53705 TRANSACTION TYPE: Renew ENDORSEMENT 000 POLICY NUMBER POLICY PERIOD AGENCYIPRODUCER CODE CP02215132-03 03/31/2015 - 03/31/2016 07221 12:01 A.M. Standard Time at the address of the insured stated herein. NAMED INSURED AND ADDRESS AGENCY/PRODUCER Ashland Gallery Association HULL & COMPANY INC PO Box 241 RALEIGH WEST EXEC BLDG STE 350 Ashland, OR 97520-0009 6443 SW BEAVERTON-HILLSDALE HW Portland OR 97221 Prems. No. Street City State ZIP 1 115 E Main St Ashland OR 97520-1830 CICG 176 (06-11) Page 1 of 1