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HomeMy WebLinkAboutInsurance Certificate: Community Works h!=x/_'015 3.38:23 P11 ._T l~__~~?2059 Pcge. 2 or AC ~ ~ CERTIFICATE OF LIABILITY INSURANCE E (MM/DD/YYYY) 76/18/2015 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 endorsements . PRODUCER Brown & Brown Northwest CONTACT NAME: Sand L. Orr 3256 Hillcrest Park Drive PIAIC, o. HONN Ext. 541 494 2687 a No: 541-494-2787 Medford, OR 97504 E-MAIL ADDRESS: sorr(@bbnw.com INSURERS AFFORDING COVERAGE NAIC # www.bbnw.com INSURER A : Alliance of Nonprofits for Insurance INSURED INSURER B : SAIF Corporation Community Works 201 W Main, Suite 3D INSURER C: Medford OR 97504 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 25161066 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 ADDL SUBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DWYYYY LIMITS A COMMERCIAL GENERAL LIABILITY ✓ 2015-19517 7/1/2015 7/112016 EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED CLAIMS-MADE ✓ OCCUR PREMISES E occurrence $ 100,000 ✓ Professional Liability MED EXP (Any one person) $ 10,000 ✓ Abuse & Molestation PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO- Z LOC 2,000,000 JECT PRODUCTS -COMP/OP AGG $ OTHER. $ A AUTOMOBILE LIABILITY 2015-19517 7/1/2015 7/l/2016 COMBINED SINGLE LIMIT $ (Ea accident 1,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ A / UMBRELLA LIAB ✓ OCCUR 2015-19517U MB 7/1 /201 5 7/1 /201 6 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 -11-1-i-/ RETENTION 10,000 $ B WORKERS COMPENSATION 352614 7/1/2015 7/112016 ✓ STATUTE CTRH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mwe space is required) All operations of the Named Insured as provided under the policy terms, conditions & exclusions. General Liability coverage includes Blanket Additional Insured coverage as required by written contract per endt CG 20 26 07/04 (Attached). CERTIFICATE HOLDER CANCELLATION of Ashland, its officers and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City 20 E of Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND OR 97520 AUTHORIZED REPRESENTATIVE Sand L. Orr © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 25161066 15-16 GL/Auto/Umbs/wC Sandy L. Orr 6/18/2015 3:e5:32 PM (PCTI Fage 1 of 2