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HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Child Study DATE (MMIDD/YYYY) Ac" J?" CERTIFICATE OF LIABILITY INSURANCE 1111 1 6/17/2015 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 NAME: Pe ggy MacMillan _ _ JD Fulwiler & Co. Insurance, Inc. gICO No Extp (503) 293-8325 FAA/C X, No): (503)293-5418_ - 5727 SW Macadam Ave E-MAIL ADDRESS: pmacmillan@'dfulwiler.com PO Box 69508 _INSURER(S)AFFORDING COVERAGE _ _ NAIC# Portland OR 97239 INSURERA:Alliance of NonProfits for Ins 10023 - - - - INSURED INSURER B:Saif COrIJOratiOn 36196 Family Solutions, DBA: Southern Oregon Child Study & INSURER 1836 Fremont St INSURER D INSURER E Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 GEN USE 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. IN LTR TYPE OF INSURANCE ADDLWVQ POLICY NUMBER MMIDIDYIYYEFF YY ! MMIDDY(YYYY LIMITS INSID $ ;COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II $ 1,000,000 I DAMAGE TO RENTED A i CLAIMS-MADE X OCCUR ( PREMISES (Ea occurrence) $ 500, 000 I 1, 201521304 7/1/2015 7/1/2016 MED EXP (Any one person) $ 20,000 PERSONAL BADVINJURY $ _ 1,000,000 i i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PR X O- POLICY JECT LOC PRODUCTS - COMP/OP AGG I $ 3, 000,000 OTHER: Professional Liability $ 1, 000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000,000 r (Ea accident) A ANY AUTO I, BODILY INJURY (Per person) $ _ ALL OWNED SCHEDULED 201521304 7/1/2015 7/1/2016 BODILY INJURY (Per accident) , $ ;AUTOS - AUTOS ! - - NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) f ~ I Underinsured motorist $ 11000, 000 1 ]({UMBRELLA LIAR X =OCCUR BEACH OCCURRENCE ______J' $ _ 3, 000, 000 EXCESS LIAB AGGREGATE l $ 3,000,000 A CLAIMS-MADE ! 201521304UMB 11 7/1/2015 7/1/2016 DED . X RETENTION $ 10, 000 ~ i $ WORKERS COMPENSATION I !'I i j PER OTH- X 1 STATUTE ER AND EMPLOYERS' LIABILITY Y / N ! r-- ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT I$ 500,000 ;(Mandatory in NH) ER EXCLUDED? i1 ~liN/A B (Mandatory in 1998536 7/1/2015 7/1/2016 E.L. DISEASE- EAEMPLOYEE 500,000 If yes, describe under 7 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Proessional Liability 201521304 j 7/1/2015 7/1/2016 Occurrence Limit $1,000, 00 7 Aggregate Limit $2, 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, its officers, and employees are included as additional insureds with regard to operations of the named insured in accordance with the policy terms, condtions, and exclusion. All operations of the named insured subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE P MacMillan/TMAYDA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)