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HomeMy WebLinkAboutInsurance Certificate: Modern Roots Foundation DATE (MMIDD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 06/25/2015 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 Reinholdt & O' Harra Insurance PHONE _ Rebecca Devau FAX Ezf . (541)482-1921 A C No : (541)488 4458 518 Washington St E-MAIL Ashland, OR 97520 ADDRESS: rdevall@reinholdtins.com License 800442 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: United States Liability Insurance INSURED INSURER B Modern Roots Foundation INSURER C: PO Box 3175 INSURER D Ashland, OR 97520 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-17717 REVISION NUMBER: 2 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 TYPE OF INSURANCE ADDLISUBRI POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY (MM/DDYYY LIMITS A X,. COMMERCIAL GENERAL LIABILITY Y NPP015U5248 06/2512015 0612512016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREM SES (Ea occurrence) $ 100,000 MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY JE L 1 LOC PRODUCTS - COMP/OP AGG $ 2,000 000 OTHER: S 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 S HIRED AUTOS AUTOS Per accident UMBRELLA LIAB FCO CCUR EACH OCCURRENCE $ EXCESS LIAB L AIMS-MADE AGGREGATE i $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E1. . DISEASE - POLICY LIMIT S i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is listed as additional insured. 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. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE / v REB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Printed by REB on June 25, 2015 at 04:30PM