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HomeMy WebLinkAboutInsurance Certificate: Childrens Advocacy Center 7 ® r ATE (MM/DD/YYYY) AC oRO CERTIFICATE OF LIABILITY INSURANCE 10/5/2015 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 Brown & Brown Northwest NAME: Sandy L. Orr-_ 3256 Hillcrest Park Drive PHONE FAX - Medford, OR 97504 AA(C•No.Ext): 541-494-2687 ~A/C No)._-- 541-494-2787 E-MAIL ADDRESS: sorr(o)bbnw.Com INSURERS AFFORDING COVERAGE NAIC # www.bbnw.com INSURER A : Great American Assurance Co 26344 INSURED INSURER B : SAIF Corporation 36196 Jackson County Child Abuse Task Force - Children's Advocacy Center of Jackson County INSURER C 816 W 10th Street INSURER D : _ Medford OR 97501 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 26817760 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. rA IADDL SUBR POLICY NUMBER M POLIM/DDM/DDIYYYY CY EF/YYYYL MPOLICY LIMITS INSD EXP - R TYPE OF INSURANCE ~ COM MERCIAL GENERAL LIABILITY ✓ PAC0629478 11/1/2015 11/1/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE DAMAGE TO RENTED /JI OCCUR PREMISES (Ea occurrence] $ 100,000 ~ 5,000 MEny one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE y $ 3,000,000 1 - PRO LOC PRODUCTS - COMP/OP AGG $ 3,000,000 ✓ POLICY JECT OTHER: ' $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ accidentl- ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) i_ AUTOS ✓ AUTOS NON-OWNED I ~ PROPERTY DAMAGE ✓ HIRED AUTOS ✓ AUTOS (Per-acciden $ I) _ - - - UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE, AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION 601 577 1/1/2015 1/1/2016 ✓ 'STATUTE OTRH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR'PARTNER'EXECUTIVE YIN E.L. EACH ACCIDENT $ 500,000 OFFICER,MEMBER EXCLUDED? ❑ NIA -------h (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 if yes, describe under i DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Professional Liability PAC0629478 11/1/2015 11/1/2016 '$1,000,000/$3,000,000 A Abuse & Molestation Liability PAC0629478 11/1/2015 11/1/2016 ,,;$1,000,000/$3,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder included as respects General Liability when required by written agreement per endorsement attached. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE its officers & employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE ~~y I~~• ~ Sand L. Orr ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 2€817760 15-16 GL/AUTO/PROF/ABUSE/WC Sandy L. Orr 10/S/2015 11:59:10 AK (PDT) + Page 1 of 5