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HomeMy WebLinkAboutInsurance Certificate: Maslow Project MASL01C OP ID: CDL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/13/2015 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). CONTACT PRODUCER NAME: Cathy Damstra-Lepley, CIC United Risk Solutions, Inc. PHONE 541-494-7725 aFAX c,No :541-245-1112 PO Box 936 (AIC No Ext ADDRESS cathy.damstra-lepley@unitedrisk.com Medford, OR 97501-0067 E-MAIL INSURER(S) AFFORDING COVERAGE NAIC INSURER A: Philadelphia Indemnity Ins Co INSURED Maslow Project INSURERB 500 Monroe St. INSURER C : Medford, OR 97501-3522 INSURER D : - _ INSURER E : - INSURER F COVERAGES CERTIFICATE NUMBER: 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 - POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LTR 00 i A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000, DEVENTED _ 1,000,000 CLAIMS-MADE OCCUR X PHPK1419614 11115/2015 11115/2016 PREMISES (Ea-occurrence MED EXP (Any one person) $ 20,00 PERSONAL & ADV INJURY $ _ 1,000,000 L PRO- S PER. GENERAL AGGREGATE $ 2,000,000 GAT GEN' AGGRE- E LI MIT APP LE LOC PRODUCTS -COMP/OP AGG 000 $ 2,000, POLICY JECT - - - - - OTHER. MI COMBINED SINGLE LIT $ - 1,000,000 !_(Eaaccidentl AUTOMOBILE LIABILITY 11/1512016 BODILY INJURY (Per person) $ A - AANY LLOWN O ED SCHEDULED PHPK1419614 11/15/2015 gODILYINJURY(Peracadent)' $ AUTOS AUTOS NON--OWNED i,LB00 Y DAMAGE - - Per acci HIRED AUTOS AUTOS dent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS--MADE AGGREGATE DED RETENTION 5 $ WORKERS COMPENSATION PER OTH- E AND EMPLOYERS' LIABILITY - L- YIN E.L. DISEASE STATUTE L- E.L. EACH CI - - ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory in OFFICER/MEMBER EXCLUDED? N/A $ - EA EMPLOYEE $ (Mandatory in NH) - - If yes describe und DESCRIPTION OF erOPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liab PHPK1419614 11115/2015 11/15/2016 Incident 1,000,00 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Liability additional insured coverage included when required by a written contract subject to policy form, PI-GLD-HS 10/11. Coverage is subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION CITAS03 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. its officers, agents and 20 E. employees AUTHORIZED REPRESENTATIVE ~ Main St. Ashland, - y ',/QO' OR 97520-1814 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD