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HomeMy WebLinkAboutInsurance Certificate: Jackson County FD #3 AC~ ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/22/2015 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 pc icy(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: Dona Holmes, CISR WHA Insurance A//CONNo EXt: (800) 852-6140 ABC No: (541)342-3786 2930 Chad Drive E-MAIL dholmes@whainsurance.com ADDRESS: PO BOX 1421 _ INSURER(S) AFFORDING COVERAGE NAIC # Eugene OR 97440-1421 INSURERA:Special Districts Assoc of OR 1119 INSURED INSURER B :Genesis Insurance Compapy__ Jackson County FD #3 INSURER C: 8333 Agate Road INSURER D : INSURER E : White City OR 97503 INSURER F COVERAGES CERTIFICATE NUMBER:2016GL/AU 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDlYYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 10,000,00o A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED - PREMISES (Ea occurrence $ X Professional Liability X 31P52299 1/1/2016 1/1/2017 MED EXP (Any one person) $ B PERSONAL & ADV INJURY $ GEl AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ None POLICY ❑ PRO F-7 LOC PRODUCTS - COMP/OP AGG $ X JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 10,000,000 Ea accident A ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED X 31P52299 1/1/2016 1/1/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS B NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Non-owned/hired limit $ 10,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER 10TH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is an additional participant and loss payee in respects to participant's use of Mobile Fire Training Unit, but only with respects to negligence claims for Bodily Injury, Property Damage or Personal Injury where the Named Participant is deemed to have liability. In no event shall coverage extend to any party for any Claim, Suit or Action, however or whenever asserted, arising out of such party's sole negligence or for any Claim, Suit or Action which occurs prior to the execution of the contract or agreement. 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 Ashland Fire & Rescue ACCORDANCE WITH THE POLICY PROVISIONS. 455 Siskiyou Boulevard Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Jeffrey Griffin/DMH~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I NS025 (201401)