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HomeMy WebLinkAboutInsurance Certificate: Planned Parenthood ® DATE (MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 12/30/2015 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 Marsh USA, Inc. NAME: - ( FAx PHONE 1L 1166 Avenue of the Americas A/c No. Ext) A/C, No)_ New York, NY 10036 EMAIL Attn: healthcare.accountscss@marsh.com Fax: 212-948-1307 ADDRESS: _ INSURER(S) AFFORDING COVERAGE _ NAIC # _ 109210-NIP-CAS-16-17 EUG,O GL INSURER A : New Hampshire Insurance Company _ 23841 INSURED INSURER B : N/A N/A PLANNED PARENTHOOD OF SOUTHWESTERN - OREGON, AN AFFILIATE OF PLANNED PARENTHOOD INSURER C : FEDERATION OF AMERICA, INC. INSURER D : 3579 FRANKLIN BLVD. EUGENE, OR 97403 INSURER E__ INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-007476578-07 REVISION NUMBER:3 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 LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY 082695195 01/01/2016 01101/2017 EACH OCCURRENCE $ 1,000.000 F-y-1 DA AGE CLAIMS-MADE OCCUR PREM SES•Ea occur....... $ 100,000 X SIR: $100,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ _ 2,000,000 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- 7v JECT OTHER: 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 $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS-MADE AGGREGATE _ $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER _ E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PPSO'S ASHLAND HEALTH CENTER - THE GET YOURSELF TESTED! (GYT) PROGRAM WILL PROVIDE FREE SEXUALLY TRANSMITTED INFECTION (STI) TESTING, COUNSELING, AND TREATMENT COORDINATION FOR YOUTH AGES 25 AND UNDER AT PPSO'S ASHLAND HEALTH CENTER. TARGET GROUPS FOR THIS PROGRAM INCLUDE YOUTH AGES 20-25, MEN, AND LGBTQ YOUTH. CITY OF ASHLAND IS INCLUDED AS ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: DAVE KANNER, CITY ADMINISTRATOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Ricki Fitzsimmons 'C c Ly- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD