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HomeMy WebLinkAboutInsurance Certificate: Family Solutions ACo ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/16 6/14/2016 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 NAME: Peggy MacMillan JD Fulwiler & Co. Insurance, Inc. PAH/ONNo.Ext): (503)293-8325 . A~ic No: (503)293-5418 macmillan@ 'dfulwiler. com 5727 SW Macadam Ave E-MAIL ADDRESS: p ~ PO Box 6 9 5 0 8 INSURER(S) AFFORDING COVERAGE NAIC # Portland OR 97239 INSURERA:Alliance of NonProfits for Ins 10023 INSURED INSURERB:Saif Corporation 36196 Family Solutions INSURER C : 1836 Fremont St INSURER D : INSURER E : Ashland OR 97520 INSURER F COVERAGES CERTIFICATE NUMBER: 16/17 Gen Use 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 NUMBER MM/ DY/YYEFF YY MM/DY EXP LTR /YYYY LIMITS ' X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 $ 11000,000 DAMAGE TO RENTED 500,000 A CLAIMS-MADE 17X OCCUR PREMISES Ea occurrence $ 201621304 7/1/2016 7/1/2017 MED EXP (Any one person) $ 20,000 `J f PERSONAL & ADV INJURY $ 11000,000 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ~ GENERAL AGGREGATE ! $ X '71 JERCOT- LOC PRODUCTS - COMP/OPAGG $ 3,000,000 Professional Liability $ 11000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I $ 11 000,000 Ea accident i A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED 201621304 7/1/2016 7/1/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Underinsured motorist $ 1, 0 0 0, 0 0 0 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 201621304UMB 7/1/2016 7/1/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A B (Mandatory in NH) 998536 7/1/2016 7/1/2017 E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe ::-der DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Professional Liability 201621304 7/1/2016 7/1/2017 Occurrence Limit $1,000,000 Aggregate Limit $2, 000,000 i i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, its officers, and employees are included as additional insureds with regard to operations of the named insured in accordance with the policy terms, condtions, and exclusion. All operations of the named insured subject to policy terms, conditions and exclusions. 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 20 East Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE P MacMillan/TMAYDA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)