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HomeMy WebLinkAboutInsurance Certificate: Ashland Supportive Housing (2) ACQ ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/20/2016 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. ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to rrte 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 C ONTACT Wauneta Ohnmacht NAME: Bliss Sequoia Insurance PHONE (503) 364-5401 FAX- _(A/C, No, Ext): _ _(A/C, No): P.O. Box 826 ADDRESS:wauneta@blissinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # Salem OR 97308 INSURERA:Philadelphia Indemnity_Ins. Co. INSURED INSURER B :Saif Corporation 36196 Ashland Supportive Housing INSURER C : & Community Outreach INSURER D : PO Box 3536 INSURER E : Ashland OR 97520-0318 INSURER F : COVERAGES CERTIFICATE NUMBER: (16-17) 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 LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 X Pollution Liability X PHPK1427533 2/1/2016 2/1/2017 MED EXP (Any one person) $ 20,000 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X PRO- jPOLICY JEC LOC PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea accid~ntl 1, 000, 000 { ANY AUTO BODILY INJURY (Per person) $ ` ALL OWNED SCHEDULED PHPK1427533 2/1/2016 2/1/2017 BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAB X , OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE A AGGREGATE $ 1,000,000 DED X RETENTION 10,000 PHUB523430 2/1/2016 2/1/2017 $ WORKERS COMPENSATION PER X ER H 1 AND EMPLOYERS' LIABILITY STATUTE Y / N 'ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A B (Mandatory in NH) 776721 4/1/2015 4/1/2016 E.L. DISEASE - EA EMPLOYEE $ 000, 000 If yes, describe under - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A PROFESSIONAL LIABILITY PHPK1427533 2/1/2016 2/1/2017 1,000,000 PER OCCURRENCE 3,000,000 AGG ABUSE/MOLESTATION 1,000,000 PER OCCURRENCE 1,000,000 AGG DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) The City of Ashland, its officers, and employees are additional insureds as respects work performed on its behalf by the named insured as required by contract per PI-GLD-HS10/11. CERTIFICATE HOLDER CANCELLATION (541) 552-2059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The 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 Lance Barnwell/NETA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)