HomeMy WebLinkAboutInsurance Certificate: Oregon Department of Transportation
CERTIFICATE OF COVERAGE
Agent This certificate is issued as a matter of information only
DIRECT and confers no rights upon the certificate holder other
than those provided in the coverage document. This
certificate does not amend, extend or alter the coverage
afforded by the coverage documents listed herein. 19
citycount , insurance services
Named Member or Participant Companies Affording Coverage
City of Ashland COMPANY A -CIS
COMPANY B - National Union Fire Insurance Company of Pitts, PA
20 East Main Street COMPANY C - RSUI Indemnity
Ashland, OR 97520 COMPANY D - Torus National Insurance Company
LINES OF COVERAGE
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any
requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage
documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents.
Type of Coverage Company Certificate Effective Termination Date Coverage Limit
Letter Number Date
General Liability A 16LASH 7/1/2016 7/1/2017 General Aggregate: $15,000,000
X Commercial General Liability Each Occurrence: $5,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
Auto Liability A 16LASH 7/1/2016 7/1/2017 General Aggregate: None
X Scheduled Autos Each Occurrence: $5,000,000
X Hired Autos
X Non-Owned Autos
Auto Physical Damage A 16APDASH 7/1/2016 7/1/2017
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
X Property A 16PASH 7/1/2016 7/1/2017 Per Filed Values
X Boiler and Machinery A 16BASH 7/1/2016 7/1/2017 Per Filed Values
Excess Liability
X Excess Crime B 16ECASH 7/1/2016 7/1/2017 Per Loss: $250,000
Excess Earthquake
Excess Flood
X Excess Cyber Liability A 16ECLASH 7/1/2016 7/1/2017 Occurrence/Aggregate: $100,000
Workers' Compensation
Description: The Oregon Department of Transportation (ODOT) is named as additional insured, with respects to the 401h Annual 4th of July Run in
Ashland, Oregon, to be held during the hours of 7:45 a.m. and 9:15 a.m. on July 4, 2016. Traffic control will be provided by the City of Ashland Police
Department.
Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date
thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail such
Maintenance & Operations Branch notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer
Oregon Department of Transportation of this certificate.
100 Antelope Road
Medford, OR 97503
B..': Date: June 14, 2016