HomeMy WebLinkAboutInsurance Certificate: Youth Symphony of Southern Oregon
Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
10/13/2016
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 have ADDITIONAL INSURED provisions or 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
Liberty Mutual Insurance NAME: _
PO Box 188065
PHONE C, o Ext). 800-962-7132 A/c, No): 800-845-3666
Fairfield, OH 45018 E-MAIL
ADDRESS: BusinessService@LibertyMutual.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA Ohio Casualty Insurance Company 24074
INSURED INSURER B : American Fire and Casualty, Company 24066
Youth Symphony Of Southern Oregon
PO Box 4291 INSURER C :
Medford OR 97501 INSURER D-: _
Medford
-INSURER E :
i
INSURER F :
COVERAGES CERTIFICATE NUMBER: 32363852 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 REOUIRFMFNT, TERM OR CONDITION OF ANY CONTRACT OR OTHFR DOCUMENT WITH RF.I;PFCT 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 SUBRi POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A ✓ COMMERCIAL GENERAL LIABILITY ✓ BLO16812121 11/24/2016' , 11 /24/2017 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE D OCCUR PREMISES (Ea _occurrence)__ $ 1,000,000
i F7 ✓ LI UOr Llablllt MED EXP (Any one person) $ 15,000
q y I -
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000
✓ 11 POLICY PJECT RO- i LOC PRODUCTS - COMP/OP AGG $ 1,000,000
7,'RO
OTHER : $
$ 1,000,000
B AUTOMOBILE LIABILITY BAA56812029 11/24/2016 11/24/2017 EOa aBcdeDtSINGLE IT
- - -
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS PROPERTY DAMAG
HIRED NON-OWNED
✓ AUTOS ONLY ✓ AUTOS ONLY Per accident) _ _
r- - $
UMBRELLA LIAB ~J OCCUR EACH OCCURRENCE $
EXCESS LIAB~ - CLAIMS-MADE AGGREGATE $
DIED RETENTION $ $
PER OTH- i
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY I STATUTE ER
~
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N I E.L. EACH ACCIDENT $
r
OFFICER/MEMBER EXCLUDED? ❑ N/A
(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)
City of Ashland is Additional Insured if required by written contract or written agreement subject to General Liability Blanket Additional
Insured Provision.
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
Finance Department ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Street
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
Kim Mainous ~r
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
32363B5:? i 55812029 1 16-17 Master Certificate Kim Mainous 10/13/2016 1:14:45 2M (FD- 1 Page 1 of 1