HomeMy WebLinkAboutInsurance Certificate: Mt Ashland Ski Area
MTASHLA-01 SDOUGHERTY
ACORN DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/4/2016
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 John Hennes
NAME:
Missoula Office PHONE FAX
PayyneWest Insurance, Inc. (A/C, No, Ext): (A/C, No):
P.O. Box 4386 E-MAIL
jhermes@paynewest.com
Missoula, MT 59808 - - -
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : MountainGuard Ins Program
INSURED INSURER B : National Union Fire Insurance Company of Pittsburgh PA 19445
Mt. Ashland Ski Area INSURER c : SAIF 36196
PO Box 220
693 Washington Street INSURER D
Ashland, OR 97520 INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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 EXI' - LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MMIDDI
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR 02LX0670433072 10/0112016 10101/2017 PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $ Excluded
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRODUCTS COMP/OP AGG $ 1,000,000
POLICY PRO- JECT LOC
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
_
A X ANY AUTO 02CA0661453112 1010112016 10/0112017 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
NON-OWNED PROPERTY DAMAGE - $
HIRED AUTOS AUTOS (Per accident)
X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,000
B EXCESS LIAB CLAWS-MADE 29UD011165042 10/01/2016 10/0112017 AGGREGATE $ 10,000,000
DED X RETENTION $ 10,000 $
PER OTH-
WORKERS COMPENSATION X
AND EMPLOYERS' LIABILITY Y / N STATUTE _ ER -
766771 0110112016 0110112017 E .L. EACH ACCIDENT $ 5500,000
C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ _ 5500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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
tY ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St.
Ashland, OR 97520
AUTHORIZED REPRESENTATIVE
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