Loading...
HomeMy WebLinkAboutInsurance Certificate: Proactive Health Resources F LIABILITY INSURAN E OP ID C DATE `MM/°DIYYYl7• ACDRD~ CERTIFICATE O PROAC-1 10/31/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Davidson Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 7101 NE Fourth Plain Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. -.ouver WA 98662 :Ae : 360-514-9550 Fax: 360-514-9551 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Nationwide Mutual Insurance Co INSURER B: Proactive Health Resources LLC INSURER C: : 1±ss VanderVeer 7 Jefferson Parkway INSURER D: Lake Oswego OR 97035 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER DATEYMM/DD/YY EFFECTIVE )POLICY EMM/DD/YY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY ACP7521854462 07/11/07 07/11/08 PREMISES (Eaoccurence) $ 300,000 rI AIhA0 rnA,DE 51]. nrCI IP MED EXP (Anv one person) $ 5 , 000 X Business Owners PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 PRO- X POLICY PRO- LOC LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO ACP7521854462 07/11/07 07/11/08 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ ATU H- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER • r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: All Operations of the Insured. CERTIFICATE HOLDER CANCELLATION ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 E Main St Ashland OR 97520 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Susan M. Chambers © ACORD CORPORATION 1988 ACORD 25 (2001/08) IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)