HomeMy WebLinkAboutInsurance Certificate: NWSA (2)
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Agent' This certificate is issued as a matter of information only and confers no rights upon the
DIRECT 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.
Companies Affording Coverage
Named Member or Participant COMPANY A - City County Insurance Services (CIS)
City of Ashland COMPANY B - National Union Fire Insurance Company of Pitts, PA
20 East Main Street COMPANY C - RSUI Indemnity
Ashland, OR 97520
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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.
CO Type of Coverage Certificate # Effective Expiration Limits
LT Date Date
A General Liability 08LASH 7/1/2008 7/1/2009 General Aggregate $15,000,000
X Commercial General Liability Each Occurrence $5,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
A Auto Liability 08LASH 7/1/2008 7/1/2009 General Aggregate None
X Scheduled Autos Each Occurrence $5,000,000
X Hired Autos
X Non-Owned Autos
A Auto Physical Damage 08APDASH 7/1/2008 7/1/2009
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
A X Property 08PASH 7/1/2008 7/1/2009 Per Filed Values
A X Boiler and Machinery 08BASH 7/1/2008 7/1/2009 Per Filed Values
B X Excess Crime 08CASH 7/1/2008 7/1/2009 Per Loss $250,000
C Excess Earthquake
C Excess Flood
A Workers' Compensation
escription: One Northwest Service Academy (NWSA) member is to be covered under the City Ashland's general liability insurance and
utomobile insurance while providing services to the Ashland Parks & Recreation Department as an agent of the City of Ashland from
eptember 22, 2008, through August 18, 2009, per the written AmeriCorp's Service Agreement between the NWSA and the Ashland
arks & Recreation Department dated September 2008. As per the agreement, NWSA will carry workers' compensation insurance for its
embers. The City of Ashland and its Parks & Recreation Department does not carry workers' compensation coverage for non-
mployees. NWSA will also provide automobile insurance for its members who drive an NWSA vehicle when they are providing project
ervices as per the agreement.
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
Northwest Service Academy (NWSA) such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the
Lower Columbia Center issuer of this certificate.
2500-D NE 65th Avenue
Vancouver, WA 98661-6812
By: /7,t~,sS, Date: Oct. 14, 2008