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HomeMy WebLinkAboutInsurance Certificate: Kiwanis International ACORDL CERTIFICATE OF LIABILITY INSURANCE OP ID 31 DATE(MM/DD/YYYY) KIWAN03 06/11/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hylant Group Inc-Indianapolis HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 01 Pennsylvania Parkway, #201 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW .ndianapolis IN 46280 Phone: 800-678-0361 Fax:317-817-5151 INSURERS AFFORDING COVERAGE NAIC # INSURED Klwanis International INSURER A: Lexington Insurance Company 019437 All Clubs and Their Members Insured Local Club : INSURER B: A hland, Oregon Foundation INSURER C: c o Jeanne Walcher 4 0 Schofield St INSURER D: Ashland OR 97520 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 POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD/YY DATE MM/DDIYY GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X X COMMERCIAL GENERAL LIABILITY 065302393 11/01/08 11/01/09 PREMISES (Ea occurence) $ 100,000 CLAIMS MADE FxIOCCUR MED EXP (Any one person) $ X Agg Per District PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS A X HIRED AUTOS 065302393 11/01/08 11/01/09 BODILY INJURY (Per accident) $ A X NON-OW NED AUTOS Ilk X $3,000,000 Agg 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 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER A Self Insured 065302393 11/01/08 11/01/09 All Claim $100,000 Retention DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is named as Additional Insured as respects to General Liability regarding the following Kiwanis event: Ashland Lithia Park Run 1 mile & 5K run on 10/31/09 in Downtown plaza Ashland OR Additional Insured: "The City of Ashland, its agents and employees" CERTIFICATE HOLDER CANCELLATION ALLCERT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN The City of Ashland NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn : Martha Bennett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Administration 20 East Main Street REPRESENTATIVES. Ashland OR 97520 AUTHO ESE E ilZ d2, L ACORD 25 (2001/08) © ACORD CORPORATION 1 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. r F ACORD 25 (2001/08)