HomeMy WebLinkAboutInsurance Certificate: State of Oregon Department of Forestry
City County Insurance Services CERTIFICATE OF COVERAGE Rev. 717/05
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
COVERAGES
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 09LASH 7/1/2009 7/1/2010 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 09LASH 7/1/2009 7/1/2010 General Aggregate None
X Scheduled Autos Each Occurrence $5,000,000
X Hired Autos
X Non-Owned Autos
A Auto Physical Damage 09APDASH 7/1/2009 7/1/2010
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
A X Property 09PASH 7/1/2009 7/1/2010 Per Filed Values
A X Boiler and Machinery 09BASH 7/1/2009 7/1/2010 Per Filed Values
B X Excess Crime 09CASH 7/1/2009 7/1/2010 Per Loss $250,000
C Excess Earthquake
C Excess Flood
A Workers' Compensation
Description: The State of Oregon, its officers, employees, and agents are included as Additional Insureds but only with respect to
ontractor's activities to be performed under this American Recovery and Reinvestment Act Funded Program Grant Contract
Agreement between the Oregon Department of Forestry and the City of Ashland Parks Department. This contract is for the purpose of
onducting wildland urban interface fuels reduction. This contract is effective on the date it has been signed by all parties and all
equired State of Oregon approvals have been obtained and shall continue in full force until December 31, 2010, unless extended by
ritten contract of all parties or terminated per contract provisions. Coverage shall be primary and non-contributory with any other
nsurance and self-insurance.
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
State of Oregon such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the
Department of Forestry issuer of this certificate.
Procurement Office
2600 State Street
Salem, OR 97301 By: Date: June 14, 2010