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HomeMy WebLinkAboutInsurance Certificate: Jackson County School District #4 CERTIFICATE OF LIABILITY INSURANCE bATE(MM/DD/YYYY) OP ID SAW PHOEN-4 06/25/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Protectors Insurance, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Pilot Rock Ins Agency LLC (CA) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 4669 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 'ford OR 97501 ine:541-773-5358 Fax:541-772-1906 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: PACE Jackson County School Dist #4 INSURERB: SAIF Corporation Attn : DouSpani INSURER C: PO BOX 699 INSURER D: Phoenix OR 97535 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/YYYY DATE MM/DDNYYY GENERAL LIABILITY EACH OCCURRENCE $ 5 0 0, 0 0 0 A X X COMMERCIAL GENERAL LIABILITY 2 4 P 6 0 0 3 5 07/01/09 07/01/10 PREMISES (Ea occurence) $100,000 CLAIMS MADE 1XI OCCUR MED EXP (Any one person) $ X Public Entity Lia PERSONAL & ADV INJURY $500,000 GENERAL AGGREGATE $ 5 0 0, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 5 0 0 , O O O POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Included in ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ GL Limit A X SCHEDULED AUTOS 24P60035 07/01/09 07/01/10 (Per person) A X HIRED AUTOS 24P60035 07/01/09 07/01/10 BODILY INJURY A X NON-OWNED AUTOS 24P60035 07/01/09 07/01/10 (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 9,500,000 A X OCCUR C] CLAIMSMADE 24P60035 07/01/09 07/01/10 AGGREGATE s20,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION - AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER X ANY PROPRIETOR/PARTNER/EXECUTIVr~-T 4 8 6 6 7 9 07/01/09 07/01/10 E.L. EACH ACCIDENT $ 500, 000 OFFICER/MEMBER EXCLUDEG' L_[ - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 5 0 0 , 0 0 0 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5 0 0 , 0 0 0 OTHER A Hired Auto PD 24P60035 07/01/09 07/01/10 Comp/Coll 50,000 Deduct 100/500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Ashland is Additional Participant as respects the use of Lithia Park Band Shell for Phoenix High School Graduation, but only with respects to negligence claims for bodily injury or property damage where the Named Participant is deemed to have liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYAS2 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Parks Dept 20 E Main Str( t:I REPRESENTATIVES. Ashland OR 97520 AUTHO IZED REP MW5E ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD game and logo are registered marks of ACORD 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 This Certificate of Insurance 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 (2009/01)