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HomeMy WebLinkAboutInsurance Certificate: City of Ashland ACQR" CERTIFICATE OF LIABILITY I DATE(MMIDDIYYYY) INSURANCE 7/28/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER ACT NAM Sandy Orr Beecher Carlson Insurance Agency IMC PP O No,Ext1: (541) 772-1111 AIC,No: (541)772-3785 707 Murphy Rd ADDRESS, sandy - orr@beechercarlson.com PRODUCER 00006545 CUSTOMER ID a: Medford OR 97504 INSURER(S) AFFORDING COVERAGE NAIC INSURED INSURER A :NeW York Marine & Gen Ins Co INSURER B City Of Ashland INSURER C 20 E Main St INSURER D INSURER E : Ashland OR 97520 INSURERF : COVERAGES CERTIFICATE NUMBER:2010-11 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH GCCURRENCE $ DA.Ma~ ETO RENTED COMMERCIAL GENERAL LABILITY PREML,E.~, 'Ea occurrence) $ CLAIMS MADE 0f_C_!R MED E>.P (Any one person) $ PERSONAL & AD,/ IN,9JRY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY PRO LCIC JECT $ AUTOMOBILE LIABILITY _OMBINED SINGLE LIMIT $ (E i accident) ANY AUTO - BGC:IL'( Ir,dJUP'' (Per person) $ ALL OWNED AU7OS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident ) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH Od iURPENCE $ EXCESS LIAR CLAIMS-MADE qr~ r, RELATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION Excess Workers VW STATU- oTH- AND EMPLOYERS' LIABILITY YIN X_ TOR`i LA,11TS ER ANY PPOPRIETOR/PARTNERIEXECUTIVE Compensation EL EACH ACS-IDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED" N /A (Mandatory in NH) MW100287 /1/2010 /1/2011 E L DISEASE - EA EMPLOYEE $ 1,000,000 If ya;, describe und?r DESCRIPTION OF OPERATIONS belrnv~ E L DIJEP,SE - POLICY LIMIT $ 1,000,000 Dedu~%le -Code 7s39 $650,000 Dedu11hble -AI -)trler $450,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) American Recovery & Reinvestment Act Funded Program Grant between ODF and Ashland Parks Department. CERTIFICATE HOLDER CANCELLATION poverhulser@ odf .state . or . u SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oregon Depart ACCORDANCE WITH THE POLICY PROVISIONS. ment of Forestry Procurement Office Attn: Pam Overhulser, Grant Operations C AUTHORIZED REPRESENTATIVE 2600 State Street Salem, OR 97301 Sandy Orr/S ~G~ [p~~ ~,NDOR ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (2C09CO) The ACORD name and logo are registered marks of ACORD