HomeMy WebLinkAboutInsurance Certificate: Jackson Soil & Water Conservation Dist
ACX__PR0® CERTIFICATE OF LIABILITY INSURANCE OP ID 4M DATE (MM/DD/YYYY)
1~ JACKS 11 06/03/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Western States Ins. - Medford HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
38 N. Central Ave Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3ford OR 97501
one: 541-779-1321 Fax: 541-779-9187 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Special Districts Ins Service
INSURER B:
Jackson Soil & Water
Conservation District INSURER C:
573 Parsons Dr suite 102 INSURER D:
Medford OR 97561
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 INSR TYPE OF INSURANCE DATE MM/DD/YYYY DATE MM/DDIYYYY
GENERAL LIABILITY EACH OCCURRENCE $500,000
A X COMMERCIAL GENERAL LIABILITY 25P18092193 01/01/10 01/01/11 PREMISES (Ea occurence) $ 100,000
CLAIMS MADE F x ]OCCUR MED EXP (Any one person) s5,000
PERSONAL &ADV INJURY $ 500 , 000
GENERAL AGGREGATE $500,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $500,000
X POLICY PRO LOC Em Ben. 500,000
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
11 EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $4,500,000
A OCCUR CLAIMS MADE 25P18092193 01/01/10 01/01/11 AGGREGATE s4,500,000
DEDUCTIBLE $
X RETENTION $ $
WORKERS COMPENSATION - QIH-
AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE~- E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDtD? - -
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Re: Natural Resource Day Camp June 21-25, 2010.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
North Mountain Park REPRESENTATIVES.
620 N Mountain Ave AUTHORIZED REPRESENTATIVE
Ashland OR 97520 47 ACORD 25 (2009101) - 0 II rights reserved.
The ACORD name and logo are registered marks of ACORD