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HomeMy WebLinkAboutInsurance Certificate: Health Future LLC A~~~ CERTIFICATE ~ i DATE F LIABILITY INSURANCE 06/01/2010 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 111 S.W. COLUMBIA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR FIFTH FLOOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PORTLAND, OR 97201 902317 10/1 1 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American States Insurance Co 19704 Health Future LLC 777 Murphy Road INSURER B: Medford, OR 97504 INSURER C: INSURER D: 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 COND_ ITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS ADD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER LTR INSR DATE (MM/DD/YYYY) DATE (MM/DD/YYYYI GENERAL LIABILITY 01CH0740385 05'31/2010 05/31/2011 EACH OCCURRENCE 1 000 000 A X DAMAGE TO RENTED 1 000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence $ ! CLAIMS MADE 71-1 OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,0001 GENERAL AGGREGATE I$ 3,000,000 GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AG O$ 3,000,000 PRO- LOC POLICY 1 JECT I A AUTOMOBILE LIABILITY 01CH0740385 05/31/2010 05/31/2011 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) Is i GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG I ! EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE AGGREGATE I$ is DEDUCTIBLE $ RETENTION $ H WC STATU- LOTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY LEACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? , E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under - IV - E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS beloN OTHER I ~ II I~ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Ashland, Oregon, and its elected officials, officers and employees are included as Additional Insureds regarding Third Party Administrator services contract. CERTIFICATE HOLDER SEA-001565090-03 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 East Main Street 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Ashland, OR 97520 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Lorie Larsen-Denning ACORD 25 (2009101) 1998-2009 ACORD CORPORATION. All Rights Reserved L © The ACORD name 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 fisted thereon. Acord 25 (2009/01)