HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Farm to School
0 DATE (MWDD/YYYY)
ACCORD CERTIFICATE OF LIABILITY INSURANCE
09/15/2011
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 C
NAME: ONTACT Allison Ward
Reinholdt & 0' Harra Insurance PHONE i FAX
ac No Ext : (541)482-1921 A/c No : (541)488-4458
518 Washington St E-MAIL
Ashland, OR 97520 ADDRESS: award@reinholdtins.com
License 800442 INSURER(S) AFFORDING COVERAGE _ NAIC #
INSURER A_ Montpelier US Insurance CO_
INSURED INSURER B
Rogue Valley Farm to School
Tracy Harding INSURER C
P.O. Box 898 INSURER-D:
-
Ashland, OR 97520 INSURER E - - -
INSURER F :
COVERAGES CERTIFICATE NUMBER: 00014506-0 REVISION NUMBER: 8
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 ADDL SUBR I POLICY EFF POLICY EXP ' LIMITS
LTR TYPE OF INSURANCE INSR WV POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A GENERAL LIABILITY Y N MP0046003000650 07/05/2011 07/05/2012 j EACH OCCURRENCE _ $ 1000,000
F-- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) 1$ 505000
CLAIMS-MADE 11 X OCCUR MED EXP (Any one person) $ Excluded
PERSONAL & ADV INJURY $ 1,000,000
i I GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER! PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PROJ E_ LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident)$
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS _(Per accidence
I I $
UMBRELLA LIAB OCCUR EACH OCCURRENCE
- -
EXCESS LIAB CLAIMS-MADE AGGREGATE 1 $
__T I
DDEDT 11 RETENTION $ $
WORKERS COMPENSATION WC STATU OTH-
AND EMPLOYERS' LIABILITY Y / N T Y LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEF $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
it
II I! i
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The City of Ashland and all other governmental bodies having jurisdiction in the area, their officers and employees are
included as additional insureds.
Event: Siskiyou Challenge 2011
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main Street
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
I
6zl 6-cal ~W-)a (ALI)
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Printed by ALI on September 15, 2011 at 07:06AM