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Insurance Certificate: OSF (2)
OP ID: KCF +t~. i J►f~ DATE (MM/DD/(YYY) CERTIFICATE OF LIABILITY INSURANCE 06/29/11 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 541-245-1111 CONTACT NAME_ KC Ferguson United Risk Solutions Inc. - - PO Box 936 541-245-1112 a°NN EXtJ.-541-494-7752_ ac " 541-245-1112 Medford, OR 97501-0067 E-MAIL ADDRESS: kc.ferguson@uu - nitedrisk- - .com - In i L. Jayubo, IC, CRM PRODUCER OREG10W CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC # INSURED Oregon Shakespeare Festival INSURER A: Oregon Nonprofit Employers - - - PO Box 158 INSURER B : Trust (Self-Insured Group) _ Ashland, OR 97520 INSURER c : New York Marine & General Ins - INSURER D _Co (Excess Insurance Company) INSURER E : c/o Empire Pacific Risk Mngmnt INSURER F : COVERAGES CERTIFICATE NUMBER: 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 UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ _7 CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PROT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATUS OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS X ER C OANY FFICER/MEMBER/EXCLUDED? ECUTIVE N / A 028 WC09 0036 04/01/11 04/01/12 E.L. EACH ACCIDENT $ 1,000,000 A (Mandatory in NH) 028 WC07 0035 (SELF-INS) 04/01/11 04101/12 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: All Operations of the Named Insured CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Lohman, City Attorney ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD