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HomeMy WebLinkAboutInsurance Certificate: OR Dept of Forestry Procurement Office A RD® CERTIFICATE OF LIABILITY INSURANCE Y) 6i2i2oi1 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 CONTACT NAME: Sandy Orr PHONE ) Beecher Carlson Insurance Agency LLC A / No Ext : (541) 772-1111 A/C No : (591)772-3785 707 Murphy Rd -ADDRESS: : sandY- orr@beechercarlson. com PRODUCER 00006545 CUSTOMER ID II: Medford OR 97504 INSURER(S) AFFORDING COVERAGE NAIC INSURED INSURERA :NEW York Marine & Gen Ins Co INSURERB : City Of Ashland INSURER C 20 E Main St INSURER D INSURER E : Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:2011-12 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 OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F-IOCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 7 POLICY F P LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTO PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NOWOWNED AUTO'S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION X TORY VVC T MIT ER AND EMPLOYERS' LIABILITY Y / N ANY PRO PRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1 1000,000 OFFICER/MEMBER EXCLUDED? El N / A 7/1/2011 7 /1 /2012 (Mandatory in NH) MW100496 E L DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 FIT Deductible - Code 7539 $650,000 Deductible -All Other $450,000 DESCRIPTION OF OPERATIONSI LOCATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. Oregon Department of Forestry Procurement Office Attn: Pam Overhulser, Grant Operations C AUTHORIZED REPRESENTATIVE 2600 State Street Salem, OR 97301 Sandy Orr/SANDOR ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD