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HomeMy WebLinkAboutInsurance Certificate: Mt Ashland Association p SKI31499 AC" ® DATE (MM/DD/YYYY) lllllha~. CERTIFICATE OF LIABILITY INSURANCE 9/30/2011 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 :PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ...IPORTANT: 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 Commercial Lines 206-701-5900 NAME: _ PHONE FAX Wells Fargo Special Risks, Inc. CAL# OG13561 Ma L° Ext - - Lai' N ADDRESS: 520 Pike Street, Suite 2100 INSURER(S) AFFORDING COVERAGE l _ NAIC # Seattle, WA 98101 INSURER A : NOVA Casualty Company INSURED Mt. Ashland Association INSURER B : P.O. BOX 220 INSURER C INSURER D : INSURER E : Ashland, OR 97520 INSURER F : COVERAGES CERTIFICATE NUMBER: 3336801 REVISION NUMBER: See below 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A WFR-GL-0010050-2 10/01/11 10/01/12 - - - X DAMAGE TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS-MADE X-1 OCCUR MED EXP (Any one person) $ Not Covered PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ None GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 2,000,000 RO- LOC $ POLICY P JECT >UTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidenAt $ - - - - ANY AUTO BODILY INJURY (Per person) $ ~ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS - PROPERTY DAMAGE $ HIRED AUTOS NON-OWNED L-_ 1 - Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS' LIABILITY Y / N -TORY LIMITS_ _ ER ANY PROPRIETOR/PARTNER/f._XECUTIVE ❑ E.L EACH ACCIDENT $ - - - - - - - OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Excess Liability WFR-XS-0010008-2 10/01111 10/01/12 $5,000,000 Occur. / $10,000,000 Agg. Products - Comp/Op Agg: $10,000,000 Personal & Adv Injury: $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland, its Officers & Employees are Additional Insured when required by written contract, agreement, lease, or permit, solely as respects liability arising from operations of Named Insured Re: Interest in Owned assets acquired 07/01/92. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland, Its Officers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. nployees E. Main Street AUTHORIZED REPRESENTATIVE Ashland, OR. 97520 ..221. The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 11111111111111111111111111111111111111111111111111111111111111111111111111111111 'CYB01 A30/000959/02/02/0/0/0/0'