HomeMy WebLinkAboutInsurance Certificate: Claycomb Charitable Remainder Unitrust
CERTIFICATE OF COVERAGE
Agent This certificate is issued as a matter of information
DIRECT only and confers no rights upon the certificate holder
other than those provided in the coverage document
This certificate does not amend, extend or alter the
coverage afforded by the coverage documents listed
herein
citycounty insurance services
Named Member or Participant Companies Affording Coverage
City of Ashland COMPANY A - CIS
20 East Main Street COMPANY B - National Union Fire Insurance Company of Pitts, PA
Ashland, OR 97520 COMPANY C - RSUI Indemnity
LINES OF COVERAGE
This is to certify that -overage documents listed herein have been issued to the Named Member herein for the Coverage period indicated Not withstanding any
requirement, term or cond tion of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage
documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents
Company Certificate Effective Termination Coverage Limit
Type of Coverage Letter Number Date Date
General Liability A 12LASH 7/1/2012 7/1/2013 General Aggregate: $15,000,000
X Commercial General Liability Each Occurrence: $5,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
Auto Liability A 12LASH 7/1/2012 7/1/2013 General Aggregate: None
X Scheduled Autos Each Occurrence: $5,000,000
X Hired Autos
X Non-Owned Auto;
Auto Physical Damage A 12APDASH 7/1 /2012 7/1 /2013
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
X Property A 12PASH 7/1/2012 7/1/2013 Per Filed Values
X Boiler and Machinery A 12BASH 7/1/2012 7/1/2013 Per Filed Values
X Excess Crime B 12ECASH 7/1/2012 7/1/2013 Per Loss $250,000
Excess Earthquake
Excess Flood
Excess Cyber Liability
Workers' Compensation
Description: The Claycomb Charitable Remainder Unitrust , landlord, is named as additional insured under the City of Ashland's policy as outlined in
the Ashland Police Substation Lease Agreement dated April 1, 2013, in which the City of Ashland is named as tenant.
Certificate Holder: CANCELLATION Should any of the coverage documents herein be cancelled before the expiration date
thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail
Claycomb Charitable Remainder Unitrust such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or
Stefanie Claycomb, Trustee the issuer of this certificate.
105 Christy Court
Phoenix, OR 97535
Date: June 4, 2013