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HomeMy WebLinkAboutInsurance Certificate: Jackson County (2) AC~ ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 7/1/2013 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 Sand Orr NAME: y Beecher Carlson Insurance Agency LLC PHONE (541) 772-1111 AC No: (541) 772-3785 3256 Hillcrest Park Drive E-MAIL DRESS: sandy• orr@beechercarlson.com INSURER(S AFFORDING COVERAGE NAIC # Medford OR 97504 INSURER A:Midwest Employers Casualty Co INSURED INSURER B : City Of Ashland INSURER C: 20 E Main St INSURER D: INSURER E : Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:2013-14 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 INS JRANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR 1 POLICY NUMBER MM/DD/YYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES DAMAGES (Ea RENTED $ Ea occurrence CLAIMS-MADE ❑ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ POLICY PRO 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 accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTN=R/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) EW0008757 /1/2013 /1/2014 E L DISEASE - EA EMPLOYE $ 1 000 000 If yes, describe under Retention - All Other $500 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 Retention - Codes 7539, $750,000 7720 & 7710 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Contract for re-assignment of ASA #3 to Ashland Fire and Rescue. CERTIFICATE HOLDER CANCELLATION bergmapl@jacksoncounty.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Jackson County Attn: Penny Bergman 1005 E Main Street AUTHORIZED REPRESENTATIVE Medford, OR 97504 Sandy Orr/SANDOR o,1__ ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (2o1oo5).o1 The ACORD name and logo are registered marks of ACORD