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CERTIFICATE OF COVERAGE
Agent This certificate is issued as a matter of information only
and confers no rights upon the certificate holder other
DIRECT than those provided in the coverage document. This
certificate does not amend, extend or alter the coverage
afforded by the coverage documents listed herein. 19
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 coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any
requirement, term or condition 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.
Type of Coverage Company Certificate Effective Termination Date Coverage Limit
Letter Number Date
General Liability A 14LASH 7/1/2014 7/1/2015 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 14LASH 7/1/2014 7/1/2015 General Aggregate: None
X Scheduled Autos Each Occurrence: $5,000,000
X Hired Autos
X Non-Owned Autos
Auto Physical Damage A 14APDASH 7/1/2014 7/1/2015
X Scheduled Autos
X Hired Autos
X Non-Owned Autos,
X Property A/C 14PASH 7/1/2014 7/1/2015 Per Filed Values
X Boiler and Machinery A 14BASH 7/1/2014 7/1/2015 Per Filed Values
X Excess Crime B 14ECASH 7/1/2014 7/1/2015 Per Loss: $250,000
Excess Earthquake
Excess Flood
Excess Cyber Liability
Workers' Compensation
Description:
The Oregon Department of Transportation (ODOT) is named as an additional insured with respects to the 38th Annual 4th of July Run in Ashland,
Oregon, to be held during the hours of 7:45 a.m. and 9:15 a.m. on July 4, 2014. Traffic control will be provided by the City of Ashland Police
Department.
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
Maintenance & Operations Branch such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the
Oregon Department of Transportation issuer of this certificate.
800 Airport Road SE
Salem, OR 97301
Date: June 19, 2014
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