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HomeMy WebLinkAboutInsurance Certificate: Nature Conservancy ® DATE (MM/DD/YYYY) AC40RL> CERTIFICATE OF LIABILITY INSURANCE 06/22/2015 F 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 - - - MARSH USA, INC. NAME:----- PHONE r FAX 1050 CONNECTICUT AVENUE, SUITE 700 - CNo,_Ext : (A/C, No); - - - - WASHINGTON, DC 20036-5386 E-MAIL Attn: DC.Certs@marsh.com or Fax to 212-948-0503 -ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 040631--WC-15-16 INSURER A Insurance Company Of The State Of PA 19429 INSURED INSURER B THE NATURE CONSERVANCY _ 4245 NORTH FAIRFAX DRIVE INSURER C : SUITE 100 INSURER D ARLINGTON, VA 22203 _ ~ INSURER E : I INSURER F : COVERAGES CER T is ',CATE NUNME`R: Ct_E-n04947666-02 REVISION NUMBF_R:3 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 S r POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD 'WVD POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) MED EXP (Any one person)- $ r i PERSONAL & ADV INJURY $ PRO GENERAL AGGREGATE PLIES PER: - GEN'L AGGREGATE LIMI- AP 'PRODUCTS COMP/OP AGG $ ~ POLICY JECT 1 LOC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea_ accident) - - ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS !AUTOS BODILY INJURY (Per accident) $ rPROPERTY DAMAGE - is NON-OWNED - HIRED AUTOS _ AUTOS (Per accident) i $ UMBRELLA LIAB EACH OCCURRENCE $ OCCUR - - - ~ a EXCESS LIAB CLAIMS MADE AGGREGATE $ L - - - r I DED RETENTION $ A WORKERS COMPENSATION WC 067712613 (AOS) 07101/2015 107/01/2016 X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER - ANY oROPPIGTr)P!PARTNFR!Ii tITNF Yr--; ADDITIONAL POLICIES F.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I N I A 1,000,000 • _ (Mandatory in NH) ;ARE ON PAGE 2 E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i I 'I i DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Chris Chambers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 455 Siskiyou Blvd. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) ACORD name and logo are registered marks of At'C,RD AGENCY CUSTOMER ID: 040631 LOC Washington AC4 ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA, INC. THE NATURE CONSERVANCY 4245 NORTH FAIRFAX DRIVE POLICY NUMBER SUITE 100 ARLINGTON, VA 22203 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance ADDITIONAL WORKERS COMPENSATION POLICIES EFFECTIVE DATE (ALL POLICIES): 07/01/2015 EXPIRATION DATE (ALL FOL CIES) 07%01;2016 INSURER AFFORDING COVERAGE (ALL POLICIES): INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA - NAIC: 19429 POLICY NUMBER / STATE(S) WC 067712614/ CA WC 0677126151 FL WC 0156846641 MA, ND, OH, WA, WI, WY WC 069862929/ NJ, PA WC 069862930 ( AK, AZ, GA, VA WC 069862931 l IL, KY, NC, NH, UT, VT ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of AC0F°.D