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HomeMy WebLinkAboutInsurance Certificate: Jackson County ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/25/2014 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). CONTACT PRODUCER [!E AME: Sandy Orr C-No NE (541) 772-1111 FAX (541)772-3785 aC No Brown & Brown Northwest HO 3256 Hillcrest Park Drive -MAIL .sorr@bbnw.com INSURERS AFFORDING COVERAGE NAIC # Medford OR 97504 INSURER AMidwest Employers Casualty Co 3612 INSURED INSURER B : City Of Ashland INSURER C : 20 E Main St INSURER D : INSURER E : Ashland OR 97520 INSURER F : COVERAGES CERTIFICATE NUMBER:14-15 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE T RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 7 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 7 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION X TORY STATU I MIT OT LS ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? L] N / A 7/1/2014 7/1/2016 (Mandatory in NH) EW0008757 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under Retention - All Other $500,000 E.L. DISEASE -POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS below Retention - Codes 7539, $750,000 7720 & 7710 DESCRIPTION OF OPERATIONS I 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 AUTHORIZED REPRESENTATIVE 1005 E Main Street Medford, OR 97504 ,,//,`lt~ Sandy Orr/SANDOR GtJZ..(K•7/1.r ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD