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HomeMy WebLinkAboutInsurance Certificate: Community Works 6/20/2017 1:56:06 PM PST (GMT-8) FROM: 100005-T0: 15415522059 Page: 2 or 3 ~ ° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) ' 6/20/2017 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 have ADDITIONAL INSURED provisions or 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 ri hts to the certificate holder in lieu of such endorsements . PRODUCER Brown & Brawn Northwest CONTACT NAME: Sand L. Orr 3256 Hillcrest Park Drive P~HONN , 541-494-2687 ~ No ; 541-494-2787 Medford, OR 97504 EMAIL ADDRESS: SOrr bbnw.com INSURERS}AFFORDING COVERAGE NAIC # www.bbnw,com INSURERA : AIIlance of Non rofits for Insurance INSURED INSURER B : SAIF COr Oration Community Works 201 W Maln, Suite 3D INSURERC: Medford OR 97504 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 36240069 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A ✓ COMMERCIALGENERALLIABILITY ✓ 2017-19517 7/1/2017 7/112018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 CLAIMS-MADE ✓ OCCUR PREMISES Ea occurrence $ ✓ Professional Liability MED ExP (Any one person> $ 10,000 ✓ Abuse & Molestation PERSONAL & ACV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑ PRO ~ LOC 2 JECT PRODUCTS - COMPIOP AGG $ ,000,OOO OTHER. $ A AUTOMOBILE LIABILITY 2017-19517 711/2017 7/112018 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULEC BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident $ A ✓ UMBRELLA LIAB OCCUR 2017-195170 MB 71112017 7/1/2018 EACH OCCURRENCE $ 2,000,QQ0 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED ✓ RETENTION 10,000 $ B WORKERS COMPENSATION 352614 711/2017 7/1/2018 STATUTE ~RH AND EMPLOYERS' LIABILrrY Y ! N ANYPROPRIETOR/PARTNEWEXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER1h9EMBEREXCLUDED? ~ N!A {Mandatory in NH} E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES {ACORD 101, Additional Remarks Schedule, may be aflached i(more space is required} All operations of the Named Insured as provided under the policy terms, conditions & exdusions. General Liability coverage includes Blanket Additional Insured coverage as required by written contract per endt CG 20 26 07104 (Attached}. CERTIFICATE HOLDER CANCELLATION Clt of Ashland, its officers and em to ees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20yEast Main Street p y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND OR 91520 AUTHORIZED REPRE SENTATIVE Sand L. Orr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016!03) The ACORD name and logo are registered marks of ACORD ~5240J59 17-16 GL/Auto/Urnb/WC Sardy L. Orr 5/20/2017 1:5 :51 PM (PDT) Page 1 of 2 6/20/2017 1:5G:06 PM PST (GMT-8) FROM: 100005-T0: 15415522059 Page: 3 of 3 POLICY NUMBER: 2017-19517 COMMERCIAL GENERAL LIABILITY CG 20 2G 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANISATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Or anization s Any person or organization that you are required to add as an additional insured on this policy, under a wrEtten contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information re aired to com lefie this Schedule, if not shown above, wilt be shown in the Declarations. Section II Il~ho Is An Insured is amended to in- clude as an additional insured the persons} or organi- zations} shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts ar omis- sions of those acting on your behalf: A. !n the performance of your ongoing operations; or B. fn connection with your premises owned by or rented to you, CG 20 26 07 04 ©ISO Properties, Inc., 2004 Pale 1 of 1 ❑ 36240069 17-16 GL/Auto/Umb/WC Sandy L. Grr 6/20/2017 1:53:51 Ft4 {?DTJ Fage 2 of 2