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HomeMy WebLinkAboutInsurance Certificate: St Vincent de Paul ~essica Cleeton BBN~I (~/4) 07/13/2017 03;43:41 PM -050( ~ 1 ® DATE (MNUDDIYYY1f~ AcoRO CERTIFICATE OF LIABILITY INSURANCE 7/13/2017 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 be endorsed. If SUBROGATION IS WAIVED, subject io the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer Ights to the certificate holder in lieu of such endorsement(s). PRODUCER ~~EACT Jessica Cleeton HrOxn & Brown Northeast PHONE (541) 772-1111 ~ Ne : (541) 772-3785 3256 flillcrest Park Drive E-MAIL cleeton bbn~o. com ADDRESS: ~ INSURER S AFFORDING COVERAGE NAIC ~ Medford OA 97504 INSURER A Philadel hie Indemnit Ins Co 18058 INSURED INSURER B Roque Valley District Council St Vincent de Paul INSURERC: PO BOX 1653 INSURER D INSURER E : Medford OR 97501 INSURER F COVERAGES CERTIFICATE NUMBER;cL1771351479 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, POLICY EFF POLICY EXP ILgR TYPE OF INSURANCE POLJCY NUMBER MMIDDIYYYY MMIDDIYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 DAMAGE TO RENTED 100, 000 A CLAIMS-MADE ~X OCCUR PREMISES Ea occurrence $ X l?~K1516910 7/1/2017 7/1/2016 MED EXP (Any one person) $ 5, 000 PERSONAL 8 ADV INJURY $ 1, 000, O00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000, 000 X POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: Sexual Misconduct Liability- $ 1, 000, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000, 000 Ea accident BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED p>E~K1516910 7/1/2017 7/1/2018 BODILY INJURY (Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP•Basic $ Statutory X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1 000 000 A EXCE55 LIAR CLAIMS-MADE AGGREGATE $ DED X RETENTION 10 000 pA08546818 7/1/2017 7/1/2018 $ WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YD E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under E.L. DISEASE -POLICY LIMff $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If more apace Is required) The City of Ashland, its officers, officials, agents, volunteers and employees are additional insureds as respects General Liability xhen required by Nritten agreement per attached endorsement. Thia form is subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION (541)552-2059 SHOULD ANY OF THE ABOVE DESCRIBED POLIgES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97502 AUTHORItED REPRESENTATIVE J Cleeton/JESSCL ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 r~n~am~ ~essica Cleeton BBN~I (3/4) 07/13/2017 03:44:42 PM -050( PI-GLD-HS (10111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, ar Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments -Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments -Bail Bonds $5,000 5 Supplementary Payment -Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement -Janitorial Services Client Coverage $10,000 limit 6 Additional Insured -Newly Acquired Time Period Amended 6 Additional Insured -Medical Directors and Administrators Included 7 Additional Insured -Managers and Supervisors (with Fellow Included 7 Em to ee Covera e Additional Insured -Broadened Named Insured Included 7 Additional Insured -Funding Source Included 7 Additional Insured -Home Care Providers Included 7 Additional Insured -Managers, Landlords, or Lessors of Premises Included 7 Additional Insured Lessor of Leased Equipment Included 7 Additional Insured - Grantor of Permits Included 8 Additional Insured -Vendor Included 6 Additional Insured -Franchisor Included 9 Additional Insured -When Required by Contract Included 9 Additional Insured -Owners, Lessees, or Contractors Included 9 Additional Insured - State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 2011 Philadelphia Indemnity Insurance Company ~essica Cleeton BBN~I (4/4) 07/13/017 03;45;32 PM -050( PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit lncluded 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury -includes Mental Anguish Included 11 Personal and Advertising Injury -includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury' or property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury' or "property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I -COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of daim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non-Owned Watercraft SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I -COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company