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HomeMy WebLinkAboutInsurance Certificate: City of Ashland (2) CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 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. Notwithstanding 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 18LASH 7/1/2018 7/112019 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 18LASH 7/1/2018 7/1/2019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 7/1/2018 7/1/2019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 18PASH 7/1/2018 7/1/2019 Per Filed Values X Boiler and Machinery A 18BASH 7/1/2018 7/1/2019 Per Filed Values Excess Liability X Excess Crime B 18ECASH 7/1/2018 7/1/2019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 7/1/2019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: For the rental of a van from Southern Oregon University by the Ashland Parks and Recreation Department, for its use in its Youth Conservation Corp. program. The van is to be used for transporting students from park to park. The van will be rented during scheduled dates during the fiscal year beginning on July 1, 2018, and June 30, 2019. Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date Southern Oregon University thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail such A University with a Governing Body notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer 1250 Siskiyou Boulevard of this certificate. Ashland, OR 97520 By Date: June 12, 2018 CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycouny insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 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 18LASH 7/1/2018 7/1/2019 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 18LASH 7/1/2018 7/1/2019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 7/1/2018 7/1/2019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 18PASH 7/1/2018 7/1/2019 Per Filed Values X Boiler and Machinery A 18BASH 7/1/2018 7/1/2019 Per Filed Values Excess Liability X Excess Crime B 18ECASH 7/1/2018 7/1/2019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 711/2018 7/1/2019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 7/1/2019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: For use of Jackson County School District #5's meeting facilities by any department or division of the City of Ashland. Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date Jackson County School District #5 thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail such 885 Siskiyou Boulevard notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer Ashland, OR 97520 of this certificate. / BY E`-{ it--- Date: June 12, 2018 CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 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 18LASH 7/1/2018 7/1/2019 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 18LASH 7/1/2018 7/1/2019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 7/1/2018 7/1/2019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 18PASH 7/1/2018 7/1/2019 Per Filed Values X Boiler and Machinery A 18BASH 7/1/2018 7/1/2019 Per Filed Values Excess Liability X Excess Crime B 18ECASH 7/1/2018 7/1/2019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 7/1/2019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: Jackson County is named as additional named per the agreement made between Jackson County and the City of Ashland giving Ashland Fire & Rescue the exclusive right to provide ambulance service in ASA #3. 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 such Jackson County notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer 140 South Holly Street of this certificate. Medford, OR 97501 By* Date: June 12, 2018 CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 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 18LASH 7/1/2018 7/1/2019 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 18LASH 7/1/2018 7/1/2019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 7/1/2018 7/1/2019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 18PASH 7/1/2018 7/1/2019 Per Filed Values X Boiler and Machinery A 18BASH 7/1/2018 7/1/2019 Per Filed Values Excess Liability X Excess Crime B 18ECASH 7/1/2018 7/1/2019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 7/1/2018 7/112019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 7/1/2018 7/112019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 7/1/2019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: For training(s) conducted by Ashland Fire & Rescue on property belonging to Southern Oregon University. Southern Oregon University is additionally named for these training events. 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 such Southern Oregon University notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer A University with a Governing Body of this certificate. 1250 Siskiyou Boulevard Ashland, OR 97520 By. ! ~2Jc~ ty~~ti-,ate Date: June 13, 2018 CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 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, tens 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 18LASH 7/1/2018 7/1/2019 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 18LASH 7/1/2018 7/1/2019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 7/1/2018 7/1/2019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 18PASH 7/1/2018 7/1/2019 Per Filed Values X Boiler and Machinery A 18BASH 7/1/2018 7/1/2019 Per Filed Values Excess Liability X Excess Crime B 18ECASH 7/1/2018 7/1/2019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 7/1/2019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: Ron Deluca, owner and landlord of property in the Claycomb Plaza Mall, leased by the City of Ashland, and CPM Real Estate Services, as managers of leased property, are listed as additional named as outlined in the Ashland Police Substation Lease Agreement, dated April 1, 2013, and in Lease Addendum #1. 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 such Ron Deluca and notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer CPM Real Estate Services, Inc. of this certificate. 718 Black Oak Drive, Suite A Medford, OR 97504 By- Date: June 13, 2018 CERTIFICATE OF COVERAGE All Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 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. Notwithstanding 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 18LASH 7/1/2018 7/1/2019 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 18LASH 7/1/2018 7/1/2019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 7/1/2018 7/1/2019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 18PASH 7/1/2018 7/1/2019 Per Filed Values X Boiler and Machinery A 18BASH 7/1/2018 7/1/2019 Per Filed Values Excess Liability X Excess Crime B 18ECASH 7/1/2018 7/1/2019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 7/1/2018 7/1/2019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 7/1/2019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: Certificate Holder and its officers, employees, and agents are additional members (insured) in respects to the agreement between the City of Ashland and the City of Medford for the US Cellular Community Park Fiber Project, dated December 2017, subject to the conditions and terms of the CIS coverage agreement. 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 such City of Medford notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer Parks & Recreation of this certificate. 411 West 81" Street, Room 225 Medford, OR 97501 By. ~'y ;L*,- Date: June 13, 2018 CERTIFICATE OF LIABILITY INSURANCE DATE (MMloormY) 6/1312018 V 1 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown Northwest CONTACT ' Sand L. Orr NAME: 3256 Hillcrest Park Drive PNCNE 541-094-2687 a No: 541-094-2787 Medford, OR 97504 E-MAIL ADDRESS: sort bbnw.com INSURER(S)AFFORDING COVERAGE NAIC0 www.bbnw.com INSURERA: Midwest Employers Casual Company 23612 INSURED INSURERB: City of Ashland INSURER C: 20 E Main St Ashland OR 97520 INSURERD: INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 42507253 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. MEN TYPEOFINSURANCE ADDLE BR POLICY NUMBER M~pCCY EFF m~OCp UP OMITS LT0. COMMERCIALGENERALLUIBRJTY EACH OCCURRENCE E DAMAGE TO RENT D CLAIMS-MADE F-IOCCUR PREMISES Eaocwnence $ MED UP (Any one person) E PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ R POLICY ❑ PRO- r LOC PRODUCTS-COMPIOPAGG $ JECT -1 OTHER: $ AUTOMOBILELUIBIOTY COMBINED SINGLEOMIT S Be as dent ANY AUTO BODILY INJURY (Per Person) E OWNED SCHEDULED BODILY INJURY (Far accident) 8 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Pereeddem E UMBRELLADAB OCCUR EACHOCCURRENCE $ EXCESS LUIS CLAIMS-MADE AGGREGATE $ DED RETENTIONS S A WORNERSCOMPENSATION EW0008757 7/1/2018 7/1/2020 STATUTE ✓ ERH -XCeSS WC. AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER0(ECUTIVE NIA EL EACH ACCIDENT $1000000 OFFICERIMEMBER EXCWDEDT (Mandatory In NH) EL DISEASE - EA EMPLOYEE $1000000 If yes. desaibe under DESCRIPTION OF OPERATIONS nal. E.L. DISEASE-POLICY LIMIT $1000000 X-WC Retention - $750,000 Codes 7720, 7710, 7539 X-WC Retention - $500,000 All Other Codes DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES(ACORDded,AddlSonal Remad Schedule,maybeattached Umomspareisr ulmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Medford THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 411 West 8th Street ACCORDANCE WITH THE POLICY PROVISIONS. Medford OR 97501 AUTHOR6EDREPRESENTANVE Sand L. Off ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 42507253 1 18-20 Szcees wC I Sandy L. Uza 16/13/2018 10:S3:16 AM (PDT) I Page 1 or 1 CERTIFICATE 00 COVERAGE Agent This certificate is issued as a matter of informailon only and canters no rights upon the certificate holder other DIRECT than those provided in the coverage dominant This certificate does not amend, extend or alter the coverage afforded by the coverage documems listed herein. cilycounty 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 Pills, PA COMPANY C - RSUI Indemnity Ashland, OR 97520 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. Notwithstanding 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 exdusions of such coverage documents. Type of Coverage Company Certificate Effective Termination Date Coverage Limit Letter Number Date General Liability A 18LASH 7/112018 7112019 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 18LASH 711/2018 71112019 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 18APDASH 711/2018 7/12019 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 1SPASH 7/112018 7/1/2019 Per Fled Values X Boller and Machinery A 18BASH 7/1/2018 - 711/2019 Per Fled Values Excess Liability X Excess Crime B 18ECASH 71112018 7/112019 Per Loss: $1,000,000 X Excess Earthquake C 18EQASH 7/12018 7/112019 Each Occurrence: $10,000,000 X Excess Flood C 18FASH 71112018 7112019 Each Occurrence: $10,000,000 Difference in Conditions X Excess Cyber Liability A 18ECLASH 7/1/2018 71112019 Occurrence/Aggregate: $950,000 Workers' Compensation Description: Jackson County, and its elected officials, officers, volunteers, agents, and employees are named as additional named with respect to Jackson County's law enforcement services within the Ashland Interface and the Ashland Watershed to be provided under the intergovernmental agreement between the county and the City of Ashland for forest patrol during the limeframe of July 1, 2018, through June 30, 2019. 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 such Jackson County notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer 5179 Crater Lake Highway of this certificate. Central Point, OR 97502 Date: June 13, 2018 v Member / Account Number: CITY OF ASHLAND / 18LASH Endorsement: Additional Member- Designated Person or Organization This Endorsement changes the Excess Liability Coverage Agreement. Please read it carefully. Name of Person or Organization: Jackson County, and its elected officials, officers, volunteers, agents, and employees. In consideration of the contribution received, it is agreed the above named person or organization is a Member, as defined under section SK(z), but only to the extent the Named Member has agreed under contract, or other agreement lawfully entered into, to hold harmless, indemnify, or defend such named person or entity. This coverage is subject to the following additional provisions: 1. The Trust will pay damages for which the above named person or organization becomes legally responsible only if damages arise out of acts or omissions of the Named Member. 2. The designation of the above named person or organization shall not operate to increase the Trust's limits of liability. ALL OTHER TERMS AND CONDITIONS OF THIS COVERAGE AGREEMENT REMAIN THE SAME AUTHORIZED REPRESENTATIVE Tena Purdy/Scott Moss CIS -XSGL AM (7/1/18) L o~ Member / Account Number: CITY OF ASHLAND / 18LASH Endorsement: Additional Member- Designated Person or Organization This Endorsement changes the General and Auto Liability Coverage Agreement. Please read it carefully. Name of Person or Organization: Jackson County, and its elected officials, officers, volunteers, agents, and employees. In consideration of the contribution received, it is agreed the above named person or organization is a Member, as defined under section 1K(2), but only to the extent the Named Member has agreed under contract, or other agreement lawfully entered into, to hold harmless, indemnify, or defend such named person or entity. This coverage is subject to the following additional provisions: 1. The Trust will pay damages for which the above named person or organization becomes legally responsible only if damages arise out of acts or omissions of the Named Member. z. The designation of the above named person or organization shall not operate to increase the Trust's limits of liability. ALL OTHER TERMS AND CONDITIONS OF THIS COVERAGE AGREEMENT REMAIN THE SAME AUTHORIZED REPRESENTATIVE Tena Purdy/Scott Moss CIS - G L/AL AM (7/1/18)