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HomeMy WebLinkAboutInsurance Certificate: Community Works 7/23/2018 10:54:04 AM PST (GMT-8) FROM: 7145052201-TO: 15415522059 Page: 2 of 2 ® DATE(MM/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 7!23/2018 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). CONT PRODUCER Brown & Brown Northwest NAMEACT Sandy L.Orr 3256 Hillcrest Park Drive Medford, OR 97504 PHONE E-MAIL Ea 1: 541-494-2687 FAX Medford, 541-494-2787 ADDRESS: sorr @bbnw.com INSURER(S)AFFORDING COVERAGE NAIC# www.bbnw.com INSURER A: Alliance of Nonprofits for Insurance INSURED INSURER B: SAIF Corporation Community Works 2594 E. Barnett Rd, Suite C INSURER C: Medford OR 97504 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 43266131 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W UNITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A ,/ COMMERCIAL GENERAL LIABILITY ✓ 2018-19517 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE ../ OCCUR PREMISES Ea occurrence) $100,000 ✓ Professional Liability MED EXP(Any one person) $10,000 ✓ Abuse&Molestation PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 POLICY PRO-JECT I LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 2018-19517 7/1/2018 7/1/2019 (Eo MBcINdEX INGLE LIMIT $1,000,000 . ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) A ,/ UMBRELLA LIAB ✓ OCCUR 2018-19517U M B 7/1/2018 7/1/2019 EACH OCCURRENCE $2,000,000 EXCESS[JAB CLAIMS-MADE AGGREGATE $2,000,000 DED ✓ RETENTION$10,000 $ B WORKERS COMPENSATION 352614 7/1/2018 7/1/2019 ✓ I STATUTE I ERH AND EMPLOYERS'LIABILITY Y ANYPROPRIETORARTNER/EXECUrIVE IP pi N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? (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 R 101,Additional Remarks Schedule,may be attached if more ace is required) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD y p q ) All operations of the Named Insured as provided under the policy terms, conditions&exclusions. General Liability coverage includes Blanket Additional Insured coverage as required by written contract per endt CG 20 26 07/04(Attached). CERTIFICATE HOLDER CANCELLATION City of Ashland, its officers and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATON 20 East Main Street ACCORDANCEIWITHDTH ATE THEREOF,PO ICY PROVISIONS. WILL BE DELIVERED IN ASHLAND OR 97520 AUTHORIZED REPRESENTATIVE ��`� �` I Sandy L.Orr 5 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 43266131 18-19 GL/Auto/Umb/WC Sandy L. Orr 7/23/2018 10:50:28 AM (PDT) Page 1 of 1