HomeMy WebLinkAboutInsurance Certificate: Community Volunteer Network (2)---1 ® CERTIFICATE OF LIABILITY INSURANCE
DATE(26/DDIYYYY)
�..
12ll2019
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).
PRODUCER
CONTACT
NAME Underwriting Associate
Caring Communities Shared Services LTD
PHONE 847-549 8225
FAx 847-549-8095
1850 W. Winchester Road
(A/C, No, EXt
(,C No).
ADDRESS Certificates@caringcomm.org
Suite 109
Libertyville IL 60048
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED Pacific Retirement Services Inc.
INSURER A: Caring Communities, A Reciprocal RRG
12373
INSURER B:
Community Volunteer Network
One West Main St.
INSURER C:
Suite 303
INSURER D.
Medford OR 97501
INSURER E
COVERAGES CERTIFICATE NUMBER: 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
LTR
TYPE OF INSURANCE
ADVL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MMIDD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ❑X OCCUR
X
CCRRRG-0015-20
01/01/2020
01/01/2021
EACH OCCURRENCE
$ 1,000,000.00
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300,000.00
MED EXP (Anyone person)
$
PERSONAL BADVINJURY
$ 1,000,000.00
GEN'L
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 3,000,000.00
PRODUCTS - COMP/OP AGG
$ Incl
X
POLICY PRO- ❑ LOC
JECT
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIREDAUTOS NON -OWNED
AUTOS
EACH OCCURRENCE
$
UMBRELLA LIAR OCCUR-GL
AGGREGATE
$
$
EXCESS LIAR CLAIMS MADE-PL
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
PER
OTH-
EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE❑
OFFICER/MEMBER EXCLUDED?
N / A
STATUTE
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
12/26/2019 16:02:39
The Certificate Holder is included as an Additional INSURED under Coverage B, Commercial General Liability of this POLICY but only with respect to liability arising out of the
Retired Senior Volunteer Program (RSVP) as described within the Financial Assistance Award Contract entered into with the Named INSURED.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
g
ACORD 25 (2014/01) CO 19BB-2014 ACORD GURPURATIUN. All ngnts reserved.
The ACORD name and logo are registered marks of ACORD