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HomeMy WebLinkAboutInsurance Certificate: Community Works /31/2022 10:00:47 AM PST (GMT-8) FROM: 7142854282-TO: 15415522059 Page: 2 of 3 Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/31/2022 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). CONTACT PRODUCER Brown& Brown Northwest NAME: Sandy L.Orr 3256 Hillcrest Park Drive lac No.ExtI: 541-494-2687 FAX ,No): 541-772-3785 Medford, OR 97504 E-MAIL ADDRESS: sandy.orr@bbrown.com • INSURER(S)AFFORDING COVERAGE NAICII www.bbnw.com INSURERA: Alliance of Nonprofits for Insurance INSURED INSURER B: SAIF Corporation Community Works 2594 E. Barnett Rd Suite C INSURER`: Medford OR 97504 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 68527893 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 INSD Swvo POLICY NUMBER R POLICY EFF POLICY EXP LIMITS (MMIDDlYYYY) (MMID D/YYYY) A , COMMERCIAL GENERAL LIABIUTY ✓ 2022-19517 7/1/2022 7/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE J. OCCUR PRMAGtIORtNItD PREMISES(Ea occurrence) $100,000 ✓ Professional Liability MED EXP(Any one person) $10,000 / Abuse&Molestation PERSONAL SADV INJURY $1 000,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PELT 1-7 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILEUABILITY 2022-19517 7/1/2022 7/1/2023 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 _ ANY AUTOl BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS • HIRED PROPERTY $✓ AUTOS ONLY ✓AUTOS ONLY (Per accident) A j UMBRELLA UAB ✓ OCcuR 2022-19517UMB 7/1/2022 7/1/2023 EACH OCCURRENCE $2,000,000 _ EXCESS UAB CLAIMS-MADE AGGREGATE $2,000,000 •DED ✓ RETENTION$10,000 $ B WORKERS COMPENSATION 352614 7/1/2022 7/1/2023 ✓_ PERTUTE ETH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNEPJEXECUTIVE ❑ N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Ashland, its officers and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20-East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND OR 97520 • AUTHORIZED REPRESENTATIVE '--- difekodil. tallAoe I Sandy L.Orr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 58527893 122-23 GL/Auto/Umb/WC I Sandy L. Orr 15/31/2022 10:00:08 AM (PDT) I Page 1 of 2 /31/2022 10:00:47 AM PST (GMT-8) FROM: 7142854282-TO: 15415522059 Page: 3 of 3 POLICY NUMBER: 2022-19517 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written 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 required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds, the following is added to organization(s)shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property damage"or"personal and advertising injury" If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 )8527893 122-23 GL/Auto/Umb/WC I Sandy L. Orr 15/31/2022 10:00:08 AM (PDT) I Page 2 of 2 /2022 10:00:47 AM PST (GMT-8) FROM: 7142854282—TO: 15415522059 Page: 1 of 3 4 -own& Brown Northwest _56 Hillcrest Park Drive Medford, OR 97504 1 FAX DOCUMENT a Certificate of Insurance Delivery by ecertsonline,r" 541-772-1111 _• z www.bbnw.com From:, Sandy L.Orr I w.__._....... �. ..,... ., w. ..._...`...... TO: , , ,�,T., ,,..,..., , ,,.. u.H, . ..... ,., ,,. , z :T Subject: Cert No.68527893-Certificate of Liability:Community • Works- i. City of Ashland, its officers and employees I. 20 East Main Street Date: 5/31/2022 ASHLAND OR 97520 1 1 i Delivery Via: FAX 15415522059 T No. of Pages: 3 THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVLEGED,CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW.IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT,OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DEL NERING THE MESSAGE TO THE INTENDED RECIPIENT,YOU ARE HEREBY NOTFIED THAT ANY DISSEMINATION.DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION N ERROR,PLEASE NOTIFY US(MEDIATELY BYTELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertson line TM Insurance Visions,Inc.All rights reserved.