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HomeMy WebLinkAboutInsurance Certificate: Ashland Supportive Housing & Community Outreach ® � DATE(MM/DDlYYYIf) A 3 o CERTIFICATE OF LIABILITY INSURANCE 01/29/2021 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 CONTACT Wauneta Ohnmacht NAME: Bliss Sequoia Insurance PHONE (503)364-5401 FAX (AIC,No.Ext): (NC,No): P.O.Box 826 E-MAIL wauneta@blissinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Salem OR 97308 INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: Ashland Supportive Housing&Community Outreach INSURER C: PO Box 3536 INSURER D: INSURER E: Ashland OR 97520-0318 INSURER F: COVERAGES CERTIFICATE NUMBER: (21-22) 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDNYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITYEACH OCCURRENCEDAMAGE TO $ 1,000,000 CLAIMS-MADE n OCCUR PREMISES Ea occurrence) $ 1,000,000 X Pollution LiabilityMED EXP(Any one person) $ 20,000 A Y PHPK2232480 02/01/2021 02/01/2022PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 n PRO- n 3,000,000 POLICY I 1 JECT I I LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PHPK2232480 02/01/2021 02/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) _ _ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A .-..--,-EXCESS LIAB CLAIMS-MADE PHUB754918 02/01/2021 02/01/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION I STATUTE I PER I ETH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE (� N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 per Occ 3,000,000 Agg A Professional Liability PHPK2232480 02/01/2021 02/01/2022 1,000,000 erOcc 1,000,000A Abuse/Molesation p g9 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Ashland,its officers,and employees are included as additional insureds as respects work performed on its behalf by the named insured as required by contract per PI-GLD-HS10/11. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 /' I �/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD