Loading...
HomeMy WebLinkAboutInsurance Certificate: Community Works /7/ZUZ1 5:UU:2J PM PST (GMT–d) fl-,OM: /14Ztb4ZJZ–TO: 1b41b5ZZUJJ, rage: L of .i Ac DATE(MM/DD/YYYY)c, CERTIFICATE OF LIABILITY INSURANCE 6/7/2021 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 Brown& Brown Northwest - CONTANAME; Sandy L.Orr 3256 Hillcrest Park Drive (A/C.No.Exp: 541-494-2687 FAX No): 541-494-2787 Medford, OR 97504 E-MAIL ADDRESS: sorr@bbnw.com INSURER(S)AFFORDING COVERAGE NAIC# www.bbnw.com INSURERA: Alliance of Nonprofits for Insurance INSURED INSURER B: SAIF Corporation Community Works 2594 E.Barnett Rd Suite C INSURERC: Medford OR 97504 - INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 62203748 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 SUER w ' POLI /YCY EFF POLICY EXP LIMITS LTRINSD VD POLICY NUMBER (MM/DD/YYYY) (MMIDDYYY) A ✓ COMMERCIAL GENERAL LIABILITY ✓ 2021-19517 7/1/2021 7/1/2022 EACH OCCURRENCE $1,000,000 DAMAGE IO REN I ED 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'LAGGREGATE UHT APPLIES PER: GENERAL AGGREGATE $2,000,000 _ —1 POLICY PRO I )LOC PRODUCTS-COMP/OP AGG $'2,000,000 • OTHER: $ A AUTOMOBILEUABILITY 2021-19517 7/1/2021 7/1/2022 (V aBadeDESINGLELIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED, SCHEDULED BODILY INJURY(Per accident) $ ' AUTOS ONLY AUTOS PROPERTY - $✓ AUTOS ONLY HIRED ✓ AUTOS ONLY • (Per accident) $ A �/ UMBRELLA LIAR I / I OCCUR 2021-19517U MB• 7/1/2021 7/1/2022 EACH OCCURRENCE $2,000,000 EXCESS UABI~—{I CLAIMS-MADE AGGREGATE $2 000,000 DED ✓ RETENTION$10,000 $ B WORKERS COMPENSATION 352614 7/1/2021 7/1/2022 PER H ✓ PERTUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNEPJEXECUTIVE YN/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY UMIT $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 City'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 ijail etA I\ f118 A , Sandy L.Orr ' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i2203746 121-22 GL/Auto/Ursb/WC 1 Sandy L. Orr 16/7/2021 4:56:52 PM (PDT) 1 Page 1 of 2 /7/2021 5:00:23 PM PST (GMT-8) FROM: 7142854282-TO: 15415522059 Page: 3 of 3 POLICY NUMBER: 2021-19517 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 organizations)shown in the Schedule, but only Section Ill—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 52203740 121-22 GL/Auto/Umb/WC I Sandy L. orr 16/7/2021 4:56:52 PM (PDT) I Page 2 of 2