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HomeMy WebLinkAboutInsurance Certificate: Pacific Retirement Services Inc ® A U CERTIFICATE OF LIABILITY INSURANCE DATE(MMI202 ) 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 pollcy(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 Underwriting Associate Caring Communities Shared Services LTD 1850 W.Winchester Road (A/C,ONNo,Ext): 8475498225- - (A/C,No): 847-549-8095 Suite 109 E-MAIL Certificates carin comm.or ADDRESS: G g 9 Libertyville IL 60048 - INSURER(S)AFFORDING COVERAGE NAIC# INSURED Pacific Retirement Services Inc. INSURER A: Caring Communities,A Reciprocal RRG 12373 Community Volunteer Network INSURER B: 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 ADD'L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS (MMIDD/YYYY1 (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY CCRRRG 0015-22 01/01/2022 01/01/2023 EACH OCCURRENCE $ 1,000,000.00 CLAIMS MADE n OCCUR X $ DAMAGE TO RENTED , 300,000.00 PREMISES(Ea occurrence) — MED EXP(Any one person) $ _ PERSONAL&ADV INJURY $ 1,000,000.00 GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 3,000,000.00 1 POLICY El PRO" 0LOC • PRODUCTS-COMP/OP AGG $ incl JECT OTHER: • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO , BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS _AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR GL AGGREGATE $ EXCESS LIAR CLAIMS MADE-PL $ _ $ _ DEDUCTIBLE $ RETENTION $ $ QV(JkRCKS(.UMYtNSAI RUN ANU - PbNN 0II-1- EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? n EL_EACH/A - EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 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) 12/21/2021 10:49:45 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 City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD