HomeMy WebLinkAboutInsurance Certificate: Mountain Star Preschool LLC DATE(MMIDD/YYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCEFL...-� 07/29/2025
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
Ed Clark Insurance, Inc. NAME: Lissy Fouts
2295 Liberty Street NE A/CNNo Ext: (503)581-3360 FAX No: (503)581-3428
Salem, OR 97301 E-MAIL
E-MAIL ADDRESS: cissy@edclarkinsurance.net
License #: 811033 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Evanston Insurance Company
INSURED
INSURER B
Mountain Star Preschool LLC INSURERC:
185 N Mountain Avenue INSURER D:
Ashland, OR 97520 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00012595-0 REVISION NUMBER: 3
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 CONTRACTOR 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 SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY
A X COMMERCIAL GENERAL LIABILITY Y 3AA864677 02/03/2025 02/03/2026 EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE F�vl DAMAGE TO J RENTE OCCUR PREM SES(E.occurrD.r ce) $ 100,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
�( POLICY PRO-
JECT LOC PRODUCTS-COMP/OPAGG $ Included
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Abuse Molestation or 3AA864677 02/03/2025 02/03/2026 Each Person 100,000
A Abuse Molestation or 3AA864677 02/03/2025 02/03/2026 Aggregate 200,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Evanston Insurance Company
Policy#3AA864677
2/3/25-2/3/26
Professional Liability Insurance
$1,000,000 Each Wrongful Act
$1,000,000 Aggregate
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS.
20 E MAIN ST
Ashland OR 97520 AUTHORI 71A
RRESEN�7ATIV
N ' (CNF
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CNF on 07/29/2025 at 09:15AM