HomeMy WebLinkAboutInsurance Certificate: Ashland Supportive Housing & Community Outreach AC40" CERTIFICATE 4F LIABILITY INSURANCE FDATE(MMIDDrrM)
01/13/2026
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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
NAME:CONTACT Linzi Laughery
Bliss Sequoia Insurance PHONEEElt: )364-5401
A/C No {AIC.No:
P.O.Box 826 E- AILlissinsurance.com
ADDRESINSURER(S)AFFORDING COVERAGE NAIC#
Salem OR 97308 INSURERelphia Indemnity Insurance Company 18058
INSURED INSURER B: SAIF
Ashland Supportive Housing&Community Outreach INSURER C
2305 Ashland Street#104-400
INSURER D:
INSURER E:
Ashland OR 97520 INSURER F:
COVERAGES CERTIFICATE NUMBER: 26/27 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE 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 POLICY EFF LICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) $ 1,000,000
X Pollution Liability
MED EXP(Any one person) $ 20,000
A Y PHPK2633445-022 02/01/2026 02/01/2027 1,000,000
PERSONAL&ADV INJURY $
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000
POLICY PRO
�
JECT
OTHER: LOC 3,000,000
PRODUCTS-COMPIOPAGG $
$
AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 1,000,000
Ea accident)
6WN
ANYAU BODILY INJURY(Per person) $
AL
LY PHPK2633445-022 02/0112026 02/01/2027 BODILY INJURY(Per accident) $
PROPERTY DAMAGE Y Per accident $
LIAB 1,000,000
EACH OCCURRENCE $ABADE PHUB892661-022 02101/2026 02/01/2027 $ 1,000,000
AGGREGATE RETE
WORKERS COMPENSATION Is -
AND EMPLOYERS'LIABILITY YIN X STA UTE EORH
B OFFICERIMEANY IMBERjEXC EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE ❑ NtA 776721 E.L.EACH ACCIDENT $ 1,000,000
04t01t2025 04i0112026
(Mandatory in NH)
If yes,describe under E.L.DISEASE-FA EMPLOYEE $ 1,000,000
DESCRIPTION OFOPE RATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
Professional Liability 1,000,000 per Occ 3,000,00OAgg
A Abuse/Molestation PHPK2633445-022 02/01/2026 02/01/2027 1,000,000 per Occ 2,000,00OAgg
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES{ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
The City of Ashland,its officers,agents and employees are included as additional insureds as is required by Written contract per the policy forms.
RE:Work performed on its behalf by the named insured.
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 ......
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