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DATE{MMIDDtYYYY}
CERTIFICATE OF LIABILITY INSURANCE 06/01/2026
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 andorsement(S).
PRODUCER CON ACT WTW Certificate Center
NAME:
Willis Towers Watson Northeast, Inc. PAX
c/o 26 Century Blvd ,A' N . 1-877-945-7378 No. 1-888-467-2378
E-MAIL P,O, Box 305191 ADDRESS: certifi Cates @wtwco.ecrm
Nashville, TN 372305191 USA _ INSURER(S)AFFORDINGCOVERAGE NAIC##
INSURER A: Bompo America Insurance Company 11126
INSURED INSURERS: Safety National Casualty Corporation 15105
Ricoh Americas Holdings, Inc. -
Ricoh USA, Inc. INSURER C:
300 Eagleview Blvd., Suite. 200 INSURER D:
Exton; PA 19341 _
iNSUREfI E
INSURER F:
COVERAGES CERTIFICATE NUMBER:W46344799 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. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. *Not Applicable in WY
TN_SR __.... ,_.. ..._ ..... ADC U� _ POLICY EFF_J POLICY EXP LINTS
TR• TYPE OF INSURANCE I POLICY NUMBER M DOtYYYY MM DD YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
—.__---
CLAIMS-MADE j OCCUR PREMISES(Ea occurrence} $ 500,000
A MED EXP(Any one person} $ 15,000
AGL30038682203 06/01/2026 0E10112027, PERSONAL&ADV INJURY ?$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000
I POLICY PRO, X:LOO PRODUCTS-COMPIOP AGG $ 2,000,000
JECT
OTHER: i
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident I$ 1,000,000
ANY AUTO BODILY INJURY{Per person} $
A OWNED SCHEDULED AAL30020107704 05/Ol/2026(E06/01/2027; BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED j pROPEF7TYDAMACaE`
AUTOS ONLY AUTOS ONLY t'er aaaident} $
UMBRELLA LIABy! OCCUR !EACHOCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED ! RETENTION$` -- $
WORKERS COMPENSATION ,STEAT_UTE - TRH
AND EMPLOYERS"LIABILITY
B !ANYPROPRIETOR?PARTNErd,EXECUTIVE YIN E.L.EACHACCIDENT $ 2,000,
000
OFFICERIMEMBEREXCLUDED? No NrA Y LDC4054740 06/Ol/2026iO6/09/2027 — Z,000,00D
;(Mandatary In NH) E.L.DISEASE-EA EMPLOYEE;
ti yyes,describe under 2,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
i
DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
Waiver of Subrogation applies to Workers Compensation, where required by written contract and as permitted by law.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DACE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
Community Development Department
AUTHORIZED REPRESENTATIVE
Attn: April Lucas
51 Winburn Way
Ashland, OR 97520
d 1888-2025 ACORD CORPORATION, All rights reserved.
ACORD 25(2025/12) The ACORD name and logo are registered marks of ACORD
sat it): 30010605 BA CR: 4460867
13528: 2 ol2