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Home My WebLink AboutLa Familia ACORD.. CERTIFICATE OF LIABILITY INSURANCE [ DATE (MM/DD/YYVY) 0110512006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WESTERN STATES INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE POBOX 65 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ASHLAND, OR 97520 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (888) 661-3938 XW894 882 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:THE TRAVElERS INDEMNITY COMPANY MALCOLM AMALGAMATED THREADBARE DBA LA FAMILIA INSURER B: 119 A STREET INSURER C: ASHLAND, OR 97520 INSURER D: I INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION 'TD '.'''Dr TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS A X ~NERAL L1ABIITY 680-6339B65A-06 01/0512006 01/05/2007 EACH OCCURRENCE $ 1 000 000 ~ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 tJ CLAIMS MADE [R] OCCUR PRCM'C:CC: - MED EXP (Anv one oersonl $ 5,000 X HIRED AUTO PERSONAL & ADV INJURY $1,000,000 X NON OWNED AUTO GENERAL AGr.REI~ATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 Xl POLICY n PRO- n JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - (Ea accident) $ - ANY AUTO ALL OWNED AUTOS BODILY INJURY $ - (Per person) - SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY (Per accident) $ - NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCiDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 0- OCCUR D CLAIMS MADE AGGREGATE $ $ R ~EDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I T~~JI~Ys I I Ol~ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED - STATE OR POL SUBDIVISIONS-PERMITS-PRM CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND 20 E MAIN ASHLAND, OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCElLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) I I ACORD.. CERTIFICA TE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 01/05/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WESTERN STATES INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE POBOX 68 HOLDER. THIS CERTIFICATE DOES ~IOT AMEND, EXTEND OR ASHLAND, OR 97520 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (888) 661-3938 XW894 882 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:THE TRAVElERS INDEMNITY COMPANY MALCOLM AMALGAMATED THREADBARE DBA LA FAMILIA INSURER B: 11 9 A STREET INSURER C: ASHLAND, OR 97520 INSURER D: I INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADD'I POLICY EFFECTIVE POLICY EXPIRATION ITR I NSR~ TYPE OF INSURANCE POLICY NUMBER DATE IMM/DDIYY) DATE IMM/DDIYY) LIMITS A X ~NERAL L1ABIITY 680-6339B65A-06 01/05/2006 01/05/2007 EACH OCCURRENCE $ 1 000 000 .x COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 o CLAIMS MADE 00 OCCUR ---, - MED EXP IAnv one Dersonl $ 5 000 X HIRED AUTO X PERSONAL & AD" INJURY $1,000,000 NON OWNED AUTO $ 2,000,000 GENERAl AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Xl POLICY n PRO- n JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I- (Ea accident) $ I- ANY AUTO ALL OWNED AUTOS BODILY INJURY $ I- ST. PAUL TRAVELERS (Per person) SCHEDULED AUTOS I- CERTIFICATE HOLDER PLEA E TAKE NOTICE HIRED AUTOS BODILY INJURY I- THIS CERTIFICATE IS CANCI LLED EFFECTIVE 1/05/2006 (Per accident) $ I- NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ ~CESS/UMBRELILA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ $ ~ ~EDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I T~~H~Ys I I Ol~ EMPLOYERS' LIABILITY E,L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFI CER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POJCY LIMIT $ SPECIAL PROVISIONS below OTHER , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS : . i CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED - STATE OR POL SUBDIVISIONS-PERMITS-PRM : ,. r : FEB 1 5 2006 Iii ~ i L -. .-.-..,....,.--, "-";- .,........., .'.", - CERTIFICATE HOLDER CANCELLATION ~""-~......<.-............~- CITY OF ASHLAND 20 E MAIN ASHLAND, OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C,~NCElLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVO~I TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UF'ON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ) C ACORD CORPORATION 1988 ACORD 25 (2001/08)