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ACOHl)M CERTIFICATE OF LIABILITY INSURANCE OP 10 l~ DATE (MM/DD/YYYY)
9vALCAR 01/11/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hart Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3389 Crater Lake Hwy AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 I
Phone: 541-779-4232 Fax:541-772-3963 INSURERS AFFORDING COVERAGE I NAIC#
INSURED --
INSURER A: EMPIRE FIRE & MARINE INS CO i
INSURER B. !
I
Valley Care Trans Services Inc INSURER c: I
PO Box 1012 INSURER D:
Rogue River OR 97537
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.
LTR l.lsR~ TYPE OF INSURANCE
: I GENERAL LIABILITY
A !Xl COMMERCIAL GENERAL LIABILITY
~_+:=J CLAIMS MADE [!] OCCUR
W
I !
~'L AGGREGATE LIMIT APPLIES PER:
r-l POLICY n ~~~T n LOC
AUTOMOBILE LIABILITY
-_.
POLICY NUMBER
PD~~~1J~rDE~~~E P~k~CEY(~~bRD~~~N
--
LIMITS
CL311687
01/12/06
01/12/07
EACH OCCURRENCE
PREMISES (E~~'~~~~nce)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
$ 1,000,000
$ 100,000,
$ 5,000
$1,000,000
$2,000,000
$ INCLUDED
A ANY AUTO
--
ALL OWNED AUTOS
-
SCHEDULED AUTOS
--
HIRED AUTOS
. _H__
NON-OWNED AUTOS
!----
r---- -
i i
CL311686
01/12/06
COMBINED SINGLE LIMIT $ 1,000,000
01/12/07 (Ea accident)
--
BODIL Y INJURY $
(Per person)
BODIL Y INJURY $
(per accident)
- ~ --------
PROPERTY DAMAGE $
(Per accident) I
GARAGE LIABILITY
: F~ ANY AUTO
i I EXCESS/UMBRELLA LIABILITY
! tJ OCCUR CLAIMS MADE
, L_~l OEOUCTIB"
I j----l RETENTION $
i WORKERS COMPENSATION AND
, EMPLOYERS' LIABILITY
I' ANY PROPRIETOR/PARTNER/EXECUTIVE
I OFFICER/MEMBER EXCLUDED?
, If yes, describe under
I SPECiAL PROVISiONS below i
OTHER I 'II I,
! I
i I
: I [I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
AUTO ONLY - EA ACCIDENT $
--
_EA~____ __
AGG i $
EACH OCCURRENCE
OTHER THAN
AUTO ONLY
AGGREGATE
1$
$
ITbWy\'t~:~s !
E.l. EACH ACCIDENT
1$
i$
I $
IIUIH-I
ER '
$
E.l. DISEASE - EA EMPLOYEE $
--
E.L DI&EASE - POLICY LIMIT $
I
CITY REC'!2r"~::R'S COpy
CERTIFICATE HOLDER
CANCELLATION
CITYASH
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
CITY OF ASHLAND
PUBLIC WORKS DEPT
20 E. MAIN ST
ASHLAND OR 97520
ACORD 25 (2001/08)
HART INSURANCE/MEDFORD
'17
@ACORD CORPORATION 1988