HomeMy WebLinkAboutMediation Works
::>lale r-arm r-Ire ana ~asualty ~ompany
PO Box 5000
Dupont, WA 98327-5000
1-15- 2024-F472 F U 3
CITY OF ASHLAND ITS OFFICERS,
EMPLOYEES & AGENTS
20 E MAIN 5T
ASHLAND OR 97520-1850
11.1..1...1.1.1...1.111......111..1..1.1.11...1.1.,1.1...1.1,1
Insured: MEDIATION WORKS, A COMMUNITY
DISPUTE RESOLUTION CENTER
Location: 33 N CENTRAL A V STE 306
MEDFORD OR
97501 -5939
Add Ins-II: RUSS DALE PROPERTIES
Add Ins-II: CITY OF ASHLAND ITS OFFICERS,
Forms, Options, and Endorsements
Special Form 3
Amendatory Endorsement
Tree Debris Removal
Business Policy Endorsement
Products/Operations Liab Excl
Personal Injury Exclusion
Additional Insured Endorsement
Glass Deductible Deletion
Designated Premises Limitation
Advertising Injury Excl
Amendatory Endorsement
Fungus (Ii !duJing Mold) Excl
Continued on next page
FP-6103
FE-6237.1
FE-6451
FE-6464
FE-6312
FE-6346
FE-6494
FE-6538.1
FE-6351
FE-6345
FE-6551
FE-6566
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RENEWAL CERTIFICATE
~-----------
POl~Y N~~ER 97-BG-9222-6
Business. Office Policy
lMA~ 31 2006 to MAR 31 2007
r PAID BY SPECIFIED PAFlTY
1---------
I Coverages and Limits
Section I
I A Buildings
I B Business Personal Property
C Loss of Income
Deductibles - Section I
Basic
Other deductibles may
apply - refer to policy
Section II
L Business Liability
M Medical Payments
Gen Aggregate (Other than PCO)
Products-Completed Operations
(PCO Aggregate)
Annual Premium
Forms, Opts, & Endrsmnt
Bus Liability - Cov L
OlGA Fee
Total Amount
Premium Reductions
Renewal Year Discount
Yrs in Business Discount
Claim Record Discount
Cov. A - Inflation Index:
Cov. B - Consumer Price:
L
N/A
199.2
;- ~- ,
I ,:..._
--1-
I
-I
I
I
i
___J
Excluded
25,700
Actual Loss
500
$1,000,000
5,000
2;.000,000
t.xcluded
$204.00
62.00
34.00
.29
$300.29
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15816 401 AI Agent LAURA BIXBY FOX INS AGCY INC
N
Telephone (541) 482-2461
-II-z 56 3636 231 6
See reverse side for important informatIOn.
REB
Prepared FEB 06 2006
~Iale r-arm r-Ire anlJ ~asualty ~ompany
PO Box 5000
Dupont, WA 98327-5000
RENEWAL CERTIFICATE SUPPLEMENTAL PAGE
POLICY NUMBER 97.88-9222-6
Business- Office Policy
MAR 31 2006 to MAR 31 2007
1.15- 2024-F472 F U 3
l-
I
~1
J
CITY OF ASHLAND ITS OFFICERS,
EMPLOYEES 8 AGENTS
20 E MAIN 51
ASHLAND OR 97520-1850
[CONTINUED
L___~_
11.1..1...1.1.1...1.111..,...111..1..1,1.11...1.1..1,1...1,1.1
Forms, Options, and Endorsements
Subcontractor Pd Exclusion
Inc Cost and Demolition Cov
Policy Endorsement- Business
Section II Additional Insured
Terrorism Insurance Cov Notice
FE-6598
FE-6587
FE-6610
FE-6609
FE-6999
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15817
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401 AI
Agent LAURA BIXBY FOX INS AGCY INC
Telephone (541) 482-2461
REB
Prepared FEB 06 2006