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HomeMy WebLinkAboutRogue Valley Manor Community Services Caring Communities Insurance Company CERTIFICATE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MAlTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 7Jl1S CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGEAFFORDED BY THE POUClES BELOW. 7Jl1S IS TO CERT1FYTHAT THE 1'OUClES OF INSURANCE USTED BELOW 114J'E BEEN ISSUED TO THE POUCYHOLDER FOR THE POUCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOClJMEN1' WITH RESPECT TO WI1ICH mIS CERT1FlCATE MAY BE ISSUED ORMAY PERTAIN, TIlE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEIlMS, EXCLUSIONS AND CONDmONSOFSUal POUC/ES. UMlTSSHOWNMAYHAJ'E BEEN RBDUCEDBY PAIDCU1M8. Date Certificate Issued: February 23, 2006 Certificate Holder: The City of Ashland Iosurer: Caring Connmmities Insurance Company, Cayman Islands Policyholder: Pacific Retirement Services, Inc. Policy Number CCIC 0015-04 Named INSURED: RQIUe Valley Manor Community Services Policy Form: Senior Services Organization Liability Policy Policy Term: January 1,2006 - January 1,2007 at 12:01 AM. Primary Coverages: Senior Services Organization Professional Liability, Commercial General Liability and Employee Benefit Programs Liability Prbnary Coverages Limit of Liability: $ 1,000,000 Per CLAIM and $ 3,000,000 Policy Period Aggregate, all coverages SelflDsured Retention: $ 50,000 Per CLAIM Excess Coverages: Senior Services Organi7.ation Professional Liability, Commercial General Liability, Employee Benefit Programs Liability, Automobile Liability and Employers' Liability Excess Coverages are subject to the foDowing Underlying Innraace Requirements: Senior Services Organization Professional Liability S 1,000,000 Per CLAIM Commercial General Liability S 1,000,000 Per CLAIM Employee Benefit Programs Liability $ 1,000,000 Per CLAIM Automobile Liability S 1,000,000 Each Accident Employers' Liability $ 1,000,000 Each Accident I Disease Exeess Coverages IJmiU of Liability: Senior Services Organization Professional Liability S 10,000,000 Per CLAIM Commercial General Liability S 10,000,000 Per CLAIM Advertising Liability $ 5,000,000 Per CLAIM I Policy Period Aggregate Watercraft Liability $ 5,000,000 Per CLAIM I Policy Period Aggregate Employee Benefit Programs Liability S 5,000,000 Per CLAIM I Policy Period Aggregate Automobile Liability $ 6,000,000 Each Accident Employers' Liability $ 5,000,000 Each AccidentlDisease and Policy Period - Aggregate Edition: 1/06 Page lof2 B:\ins'ClV\policiC$\ccrIificales\certitic:atc temp1ates\2006 certificates\Pacific Rdimnent Servs\revised The City of AshImd.doc Seaior Services Organization Professional Liability 10IIIIeI origiuting in Texas, Florida, ArkaDsas and Louisiana are limited to: $ 2,000,000 Per CLAIM and Policy Period Aggregate Overall Aggregate Limit of Liabi&ty: $ 11,000,000 Per Any One Event $ 13,000,000 All Events for Policy Period Additioaal Terms, Conditiou and EIclnsiou: The Certificate Holder is included as an Additional INSURED wder this POUCY but only with respect to liability arising out of services rendered by the Named INSURED as outlined within the terms and conditions of the contractual agreement for the Foster Grandparent program between the City of Ashland and the Named INSURED. trJJtjCl~ Assistant Secretary As authorised representative FEB 25 2006 Date Certificate Signed Edition: 1/06 Page 2 of2 B:\ins'C'J'VlqJolicies\certificates\certificate templates\2006 certificates\Pacific Retirement Servs\revised The City of Ashland.doc