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ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYVYY)
TM. 03127/2006
PRODUCER ~~:~7001 F~:~~M THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MID VALLEY GENERAL AGENCY LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3400 STATE ST G 740 ~~LDER. THIS CERTIFICATE DOES NOT AM~,D, EXTEND OR
SALEM OR 97301 I 'n'A I'lV T1-I~ ,,i.,,,,, BEll lW.
.-
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: SCOTTSDALE INSURANCE COMPANY
ASHLAND HOUSING OPPORTUNITIES, INC. INSURER B:
1215 SW "G" ST. INSURER C:
GRANTS PASS OR 97526
INSURER 0:
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 IMTH 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 SHOWl! MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~ TYPE OF INSURANCE POLICY NUMBER ~Y :',:;~ PO~;:=~N LIMITS
LTR
GENERAL LlABIUTY CLS0973470 03131/06 03131/07 EACH OCCURRENCE $ 1,000,000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES (Eo occur.nce) $ 100,000
I CLAIMS MADE [!] OCCUR MED. EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 1,000,000
~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000
h POLICY n r;:& n LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
~
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- I rt~~~,?^MAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
DESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
I we STATU- I I OTHER
WORKERS COMPENSATION AND TORY LIMITS
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRlETORIPARTNERlEXECUTlVE
OFFICERIIIEMBER EXCLUDED? E.L. OISEASE-EA EMPLOYEE $
If yel, describe under E.L. DISEASE-POLICY LIMIT $
SPECIAL PROIllSlONS below
OTHER:
DESCRIPTION OF OPERATlONSlLOCATlONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
1971 SISKIYOU BLVD, ASHLAND, OR 97520
CERTIFICATE HOLDER
CITY OF ASHLAND
20 EAST MAIN STREET
ASHLAND, OREGON 97520
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER 'MLL ENDEAVOR TO MAIL 10 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
MID VALLEY GENERAL AGENCY
LLC
\-l L.c.- , ~ 8 bt4'_
Herman R Deiss
Attention:
ROBERT D NELSON
'I
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