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~M CERTIFICATE OF LIABILITY INSURANCE ~I DATE (MM/DDIYYYY)
05/30/2006
PRODUCER (541)482-0831 FAX (541)488-5851 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ashland Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
585 A Street Suite 1 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 880
Ashland, OR 97520 INSURERS AFFORDING COVERAGE NAIC#
INSURED Community Health Center Inc INSURER A: Mutual of Enumclaw 14761
19 Myrtle St INSURER B:
Medford, OR 97504 INSURER C:
INSURER D:
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 ~PDJ TYPE OF INSURANCE POLICY NUMBER PRH~Y EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY NCl8143 03/14/2006 03/14/2007 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE T9~RENTED $ 300,000
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 10,OQO
A X PERSONAL & ADV INJURY $ 1,000,000
- 2,000,000
GENERAL AGGREGATE $
I-- PRODUCTS. COMP/OP AGG $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
11 .nPRO. n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
I-- (Per person) $
SCHEDULED AUTOS
I--
HIRED AUTOS BODILY INJURY
I-- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
q ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:::J OCCUR o CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T"X~5T~Jg-., I IOl~-
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 ADDEO BY ENDORSEMENT / SPECIAL PROVISIONS
~ERTIFICATE HOLDER IS ADDITIONAL INSURED
R
City of Ashland
Its Officers, Employees & Agents
Bryn Morrison
20 E Main St
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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
ACORD 25 (2001/08)
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