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Home My WebLink AboutJackson County SART RECEIVED JUN 1 2 2006 ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) TM. 03/09/2006 PRODUCER Phone: 503-365-7001 Fax: 503-365-7354 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 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SALEM OR 97301 AI n::D BY DCI I\UlI INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: EVANSTON INSURANCE COMPANY 35378 JACKSON COUNTY SART INSURER B: C/O SUSAN MOEN INSURER c: 43 MORNING LIGHT DRIVE ASHLAND OR 97520 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. CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS 20 E MAIN ST WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO ASHLAND, OR 97520 DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, Irs AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MID VALLEY GENERAL AGENCY \-l ~ 0~~ LLC ~--c- . Attention: Herman R Deiss I~ ~~~ TYPE OF INSURANCE ~~ERAL LIABILITY COMMERCIAL GENERAL LIABILITY I CLAIMS MADED OCCUR ~~y:~= ~i:I~~N POLICY NUMBER EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurence MED. EXP (Anyone person) - PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. - GEN'L AGGREGATE LIMIT APPLIES PER: h POLICY n ';:& n LOC AUTOMOBILE LIABILITY f-- f-- ALL OWNED AUTOS f-- SCHEDULED AUTOS f-- HIRED AUTOS f-- ANY AUTO COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) NON-OWNED AUTOS f-- f-- Pp~~~~J:.,gAMAGE GARAGE LIABILITY R ANY AUTO ~ESS I UMBRELLA LIABILITY ~ OCCUR D CLAIMS MADE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE I DEDUCTIBLE I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERlEXECU11VE OFFICERlMEMBER EXCLUOED? If yes, describe under SPECIAL PROVISIONS below I~~TC~TS I IOTHER E.L. EACH ACCIDENT $ E.L. DISEASE-EA EMPLOYEE $ E.L. DISEASE-POLICY LIMIT $ OTHER: PROFESSIONAL LIABIUTY A INSURANCE FOR SPECIFIED MEDICAL PROFESSIONS $1,000,000 EACH CLAIM $3,000,000 AGGREGATE $2,500 DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SM-840953 03109/06 03/09/07 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) Certificate # 26940 @ACORDCORPORATION 1988 LIMITS $ $ $ $ $ $ $ $ $ $ $ EA ACC $ AGG $ $ $ $ $ $