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DATE (MM/DDIYY)
07/03/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
PRODUCER
JBL&K Risk Services
1-503-222-1831
220 NW 2nd Ave Suite 800
Portland, OR 97209-3951
COMPANY
A Colony Specialty Insurance Co
COMPANY
B Alliance for Nonprofits for Insurance
COMPANY
C
INSURED
Community Works
900 East Main
Medford, OR 97504
COMPANY
o
THIS IS TO CERTIFY THAT THE POLICIES OF INSUANCE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
POLICY EFFECTIVE
DATE (MMlDDIYY)
07/01/06
POLICY NUMBER
POLICY EXPIRATION
DATE (MM/DDIYY)
07/01/07
TYPE OF INSURANCE
B 200619517
COMMERCIAL GENERAL LIABILITY
CLAlMS MADE ~ OCCUR
OWNER'S & CONTRACTOR'S PROT
X Professional Liability
X Abuse & Molestation
B AUTOMOBILE LIABILITY 200619517
X ANY AUTO
ALL OWNEO AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED EXP (Any one person)
07/01/06
07/01/07
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH OCCURRENCE
AGGREGATE
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND EMPLOYERS'
LIABILITY
THE PRIORIETORl
PARTNERS/EXECUTIVE
OFFICERS ARE:
EL EACH ACCIDENT
EL DISEASE - POLICY LIMIT
INCL
EXCL
EL DISEASE - DISEASE
OTHER
A Foster Care Liability
APSOS061
07/01/06
07/01/07
Each Occurrence
Aggregate
Deductible:
DESCRIPTION OF OPERATIONSlLOCATlONSNEHICLES/SPECIAL ITEMS
CITY OF ASHLAND IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY ONLY.
ALL OPERATIONS OF THE NAMED INSURED AS PROVIDED UNDER THE POLICY TERMS, CONDITIONS & EXCLUSIONS.
LIMITS
$2,000,000
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 100,000
$ 10,000
$ 1,000,000
$
$
$
$
$
$
1,000,000
2,000,000
5,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL l.Q. DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
COMPANY ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~~
CITY OF ASHLAND
ATTN: FINANCE
20 EAST MAIN STREET
ASHLAND, OR 97520
USA
car1a.he1mer
4577287
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