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ACORQM CERTIFICATE OF LIABILITY INSURANCE r DATE (MM/DD/YYYY)
07/27/2006
PRODUCER (503)293-8325 FAX (503)293-5418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
J. D. Fulwiler & Co Insurance, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5727 SW Macadam Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 69508
Portland, OR 97239 INSURERS AFFORDING COVERAGE NAIC#
INSURED Options for Southern Oregon, Inc. INSURER A All i ance of NonProfi ts fOlr Ins
1215 SW "G" Street INSURER B North American Elite Ins. Co.
Grants Pass, OR 97526 INSURER C
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 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 DD'l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 200613817 08/01/2006 08/01/2007 EACH OCCURRENCE $ 1,000,000
'--
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000
I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 10,000
A PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 3,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY 200613817 08/01/2006 08/01/2007 COMBINED SINGLE LIMIT
- (Ea accident) $
X ANY AUTO 1,000,000
'--
ALL OWNED AUTOS BODILY INJURY
I- $
SCHEDULED AUTOS (Per person)
A '--
X HIRED AUTOS BODILY INJURY
'-- $
X NON-OWNED AUTOS (Per accident)
'--
'-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY 200513817UMB 08/01/2006 08/01/2007 EACH OCCURRENCE $ 3,000,000
:]] OCCUR D CLAIMS MADE AGGREGATE $
A $ 3,000,000
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I WC STATU- I 10Jbl-
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 CWAOO0459002 08/01/2006 08/01/2007 Comprehensive Oed. $250
B ~(uto Phys i ca 1 Damage Co 11 -j son Oed. $500
~IESCRIPTlON OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
E: The City of Ashland, its officers and employees are additional insured per form
G2026
~O Days Notice of Cancellation - Non Payment
CERTIFICATE H LDER
City of Ashland
Lee Tuneberg, Finance Director
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
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
_ ~.~~~. .1....:;'-L:u........
Janice Wilson/WILSON
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
Additional Coverages and Factors
07/27/2006
Line of Business Coverages for
Coverage
Combined single limit
PIP-Basic
Uninsured motorist
combined single limit
Underinsured motorist
combined single limit
Comprehensive
Collision
Medical payments
Line of Business Coverages for
Coverage
General Aggregate
Products/Completed Ops
Aggregate
Personal & Advertising
Injury
Each Occurrence
Fire Damage
Medical Expense
Employee Benefits
Improper Sexual Conduct
Liquor Liability
Social Service
Professional
Business Auto
Limits
1,000,000
10,000
1,000,000
1,000,000
5,000
General Liability
Limits
3,000,000
3,000,000
1,000,000
1,000,000
100,000
10,000
1,000,000
500,000/500,000
1,000,000/1,000,000
1,000,000/3,000,000
Oed/Oed Type
Rate
250
500
Oed/Oed Type
Rate
Premium
Factor
Premium
Factor
City of Ashland
Certificate issued to City of Ashland
J. D. Fulwiler & Co Insurance, Inc
07/27/2006
POLICY NUMBER: 200513817 COMMERCIAL GENERAL LIABILITY
07/27/2006
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
City of Ashland, its officers and employees
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in
the Schedule as an insured but only with respect to liability arising out of your operations or premises
owned by or rented to you.
CG 20 26 11 85
Copyright, Insurance Services Office, Inc., 1984
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