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ISSUE DATE (MMlDDIYY)
12/06/06
PRODUCER
ASHLAND INSURANCE, INC.
PO BOX 880
585 A ST # 1
ASHLAND, OR 97520
CODE 1 090- 30 SUB-CODE
INSURED
TARA LABS INC
TARA LABS INC 401K
550 CLOVER LANE
ASHLAND, OR 97520
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.
n?/€g~.~~jijpg~ggQYi.lj;).....'"
COMPANY A
LEITER NORTH PACIFIC INSURANCE COMPANY
PLAN COMPANY B
LEITER OREGON AUTOMOBILE INSURANCE COMPANY
COMPANY C
LEITER LIBERTY NORTHWEST INSURANCE CORPORATION
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE OLlCY EXPIRATIO
DATE (MMIDDNY) DATE (MMIDDIYY)
LIMITS
GENERAL LIABILITY
KJ COMMERCIAL GENERAL LIABILITY
B 0 CLAIMS MADE ij(I OCCUR.
o OWNER'S & CONTRACTOR'S PROT.
c08 1486]2
12/01/06
12/01/07
GENERAL AGGREGATE
PRODUCTS-COMP/OP AGG.
PERSONAL & ADV INJURY
EACH OCCURRENCE
2,000,000
1,000,000
1 , 000 , 000
1 ,000, 000
100,000
000
o
FIRE DAMAGE (Anyone fire)
MED. EXPENSE (Anyone person) $
AUTOMOBILE LIABILITY
o ANY AUTO
o ALL OWNED AUTOS
o SCHEDULED AUTOS
o HIRED AUTOS
o NON-OWNED AUTOS
o GARAGE LIABILITY
COMBINED
SINGLE LIMIT
BODILY
INJURY (Per person)
BODILY
INJURY (Per accident)
o
PROPERTY
DAMAGE
EXCESS LIABILITY
EACH OCCURRENCE
AGGREGATE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS
ITS OFFICERS, COMMISSIONS, ELECTED OFFICIALS, EMPLOYEES AND AGENTS
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED WITH RESPECT TO
LIABILITY ARISING OUT OF OPERATIONS BY OR ON BEHALF OF THE NAMED
INSURED ONLY AS SPECIFIED BY THE ADDITIONAL INSURED ENDORSEMENT.
....~'R....~;r;;'.~':T.mc.R....O......."fioii'R................................................................................".jj;XiC...E...Y/i".'..;ik"T...I..A:-ii.t....................................
y~~~...:::.:;.~:..~~:..::~t.:. .:.::. .4~i~{ ...:rr:., ::.:}~.j:: ;.:. ,,: :':'::-<:'\" }(::: \... :': ii }:.:.'. :)t~<. .:i:::~~~,:..>::.. .':~::..::'. .~i:~(\/.}:;:.:::::::.......
THE CITY OF ASHLAND
SEE DESCRIPTION BELOW
20 EAST MAIN ST
ASHLAND, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 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 REPRESENT A TIVES.
LNCI 0002 (08-02)
C 577 00
ORIGINAL
POLICY NUMBER: C08 14-86-72 COMMERCIAL GENERAL LIABILITY
TARA LABS INC CG 20 11 01 96
12/01/06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR LESSORS OF
PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
1. Designation of Premises (Part Leased to You):
550 CLOVER LANE
ASHLAND,OR 97520
2. Name of Person or Organization (Additional Insured):
THE CITY OF ASHLAND
SEE DESCRIPTION BELOW
20 EAST MAIN ST
ASHLAND,OR 97520-1849
3. Additional Premium: INCLUDED
(If no entry appears above, the 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 but only with respect to liability arising out of the ownership, maintenance or use of that
part of the premises leased to you and shown in the Schedule and subject to the following additional
exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you cease to be a tenant in that premises.
2. Structural alterations, new construction or demolition operations performed by or on behalf of the
person or organization shown in the Schedule.
CG 20 11 01 96
ORIGINAL
Copyright, Insurance Services Office, Inc., 1994
D
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