HomeMy WebLinkAboutMediation Works
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State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327-5000
1-15- 1598-F472 F U 3
CITY OF ASHLAND ITS OFFICERS,
EMPLOYEES & AGENTS
20 E MAIN ST
ASHLAND OR 97520-1850
11.1..1...1.1.1..11.111....1.111..1..1.1.11...1.1..1.1...1.1.1
Insured: MEDIATION WORKS, A COMMUNITY
DISPUTE RESOLUTION CENTER
Location: 33 N CENTRAL A V STE 306
MEDFORD OR
97501-5939
Add Ins-II: RUSS DALE PROPERTIES
Add Ins-II: CITY OF ASHLAND ITS OFFICERS,
Forms, Options, and Endorsements
Special Form 3
Amendatory Endorsement
Tree Debris Removal
Business Policy Endorsement
Products/Operations Liab Excl
Personal Injury Exclusion
Additional Insured Endorsement
Glass Deductible Deletion
Designated Premises Limitation
Advertising Injury Excl
Amendatory Endorsement
Fungus (Including Mold) Excl
Continued on next page
FP-6103
FE-6237.1
FE-6451
FE-6464
FE-6312
FE-6346
FE-6494
FE-6538.1
FE-6351
FE-6345
FE-6551
FE-6566
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16827 401 AI Agent BILL COBB CLU
N TeleDhone (541) 482-1324
RENEWAL CERTIFICATE
POLICY NUMBER 97"'BG-9222~6 .
Business- Office Policy
MAR 31 2007 to MAR 31 2008
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PAID BY SPECIFIED PARTY I
Coverages and Limits
Section I
A Buildings Excluded
B Business Personal Property 26,400
C Loss of Income Actual Loss
Deductibles - Section I
Basic 500
Other deductibles may
apply - refer to policy
Section II
L Business Liability $1,000,000
M Medical Payments 5,000
Gen Aggregate (Other than PCO) 2EOOO,000
Products-Completed Operations xcluded
(PCO Aggregate)
Annual Premium $204.00
Forms, Opts, & Endrsmnt
Bus Liability - Cov L
Total Amount
62.00
34.00
$300.00
Premium Reductions
Renewal Year Discount
Yrs in Business Discount
Claim Record Discount
Cov. A - Inflation Index: N/A
Cov. B - Consumer Price: 203.9
If you have moved, please contact your agent.
See reverse side for important information.
RES
Prepared FEB 05 2007
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State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327.5000
1-15- 1598-F472 F U 3
CITY OF ASHLAND ITS OFFICERS,
EMPLOYEES 8 AGENTS
20 E MAIN ST
ASHLAND OR 97520-1850
11.1..1...1.1.1...1.111......111..1..1.1.11...1.1..1.1...1.1.1
Forms, Options, and Endorsements
Subcontractor Pd Exclusion
Inc Cost and Demolition Cov
Policy Endorsement- Business
Section II Additional Insured
Terrorism Insurance Cov Notice
Dist Mat Violat Statues Excl
Policy Endorsement
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FE-6598
FE-6587
FE-6610
FE-6609
FE-6999
FE-6655
FE-6656
16828
N
401 AI
Agent BILL COBB CLU
Telephone (541) 482-1324
RENEWAL CERTIFICATE
SUPPLEMENTAL PAGE
97'"8G-9222'"6 .~.... ......
POLICY NUMBER ..
Business- Office Policy
MAR 31 2007 to MAR 31 2008
.....
CONTINUED
RES
Prepared FEB 05 2007
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