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ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
TM. 03120/2007
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 . --- RY RFI , ,w
INSURERS AFFORDING COVERAGE NAIC#
EVANSTON INSURANCE COMPANY --
INSURED INSURER A: 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 TOWHICH THIS CERTlACATE 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 SHO'llotl MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR =~ TYPE OF INSURANCE POLICY NUMBER ~y:.:;= ~,~~ UMITS
LTR
~ERAL LIABILITY EACH OCCURRENCE $
lWMGE TO RENTED
COMMERCIAL GENERAl LIABILITY PREMISES (Ea _co) $
I CLAIMS MADED OCCUR MED. EXP (Anyone person) $
PERSONAl & ADV INJURY $
-
GENERAl AGGREGATE $
-
GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCT8-COMPJOP AGG. $
I POliCY n ~:gT n LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
-
ALL OW NED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODilY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- r:"~~Zc~.r..;;gAMAGE $
GARAGE lIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
::5ESS / UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
I we STATU- I I OlliER
WORKERS COMPENSATION AND TORY LIMITS
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRlETORIPARTNER/EXECUTIVE
OFFICERlMEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $
. yes, dooc:ribe ...der E.L. DISEASE-POliCY LIMIT $
SPECIAL PROVISIONS bolow
OTHER: PROFESSIONAl LlABIUTY SM-84881 0 03l09/Q7 03109/08 $1,000,000 EACH CLAIM
A INSURANCE FOR SPECIFIED MEDICAL $3,000,000 AGGREGATE
PROFESSIONS $2,500 DEDUCTIBLE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil 10 DAYS
WRITTEN NOTICE TO THE CERTIACATE HOLDER NAMED TO THE LEFT, BUT FAiLURE TO
DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
MID VALLEY GENERAl AGENCY
lLC
~
i.:...
. ~ Z")~..'..
Herman R Deiss
@ACORDCORPORATION 1988
Attention:
ACORD 25 (2001/08)
Certificate #
32430