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ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
TM. 03128/2007
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 AL ~R TUC RV BEL )W.
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: SCOTTSDALE INSURANCE COMPANY
ASHLAND HOUSING OPPORTUNITIES, INC. INSURER B:
1215 SW"G" ST. INSURER c:
GRANTS PASS OR 97526
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 'MTH 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 SHO'l\lll MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I:~ TYPE OF INSURANCE POLICY NUMBER ":fe~:::= ~~':~N LIMITS
LTR
GENERAL UABILlTY CLS1330539 03131/07 03131/08 EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000
PREMISES (Eo occuronco)
I CLAIMS MADE [!J OCCUR MED. EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 1,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
~ (Ee eccident) $
ANY AUTO
f--
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDULED AUTOS
f--
HIRED AUTOS BODlL Y INJURY
f-- $
NON-OWNED AUTOS (Per accident)
f--
- rP~~~;:~ngAMAGE $
GARAGE L1ABlUTY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
::5ESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
==i DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I we: STATU- I I OTHER
TORY UMITS
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRlETORIPARTNERlEXECUT1VE
OfFICERlMEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $
It yes, describe under E.L. DISEASE-POLICY LIMIT $
SPECIAL PROVISIONS boIow
OTHER:
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
1971 SISKIYOU BLVD, ASHLAND, OR 97520
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER 'MLL ENDEAVOR TO MAIL 10 DAYS
20 EAST MAIN STREET WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
ASHLAND, OREGON 97520 DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, Irs
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
MID VALLEY GENERAL AGENCY \-t ~ ~~.~
LLC ~-..
Attention: ROBERT 0 NELSON Herman R Deiss
ACORD 25 (2001/08)
Certificate #
32546
@ACORDCORPORATION 1988