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Home My WebLink AboutOptions for Southern Oregon I AC!JBQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 07/24/2007 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 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5727 SW Macadam Ave 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: Alliance of NonProfits for Ins 1215 SW "G" Street INSURER B: North American Elite Ins Co Grants Pass, OR 97526 INSURER C. 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 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 2007-13817 08/01/2007 08/01/2008 EACH OCCURRENCE $ 1,000,000 7 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 I CLAIMS MADE m 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 - COMP/OP AGG $ 3,000,000 'I n PRO- nLOC POLICY JECT AUTOMOBILE LIABILITY 2007-13817 08/01/2007 08/01/2008 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ - 1,000,000 ALL OWNED AUTOS BODILY INJURY t-- (Per person) $ SCHEDULED AUTOS A t-- HIRED AUTOS BODILY INJURY t-- (Per accident) $ NON-OWNED AUTOS t-- t--- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY 2007-13817-UMB 08/01/2007 08/01/2008 EACH OCCURRENCE $ 3,000,000 b OCCUR 0 CLAIMS MADE AGGREGATE $ A $ 3,000,000 ~ DEDUCTIBLE $ X RETENTION $ 1O,OOC $ WORKERS COMPENSATION AND I WC STATU- I 10J~- EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ ANY PROPRIETOPJPARTNI"R/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ If yes. describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER . CWAOO04590-02 08/01/2007 08/01/2008 Comprehensive $250 B ~uto Physlcal Damage Collision $500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS he City of Ashland, its officers and employees are hereby added as additional insureds as their 'nterest may appear to the named insured, subject to policy terms, conditions and exclustions per ~ttached form CG2026. "10 days notice of cancellation for non-payment CERTIFICATE HOLDER City of Ashland Lee Tuneberg, Finance Director 20 E Main St. Ashland, OR 97520 CANCELLA TI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30'" 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_ _ f _ /1", --Mh Marlene Castillo/MCAST ~~ ACORD 25 (2001/08) @ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) Additional Coverages and Factors 07/24/2007 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 Business Auto Limits 1,000,000 10,000 1,000,000 1,000,000 5,000 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 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 Certificate issued to City of Ashland J. D. Fulwiler & Co Insurance, Inc 07/24/2007 POLICY NUMBER: 200713817 COMMERCIAL GENERAL LIABILITY City of Ashland 07/24/2007 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 5