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. ....eresa Sleight At: Protectors Insurance LLC FaxlD: To: City of Ashland Date. 11/29/2007 03:42 PM Page: 1 of
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. . -. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
_CORD~ OP 10 Tsl
. ROGUE27 11/29/07
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIDr
Protectors Insurance, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Pilot Rock Ins Agency LLC (CA) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 4669 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Medford OR 97501
Phone: 541-773-5359 Fax:541-772-1906 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A. First National Insuranoe Co 24724
INSURER B:
Ro~e Valle~ Symphony Assoc -- -
SO C Music ld~ INSURER C
1250 Siskiyou lvd INSURER D
Ashland OR 97520
INSURER E:
2
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.
POLICY NUMBER "'~U.LJ~T,!i:~f_EC-'JVE 8k~~TIAA~gb~~~N
LTR NSR TYPE OF INSURANCE DATE MMIDDIYVJ" LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
A X COMMERCIAL GENERAL LIABILITY 01CE641830 09/01/07 09/01/08 PREMISES (Ea occurence) $1,000,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $1,000,000
I---
GENERAL AGGREGATE $1,000,000
I---
GEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS - COMP/OP AGG $1,000,000
n n PRO- nloe
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
$
ANY AUTO {Ea accidenQ
I---
ALL OWNED AUTOS BODILY INJURY
1-- $
SCHEDULED AUTOS (Per person)
m
HIRED AUTOS BODILY INJURY
I--- $
NON-OWNED AUTOS (Per accident)
I---
I--- PROPERTY DAMAGE $
(pcr accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUla OTHER THAN EA ACC $
AUTO ONLY, AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
1--
$
n DEDUCTIBLE $
-.-.- _n
RETENTION $ $
WORKEIl:S COMPENSATION AND I TORY LIMITS I IOt~.
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $
-- ---
OFFICFRIMFMRFR FJ<CILJDED? [L DISEASE [A EMPLOYEE $
If yes, describe under EL DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Ashland, its officers, employees, and agents are additional insured
per attached form CG7635
CERTIFICATE HOLDER CANCELLATION
City of Ashland
20 E Main str
Ashland OR 97520
CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE ND OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUIl:ER, ITS AGENTS OR
ACORD 25 (2001/08)
ACORD CORPORATION 198:
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From: Teresa Sleight At: Protectors Insurance LLC FaxlD: To: City of Ashland
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Date: 11/29/2007 03:42 PM Page. 2 of 2
COMMERCIAL GENERAL LIABILITY
CG 76 35 02 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ rT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or OrganlzaUon:
CITY OF ASHLAND
ADDITIONAL INSURED BY WRITTEN
CONTRACT, AGREEMENT OR PERMIT, OR
SCHEDULE
The following paragraph is added to WHO IS AN
INSURED (Section II):
4. Any person or organization shown in the Sched-
ule or for whom you are required by written con-
tract, agreement or pennit to provide insurance
is an insured, subject to the following additional
provisions:
a. The contract, agreement or permit must be
in effect during the policy period shown in
the Declarations, and must have been exe-
cuted prior to the "bodily injury", "property
damage" , or .personal and advertising
injury".
b. The person or organization added as an in-
sured by this endorsement is an insured only
to the extent you are held liable due to:
(1) The ownership, maintenance or use of
that part of premises you own, rent,
lease or occupy, subject to the following
additional provisions:
(8) This insurance does not apply to
any "occurrence" which takes place
after you cease to be a tenant in
any premises leased to or rented to
you;
(b) This insurance does not apply to
any structural alterations, new con-
struction or demolition operations
performed by or on behalf of the
person or organization added as an
insured;
(2) Your ongoing operations for that in-
sured, whether the work is performed
by you or for you;
(3) The maintenance, operation or use by
you of equipment leased to you by such
person or organization, subject to the
following additional proviSions:
(a) This insurance does not apply to
any "occurrence" which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services, 2001
Safeco anlllha Safaoo logo a.a ,.glsta.ad tradema.1l'II of Saf1lCO Corporation
CG 76 35 02 07 Page' 01 4 EP
C-AG.ll.PRINTOOl-2951-OO2&O