HomeMy WebLinkAboutInsurance Certificate: Jackson Co SART
ACORD CERTIFICA TE OF LIABILITY INSURANCE r DATE (MM/DDIYYYY)
TM. 03/20/2008
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 ~~;~:R. THIS CERTIFICATE DOES ~';>~uA~M~~~;..,~~T~~~ I~R
SALEM OR 97301
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: EVANSTON INSURANCE COMPANY 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 WTH RESPECT TOWHICH 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 SHOV;N MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR I~~ TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE P~~~:.~':.,":~~N LIMITS
LlR DATE fMMIOONY\
~ERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
l CLAIMS MADE D OCCUR MED. EXP (Anyone person) $
PERSONAL & ADV INJURY $
f---
GENERAL AGGREGATE $
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
h II PRO- nLOC
POLICY JECT
~OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
~
ALL OWNED AUTOS BODI L Y INJURY
~ (Per person) $
SCHEDULED AUTOS
~
HIRED AUTOS BODILY INJURY
i--- $
NON-oWNED AUTOS (Per accident)
i--- -
i--- I PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $
R ANY AUTO I OTHER THAN EA ACC $
AUTO ONLY AGG $
OESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CI CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
I 'M:: STATU- I I OTHER
WORKERS COMPENSA TION AND TORY LIMITS
EMPLOYERS' LIABILITY
E. L. EACH ACCIDENT $
ANY PROPRIETORlPARTNERlEXECU'!IVE
OFFICER/MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $
If yes, describe under E.L. DISEASE-POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER: PROFESSIONAL LIABILITY SM-856759 03/09/08 03/09/09 $1,000,000 EACH CLAIM
A INSURANCE FOR SPECIFIED MEDICAL $3,000,000 AGGREGATE
PROFESSIONS $2,500 DEDUCTIBLE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER
ACORD 25 (2001/08)
CANCELLATION
Certificate #
36986
@ACORDCORPORATION 1988
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WLL ENDEAVOR TO MAIL 10 DAYS
20 E MAIN ST WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
ASHLAND, OR 97520 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S
AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENT A TIVE
MID VALLEY GENERAL AGENCY w,~ ~ Un"".....
LLC
Attention: Herman R Deiss