HomeMy WebLinkAboutInsurance Certificate: Health Future
MARSH
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER
PRODUCER
MARSH USA INC.
111 S.w. COLUMBIA
FIFTH FLOOR
PORTLAND, OR 97201
SEA-OO 1066727 -01
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
~02317m07/08
COMPANY
A
AMERICAN STATES INS. CO. (SAFECO)
INSURED
Health Future LLC
777 Murphy Road
Medford, OR 97501
COMPANY
B
COMPANY
C
COMPANY
o
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 2
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
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LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDD/YY) DATE (MMIDD/YY)
A
GENERAL LIABILITY
01CH0740382
05131/07
05/31/08
LIMITS
GENERAL AGGREGATE $ 2,000,000
PRODUCTS. COMP/OP AGG $ 2,000,000
PERSONAL & ADV INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 200,000
MED EXP (Anyone person) $ 10,000
COMBINED SINGLE LIMIT $ 1,000,000
BODIL Y INJURY $
(Per person)
BODIL Y INJURY $
(Per accident'!
PROPERTY DAMAGE $
AUTO ONL Y - EA ACCIDENT $
OTHER THAN AUTO ONLY
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE $
$
WC STATU- OTH
TORY LIMITS ER
EL EACH ACCIDENT $
EL DISEASE-POLICY LIMIT $
EL DISEASE-EACH EMPLOYEE $
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE
x
OCCUR
OWNER'S & CONTRACTOR'S PROT
A
AUTOMOBILE LIABILITY
01CH0740382
05/31/07
05/31/08
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
x
X
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE
OTHER
INCL
EXCL
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
The City of Ashland, Oregon, and its elected officials, officers and employees are included as Additional Insureds regarding Third Party Administrator services
contract.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF
City of Ashland
20 East Main Street
Ashland, OR 97520
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _..311 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, iTS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE
AUTHORIZED REPRESENTATIVE
Marsh USA Inc.
BY: Lorie Larsen-Denning
4<~ ~.~lA.<.l(
MM1(3/02)
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VALID AS OF:03/25/08