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Home My WebLink AboutInsurance Certificate: Community Health Center A CORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 5/28/2008 PRODUCER (541)482-0831 FAX: (541)488-5851 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ashland Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 585 A Street Suite 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 880 Ashland OR 97520 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Mu tual of Enumclaw 14761 Community Health Center Inc INSURER B: 19 Myrtle Street INSURER C: INSURER D: Medford OR 97504 INSURER E: 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. AC:;GREr:ATE LIMIT!'; !';HOWN MAY HAVE BEEN REDIIr.ED BY PAin r.1 AIMS. I~~: ADD'L P6>..t+i~:~~ggtWIE Pg~'W(~~=N LIMITS INSRD TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - ~~~~~H9E~~~Jti~cnce' X ..f2,MMERCIAL GENERAL LIABILITY $ 300,000 - A i CLAIMS MADE ~ OCCUR NC18143 3/14/2008 3/14/2009 MED EXP (Anv one oerson) $ 10,000 - PER~nNAL & ADV IN.IIIRY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Xl nPRO- n X POLICY .,.oi'T LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY (Per person) $ - SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ H ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY III"'~"'''~ $ tJ OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ 1$ WORKERS COMPENSATION AND I T~~I~JI~S I IOl~- EMPLOYERS' LIABILITY , ANY PROPRIETOR/PARTNER/EXECUTIVE E:L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E:L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E:L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER IS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION City of Ashland Its Officers, Employees & Agents Bryn Morrison 20 E Main St Ashland, OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT IGATlON OR LIABILITY OF ANY KIND UPON THE ACORD 25 (2001/08) INS025 (0108).08a @ ACORD CORPORATION 1988 Page 1 of 2 IMPORT ANT 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) INS025 (0108).08a Page 2 of 2 POLICY NUMBER: NC18143 COMMERCIAL GENERAL LIABILITY 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 20 E MAIN ST ASHLAND, OR 97520 (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 ~ervices Office, Inc., 1984 o