HomeMy WebLinkAboutInsurance Certificate: Proactive Health Resources LLC
. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
ACORD.. OP ID CB
PROAC-1 06/11/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Davidson Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
7901 NE Fourth P1ain Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Vancouver w.A 98662
Phone: 360-514-9550 Fax: 360-514-9551 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Nationwide MUtual Insurance CO
INSURER B:
Proactive Hea1th Resources LLC INSURER c:
Ph~liss VanderVeer
40 7 Jefferson Parkway INSURER D:
Lake Oswego OR 97035
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.
LTR NSRI TYPE OF INSURANCE POLICY NUMBER ~';!~i:~8~W: I ~~~Y,~a&lRA~N LIMITS
DATE MMlDDNY
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
I--
A ~ COMMERCIAL GENERAL LIABILITY ACP7531854462 07/11/08 07/11/09 PREMISES '(E~~~~~nce) $ 300,000
I-- tJ CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,000
X Business Owners PERSONAL & ADV INJURY $1,000,000
I--
GENERAL AGGREGATE $ 2,000,000
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
!xl n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I f--- $1,000,000
I ANY AUTO (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
I-- $
SCHEDULED AUTOS (Per person)
I-- 07/11/08 07/11/09
X HIRED AUTOS ACP7531854462 BODILY INJURY
I-- $
X NON-OWNED AUTOS ACP7531854462 07/11/08 07/11/09 (Per accident)
I--
I-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
i WORKERS COMPENSATION AND ITO~v"~I~:-?'S I IUE~-
: EMPLOYEl'll!' LiABl\.fTY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: All Operations of the Insured.
CERTIFICATE HOLDER
CANCELLATION
ASHLAND
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 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AU ORIZED REPRES
Ash1and
20 E Main St
Ash1and OR 97520
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)
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)
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