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Home My WebLink AboutInsurance Certificate: Rogue Initiative for a Vital Econ ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 6/25/2008 PRODUCER (541) 772-1111 FAX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Beecher Carlson Insurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 707 Murphy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A American Hallmark Ins Co 43494 The Rogue Initiative for a Vital Economy INSURER B: Farminqton Casual tv co. dba: THRIVE INSURER C: 340 "A" Street, Suite 205 INSURER 0: Ashland OR 97520 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. Ar::, ;RFr::ATF liMITS SHOWN MAY HA .- --- R"nllr"n BY PAin rl AIMS I,N.:>~ ADD'L P~k+~~~~~6gmF Pg~'~l/~~~~N LIMITS TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY FArH orrllRRFNrE $ 500,000 - X COMMERCIAL GENERAL LIABILITY ~~~t~U9E~~~JCr~nce\ $ 100,000 A I CLAIMS MADE 0 OCCUR 44-MG-4332l8-04 7/15/2008 7/15/2009 MED EXP IAnv one oerson' $ Excluded D Y $ 500,000 - - GENERAL AGGREGATE $ 1,000,000 ~'L AGGREnE LIMIT AAES PER: _ """0/"0 ^ N' $ Included X POLICY ~[WT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY (Per person) $ - SCHEDULED AUTOS f-- HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) I--- f-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ 'ANY AUTO OTHER THAN F~ ~rr $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY F."C $ tJ OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND #IFUB76l7L89208 G/28/2008 6/28/2009 x 1 T"X<6-.?T fiT.\;!" I TOJbi- EMPLOYERS' LIABILITY 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, descr~~\~~~~~ 500,000 SPErlAL PR VI I NS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is additional insured when required by written contract or agreement as respects to Liability arising from operations of insured on their behalf as per attached form #MP9538 (03/05) . Coverage is subject to the policy terms, conditions and exclusions. (Add'l insd does not apply to the Workers Comp policy) CERTIFICATE HOLDER CANCELLATION 552-2059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland EXPIRATION DATE THEREOF, THE ISSUING tNSURER WILL ENDEAVOR TO MAIL Its officers and employees 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Finance Dept. - 20 East Main Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Ashland, OR 97520 INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~~ Phyllis Hite/PHYLHI ACORD 25 (2001/08) INS025 (0108).08a @ ACORD CORPORATION 1988 Page 1 of 2 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) INS025 (0108).08a Page 2 of 2 POLICY NUMBER: #44-MG-433218-03 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization (referred to below as Additional Insured) whom you are required to add as an additional insured on this policy under: 1. A written contract or agreement: and 2. Where a certificate of insurance showing that person or organization as an additional insured has been issued; and 3. When the written contract or agreement and the certificate of insurance are currently in effect or becoming in effect during the term of the policy and executed prior to the "bodily injury," "property damage" or "personal and advertising injury." B. The insurance provided to the Additional Insu red (s) is limited as follows: 1. The Additional Insured(s) is only an additional insured for: a. "Bodily injury;' "property damage" or "personal and advertising injury" caused in "Whole or in part by negligent acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts a Named Insured may be liable. b. Liability arising out of your ongoing operations for the Additionallnsured(s) by or for you. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. 2. The Limits of Insurance applicable to the Additionallnsured(s) are those specified in the written contract or agreement but not more than the Limits of Insurance specified in the Declarations ofthis policy. The Limits of Insurance applicable to the Additionallnsured(s) are inclusive of and not in addition to the Limits of Insurance shown in the Declarations for the Named Insured. C. In addition to the other exclusions applicable to Coverages A, B. and C, the insurance provided to the Additionallnsured(s) does not apply to: 1. "Property damage" to: a. Property owned, used, occupied by, loaned or rented to the Additional Insured(s); b. Property in the care, custody or control of the Additionallnsured(s) or over which the Additional Insured(s) are for any purpose exercising physical control; or c. "Your work" performed for the Additionallnsured(s). 2. "Bodily injury," "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services for you, for the Additionallnsured(s) or for others, including, but not limited to: a. The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or b. Supervisory, inspection or engineering services. 3. "Bodily injury" or "property damage" occurring after: a, All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or b, That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. MP 95 38 03 05 Inc;ludes copYrighted material of Insurance Services Office,lnc, with its permission. Page 1 of 1