HomeMy WebLinkAboutInsurance Certificate: SO Child Study & Treatment Center
ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
06/30/2008
PRODUCER (503)293-8325 FAX (503)293-5418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
J. D. Fulwiler & Co Insurance, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5727 SW Macadam Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 69508
Portland, OR 97239 INSURERS AFFORDING COVERAGE NAIC#
INSURED Southern Oregon Child Study & Treatment Center INSURER A: Alliance of NonProfits for Ins
1836 Fremont St INSURER B: Saif Corporation
Ashland, OR 97520 INSURER C: North American Elite Ins CO
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 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.
I~~: ~Jl;~ TYPE OF INSURANCE POLICY NUMBER P~H~Y EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY 200821304 07/01/2008 07/01/2009 EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY DAMAGE TC?_ RENTED $ 100,000
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 10,00(]
A X PERSONAL & ADV INJURY $ 1,000,00(]
-
GENERAL AGGREGATE $ 3,000,00(]
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00(]
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY 200821304 07/01/2008 07/01/2009 COMBINED SINGLE LIMIT
- (Ea accident) $ 1,000,00(]
X ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
A X -
X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ A"" AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY 200821304UMB 07/01/2008 07/01/2009 EACH OCCURRENCE $ 1,000,00(]
00 OCCUR D CLAIMS MADE AGGREGATE $ 1,000,00(]
A X $
Fxi DEDUCTiBlE $
X RETENTION $ 10,00(] $
WORKERS COMPENSATION AND 998536 07/01/2008 07/01/2009 I T~g~n~~~ I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000
B ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,00(]
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,OO(]
SPECIAL PROVISIONS below
OTHER CWBOO06988-00 07/10/2008 07/10/2009 $2,132,000 Blanket Building
C P~roperty $208,200 Blanket BPP
~ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS interest may appear to the
~ertificate Holder is hereby added as an Additional Insured as their
bperations of the named insured, subjet to policy terms, conditions, and exclusions.
~dditional insured wording applies to General Liability only.
:10 days notice of cancellatiion for non-payment of premium.
City of Ashland
20 E Main Street
Ashland, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
.k~~~IG~f.LU'J0
Terasa Gilliam CHARL
ACORD 25 (2001/08)
@ACORD CORPORATION 1988