HomeMy WebLinkAboutInsurance Certificate: Casa of Jackson County
JUL. 17.2008
5 : 18 PM
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SIAlc rAKM IN~ KUKY
CERTIFICATE OF INSURANCE
(8J STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
o STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
o STATE FARM FIRE AND CASUAL TV COMPANY, Aurora, Ontario
o STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
o STATE FARM LLOYDS, Dallas. Texas
insures the following policyholder for the coverages indicated below:
Policyholder CASA OJ:' JACksON COUNTY
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This certifies that
Address of policyholder
Location of operations
Description of operations
613 MA~T ST MEDFORD, O~ 97504
SAlim
COURT APPOINTED ADVOCATE
The pOlicies listed below have been issued to the pOlicyholder for the policy periods shown. The insurance described in these policies is subject
to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD
POLICY NUM~ER TYPE OF INSURANCE Effective Date : Expiration Date
Comprehensive :
97-ES-S23S-8 F Business Liability 06/01/08 i 06/01/09
- This i;;~iura,;ce Inciudes: U .r8j produ.cts.: -Com.pleted "Operations" -- - - --. n.... -- --....... ~
l8J Contractual Liability
181 Personal Injury
18I Advertising Injury
(8J GENERAL LIJ.\BILITY
o
o
LIMITS OF LIABILITY
(at beginning of polley period)
BODILY INJURY AND
PROPERTY DAMAGE
Each Occurrence
$1,000,000
General Aggregate
$ 2, 000, 000
EXCESS LIABILITY
o Umbrella
o Other
POLICY PERIOD
. I
Effective Date : Expiration Date
Products - Completed $ 2,000,000
Operations Aggregate
BODILY INJURY AND PROPERlY DAMAGE
(Combined Single Limit)
Each Occurrence $
Aggregate $
Part I - Workers Compensation - Statutory
Workers' Compensation
and Employers Liability
POLICY PERIOD
Effective Date i Expiration Date
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POLICY NUMBER
TYPE OF INSURANCE
POLICY peRIOD
Effective Date : EXpiration Date
Part II - Employers Liability
Eaoh Accident $
Disease - Each Employee $
Disease - Policy LimIt $
LIMITS OF LIABILITY
(at beginning of policy period)
THE CERTIFICATE OF INSU~ANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR Al fERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
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Name and Address of Certificate Holder
ADDITIONAL INSURED:
If any of the described polioies are canceled before
their eXpiration date, State Farm will try to mail a
written notice to the certificate holder 30 days before
cancellation. If however. we fail to mall such notice,
no obli a' n-or liability will be imposed on Stat r=arrn
or i gen or representatives.
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
Signature of
AGENT
Title Date
RORY WOLD State Far.m Insurance
Agent Nama
Telephone Number 541-773-1404
Agent's Code Stamp
Agent Code 37-2137
AFO Code F472
558.994 a.S Prillted in U.S.A. Rev. 06.09-'-OOe