HomeMy WebLinkAboutInsurance Certificate: Jackson County SART
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYV)
TM. 02125/2009
PRODUCER Phone: 503-365-7001 Fax: 503-365-7354 THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMA nON
MID VALLEY GENERAL AGENCY LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4305 RIVER ROAD N ~?;.?!R. THIS CERTIFICATE DOES ~.?~uA..M!~,~~,~T;~?, .?~
KEIZER OR 97303
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A; EVANSTON INSURANCE COMPANY 35378
JACKSON COUNTY SART INSURER B:
C/O SUSAN MOEN INSURER c:
43 MORNING LIGHT DRIVE
ASHLAND OR 97520 INSURER 0: I
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 SHOY\-N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOC TYPE OF INSURANCE POLICY NUMBER ~~:=~= "g~~,~..70~N LIMITS
em INSR
~NERAL LIABILITY EACH OCCURRENCE ,
COMMERCIAl GENERAL LIABILITY DAMAGE TO RENTED ,
PREMISES (Eaoccuronce)
l CLAIMS MADED OCCUR MED. EXP (Anyone person) ,
- PERSONAL & ADV INJURY ,
- GENERAL AGGREGATE ,
h'LI AGGR~n LIMIT APPn:F.R: PRODUCTS-COMPIOP AGG. ,
PRO.
POLICY JECT LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Eaaccident) ,
I---
I--- ALL OWNED AUTOS BODILY INJURY
(Per person) ,
I--- SCHEDULED AUTOS
I--- HIRED AUTOS BODILY INJURY
(Per accident) ,
I--- NON...QWNED AUTOS
I--- PROPERTY DAMAGE ,
(Per accident)
RGE UABILrrY AUTO ONLY. EA ACCIDENT ,
ANY AUTO OTHER THAN EA ACC ,
AUTO ONLY: AGG ,
OESS I UMBRELLA LIABILITY . - EACH OCCURRENCE ,
OCCUR D CLAIMS MADE AGGREGATE ,
,
R DEDUCTIBLE ,
RETENTION $ ,
WORKERS COMPENSATION AND l~T~~TS I I OTHER
EMPLOYERS' LIABILITY
ANY PROPRlETORIf'ARTNER!D;ECUTlVE E.L. EACH ACCIDENT ,
OFFK:ER/MEMBER EXCLUOED? E.L. DISEASE-EA EMPLOYEE ,
l1yn.de...rlbeundef E.l. DISEASE.POLICY LIMIT ,
SPECIAL PROVlSIONS belDw
OTHER: PROFESSIONAL LIABILITY SM-863637 03/09/09 03/09/10 $1.000,000 EACH CLAIM
A INSURANCE FOR SPECIFIED MEDICAL $3,000,000 AGGREGATE
PROFESSIONS $2,500 DEDUCTIBLE
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/EXCLUSJONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLAN 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil 10 DAYS
20 E MAIN ST WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO mE lEFT, BUT FAILURE TO
ASHLAND, OR 97520 DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, Irs
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
MID VALLEY GENERAL AGENCY W. 'iJ~_'
LLC ~"C ., ~
Attention: Herman R Deiss
ACORD 25 (2001/08)
Certificate #
40526
@ACORDCORPORATION 1988