HomeMy WebLinkAboutInsurance Certificate: Memory Care Center
A CORD~ CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIVYVY)
08127/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
111 SW. COLUMBIA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
FIFTH FLOOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PORTLAND, OR 97201 I INSURERS AFFORDING COVERAGE I NAIC #
Altn: Altn: Melody Drangstveil (503) 248.4877
902310--GUPL-09-11
INSURED INSURER A: Lexington Insurance Company 119437
Memory Care Center aka Trinity Respite
905 Skylark Drive, INSURER B: Health Future Ins Exchange, A RRG 12263
Ashland, OR 97520 INSURER c.
,
l_ I INSURER 0:
INSURER E:
,-
COVERAGES
2
1 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
l 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.
INSR ADD'l..;
ILTR ]INSRD, TYPE OF INSURANCE
A X ~ERAL L1ABIUTY
B X I COMMERCIAL GENERAL LIABILITY
I X I CLAIMS MADE 0 OCCUR
I
,
~
POUCY NUMBER
POUCY EFFECTIVE IPOllCY EXPIRATIONI
I DATE (MMIDDIYY) DATE (MMIDDIYY)
. EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES{Ea occurence}
MED EXP (Anyone person) 1$
PERSONAL & ADV INJURY 1$
GENERAL AGGREGATE
UMITS
6793055
6103-2009-10
09/01/09
09/01/09
09/01/11
09/01/11
,$
1$
1,OO_Q,OOO
GENERAL AGGREGATE LIMIT APPLIES PER.
. r-l PRO- n I
I I POLICY I JECT LOG
~OMOBILE L1ABIUTY
U ANY AUTO
I I ALL OWNED AUTOS
n SCHEDULED AUTOS
q HIRED AUTOS
ri NONO~NEO-=-__
I GARAGE UABILlTY
~ ANY AUTO
! I
[$
PRODUCTS - COMP/OP AGG$
I
3,000,00
COMBINED SINGLE LIMIT $
(Eaaccident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
WORKERS COMPENSATION AND
EMPLOYERS' UABIUTY
, ANY PROPRIETOR/PARTNER/EXECUTIVE
, OFFICER/MEMBER EXCLUDED?
~~E(;I~~s~~b~JIS1gNS below
I OTHER
: A I PROFESSIONAL LIABILITY
'B
16793055
.6103-2009-10
I
,
I 09/01/09
I 09/01/09
AUTO ONLY - EA ACCIDENTI$
OTHER THAN EA ACC 1$
AUTO ONLY: AGG 1$
tEACH OCCURRENCE $
AGGREGATE $
-----
$
I -- --- I:
I 'we STATU- I 10TH- I I
, ~:TORY.L1MITS~ _ _ ER_._ ___I
E.L EACH ACC!DENT 1$
~,L. DISEASE - ~AE~PLOYEer $ ~'-I
1-- ---.-- , -,
,EL DISEASE - POLICY LIMIT I $ I
I EXCESS/UMBRELLA LIABILITY I
~ OCCUR [J CLAIMS MADE
I
1.-..,
DEDUCTIBLE
RETENTION $
109/01/11
,09/01/11
I
I OCCURRENCE LIMIT
AGGREGATE LIMIT
,
I
1,000,000
3,000,000
DESCRIPTION OF OPERATIOHS/LOCATIONSNEHIClES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Ashland, it officers, employees and agents are added as additional insured as respects to the terms of the grant effective 6/19/07
This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and regulations of your State. State
i insurance insolvency guaranty funds are not available for your risk retention group. Therefore, these funds will not pay your claims or protect your assets if
. your risk retention group, the insurer, becomes insolvent and is unable to make payments as promised.
CERTIFICATE HOLDER
SEA-001136341-07
CANCELLATION
l
City of Ashland
20 East Main Street
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~..Q___ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR lIABIUTY OF ANY KIND
Ashland, OR 97520
UPON
THE
INSURER,
ITS AGENTS OR REPRESENTATIVES.
.j(".;.,..~.~~..
A~?AA~~~E8lIj~;.SENTATlVE
Lorie Larsen-Denning
. ACORD 25 (2001/08)
0- ACO-RD CORPORATION 1988