HomeMy WebLinkAboutInsurance Certificate: Mt Ashland Association
ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
10/5/2009
PRODUCER Commercial lines 206-701-5000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPDN THE CERTIFICATE
Wells Fargo Special Risks, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
520 Pike Street, 21st Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle, WA 98101 INSURERS AFFORDING COVERAGE NAIC#
INSURED Mt. Ashland Association INSURER A: NOVA Casualty Company .
P.O'.E\ox 220, INSURER B:
INSURER C: - ','"
INSURER 0:
Ashland,OR 97520 INSURER E:
SKI31499
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.
TYPE OF INSURANCE POLICY NUMBER Pr?4~~~ EFFECTIVe POLICY EXPIRATION LIMITS
LTR NSR
A ~NERAL LIABIUTY WFR-GL-0010050-0 10/01/09 10/01/10 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL lIABILITY DAMAGE TO RENTED $ 1,000,000
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ Not Covered
f- PERSONAl & ADV INJURY $ 1,000,000
t--!- GENERAL AGGREGATE . None
n'l AGG~EnE UMIT APf~~rIPER: PRODUCTS. COMP/O? AGG $ 2,000,000
POLICY ~r'?-; lOC
~TOMOBllE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Eaaccident)
-
- ,ALL OWNED AUTOS BODilY INJURY $"
SCHEDULED AUTOS (Per person)
-'- -
- HIRED AUTOS BODILY INJURY
r -.. -, -I (Peraccidenl) $.
NON-OWNED AUTOS , n'\i,I',i.::..,,~
- n);~' " . ..; I~ 0:
PROPERTY DAMAGE. .
1! (Per accident)
~~GE LL<.,UTY :r, i OCT- 9 2009 .1 /iI AUTO ONLY - EA ACCIDENT $
ANY AUTO ill! Vi EA ACC .
' -j l!: OTHER THAN
id , AUTO ONLY; AGG $
EXCESSIUMBRELLA lIABIUTY I i EACH OCCURRENCE $
:J -OCCUR 0 ClAIMS MADE J AGGREGATE . .
$ .
=i ~EOUCTI.LE $ '"
.,'
RETENTION $ . . $
WORKERS COMPENSATION AND '-T~CJ;r~~~ I IO~'
EMPLOYERS' UABllI"lY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT .
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L DISEASE - POLICY LIMIT
SPECIAL PROVISIONS below $
OTHER
A Excess Liability WFR-XS-0010008-0 10/01/09 10/01/10 $5,000,000 Occur. I $10,000,000 Agg.
Products - ComplOp Agg: $10,000,000
, PersollBl & Adv Injury: $5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
City of Ashland, its Officers & Employees are Add'! Ins. when required by written contract, agreement or lease, solely as respects liability arising from
operations of Named Ins. Re: Interest in Owned assets acquired 07/01/92.
CERTIFICATE HOLDER
CANCELLATION Ten Day Notice for Non-Payment
City of Ashland, Its Officers
& Employees
20 E. Main Street
Ashland, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE r4-.
ACORD 25 (2001108) 1 of 2 871426
@ ACORD CORPORATION 1988
:: .-:CORDm~,I;~IEi~,~Pt;:~~;::~m2~gR"li~':I~$J[~~c,g,:~;~~,;;
':;''''.;l1~1I11
,
THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER Pl1gN~o Ext: 206-701-5000
',;;;-i>}~:Y;~:,~ DATE (MMJDDIYY)
;,,' ,,;,~r ,",' 10/5/2009
ISSUED, IS IN FORCE, AND CONVEYS ALL THE
{
COMPANY
Commercial Lines - 206-701-5000
Wells Fargo Insurance Services; CA lie. #0531007
PO Box 91143
Seattle, WA 98111
AIX Specialty Ins Co.
CODE:
AGENCY
CUSTOMER 10 #:
INSURED
Mt. Ashland Association
P.O. Box 220
SUB CODE:
LOAN NUMBER
POLICY NUMBER
EFFECTIVE DATE
10/01/09
WFZ-CL-0020037-0
10/01/10
CONTINUED UNTIL
TERMINATED IF CHECKED
Ashland, OR 97520
THIS REPLACES PRIOR EVIDENCE DATED:
LOCATION/DESCRIPTION
PROPERTY & INLAND MARINE
COVERAGElPERILSfFORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
Property/Inland Marine
Scheduled Equipment
$6,762.242
$702.374
$5,000
$5,000
Re: Interest in ?wned-€'lssets-acquired 07/01/92,
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULO THE
POLICY BE TERMINATED. THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
NAME AND ADDRESS
City of Ashland, Its Officers & Employees
20 E. Main Street
MORTGAGEE
X LOSS PAYEE
LOAN #
ADDITIONAL INSURED
AUTHORIZED REPRESENTATIVE
~~
Ashland, OR 97520