HomeMy WebLinkAboutInsurance Certificate: Jackson County SART ACORD Ti., CE OF LIABILIT INSURANCE YY
RANCE OA (MM /DD o
PRODUCER:._Phone: 593-365-7001. Fax, 503- 365 -7354 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MID VALLEY GENERAL AGENCY LLC_ ONLY AND CONFERS NO RIGHTS UPON' THE CERTIFICATE
4305 RIVER ROAD N HOLDER. THIS CERTIFICATE. DOES NOT AMEND, EXTEND OR
KEIZER OR'97303, Al TFR THE COVFRAfF AFFORDFO BY THE POI ICIFS RFI OW-
INSURERS AFFORDING COVERAGE NAIC
INSURED INSURER A: EVANSTON INSURANCE COMPANY 35378
JACKSON COUNTY SART INSURER B:
CIO SUSAN MOEN INSURER C:
43 MORNING LIGHT DRIVE
ASHLAND OR 97520 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 MW 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 ADM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ADULT EXRDAnoN LIMBS
Lin INSRE DATE IMMNtlYYJ DATE IMMNDYY)
GENERAL LIABLITY EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE E
PREMISES (Ea awmce)
CLAIMS MADE l OCCUR MED. EXP (Any ono person)
PERSONAL 8 ADV INJURY
GENERAL AGGREGATE E
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OP AGG.
7 POLICY 1 ,PEO Inioc
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) f
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT
ANY AUTO OTHER THAN EA ACC
AUTO ONLY: AGG
EXCESS UMBRELLA LIABILITY EACH OCCURRENCE E
I OCCUR I ICLAIMS MADE' AGGREGATE
S
DEDUCTIBLE
RETENTION
E
WORKERS COMPENSATION AND we STAN OTHER
EMPLOYERS' ABILITY OR LIMITS
LIABILITY
ANY PROPRIETOR EXCLUDED? ry
IENECIRE
E.L. EACH ACCIDENT
OFFICER/ME/ABER EXCLUDED? E.L. DISEASE•EA EMPLOYEE
M yes, deec.M uMx
SPECIAL PROWSICNS below E.L. DISEASE POLICY LIMIT
OTHER: PROFESSIONAL LIABILITY SM 870793 03/09110 03109(11 $1,000,000 EACH CLAIM
A INSURANCE FOR SPECIFIED MEDICAL $3,000,000 AGGREGATE
PROFESSIONS $2,500 DEDUCTIBLE
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND 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 THE LEFT, BUT FAILURE TO
ASHLAND, OR 97520 D050 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 00_0_ MID VALLEY GENERAL AGENCY
LLC
Attention: Herman R Deiss
ACORD 25 (2001/08) Certificate 43866 ACORD CORPORATION 1988