HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Manor
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ACORD- CERTIFICATE OF LIABILITY INSURANCE r DA 1E IMMlDDIYYYY)
~ 1/8/2010
PRODUCER THIS CERTIFICATION IS ISSUED AS A MA TIER OF INFORMATION
Caring Communities Shared Services L TO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1650 W. Winchester Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Suite 109 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Libertyville IL 60048 INSURERS AFFORDING COVERAGE NAIC#
INSURED Pacific Retirement Services. Inc. INSURER A:. CarinQ Communities, A ReciDrocal RRG 12373
Rogue Valley Manor Community Services Inc. INSURER B"
INSURER c:
1045 Ellendale Drive INSURER D:
Medford OR 97504 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED 8ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANOING
ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN M1\Y HAVE BEEN REDUCED BY PAID CLAIMS.
I~~ ADD' POUCY NUMBER POUCY EFFECTIVE ~~!rW7M~~N UMITS
INSR TYPE OF INSURANCE DATE (MMIODfYYYY)
~NERAL UABIUTY CCRRRG-0015-10 01/01/2010 01/01/2011 EACH OCCURRENCE S 1.000 000.00
A X X COMMERCIAL GENERAL LIABILITY ~~~GIS%S fEa occurrence\ . S .
X I ClAIMS MADE D OCCUR MED EXP (Any one person) S -
X Professional liability PERSONAL & ADV INJURY S 1.000.000.00
X Relro Dale 01/01/2002 GENERAL AGGREGATE s 3,000.000.00
~'L AGG~EnEtIMIT APnS PER: PRODUCTS-COM~OPAGG S incl
X POLlCY ~:gT LOC s .
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT S
ANY AUTO (EaaccilSent)
f--
r ALL O'v'vNEO AUTOS BOOIL Y INJURY
S
SCHEDULED AUTOS (Per person)
f--
f-- HIRED AUTOS BODILY INJURY
S
f-- NON~EDAUTOS (P8f'ecddenl)
f-- PROPERTY DAMAGE S
(Per accident)
ROE UAB1UTY AUTO ONLY - EA ACCIDENT S
Am AUTO OTHER THAN EA ACe s
AUTO ONLY: AGG S
EXCESS I UMBREllA UABIUTY CCRRRG-ll015-10 01/0112010 01/01/2011 EACH OCCURRENCE S 10.000.000.00
A X b OCCUR ~ CLAIMS MADE AGGREGATE S 1- -_. "" .00
s
R DEoucnSLE , S
RETENTION S S
WORKERS COMPENSATION AND I T~{IfJNs I IUJ,Ii
EMPLOYERS. UABIUTY Y
ANY PROPRIETORJPARTNERlEXECUTIVEO E.l. EACH ACCIDENT S
OFFlCERlMEMBER EXCLUDED?
IMlInd<OrylnNHI E.L DISEASE - EA EMPLOYE S
:!X~.~aaibeunder . E.L. DISEASE. POLlCY LIMIT S
OTHER
DESCRIPTION OF OPERATIONS I LOCATlONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
(CERT#3578) The Certificate Holder Is included as an Additional INSURED under this POLICY but only with respect to liability arising out of services rendered
by the Named INSURED as outlined within the terms and conditions of the contractual agreement for the Foster Grandparent program between the City of
Ashland and the Named INSURED.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCEu.ED BEFORE THE EXPIRATION
The City of Ashland DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NonCE TO THE CERTlFICATE HOLDER NAMED TO THE LEFT, BUT FAIWRE TO DO so SHAll
IMPOSE NO OBUGATlON OR UABIUTY OF ANY, KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATfVES.
AUTHOR~DREPRESENTA~ ~ K.~
ACORD 25 (2009/01)
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