HomeMy WebLinkAboutInsurance Certificate: Community Works
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ABRD~ CERTIFICATE OF LIABILITY INSURANCE I DATEIMMIOD/VYVYj
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO. EXTENO OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the polley, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER Beecher Carlson Insurance Agency, LLC
220 NW 2nd Avenue, Suite 800
Portland, OR 97209
CONTACT NAME:
PHONE (AIC. No, ExtJ:
E_MAIL ADDRESS:
503-222-1631
I FAX (A1C, No):
503-27 <HJ323
PRODUCER CUSTOMER 10.:
www.beechercarlson.com
INSURED
Community Works
900 East Main
Medford OR 97504
INSURER/S AFFORDING COVERAGE
INSURER A: Alliance of Nonprofits for Insurance
INSURER B: Lexinaton Insurance COffiDanv
INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
HAlC'
COVERAGES CERTIFICATE NUMBER: 7696612 E N MBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL UBR POLICY EFF POLICY EXP
L TR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY
A GENERAL LIABILITY
7 COMMERCIAL GENERAL LIABILITY
I CLAIMS-MADE [L] OCCUR
....:f.... ProfessIonal Llab
~ Abuse & Molestation
GEN'LAGGREGATE LIMIT APPLIES PER
'~f~L1c;L-n"~~g: -"r4"LOC
A ~TOMOB1LE LIABILITY
..:L ~Y AUTO
_ ALL OWNED AUTOS
_ SCHEDULED AUTOS
_ HIRED AUTOS
_ NON-OWNED AUTOS
-
LIMITS
./
2010-19517
7/112010
7/1/2011
EACH OCCURRENCE I, 1 000 000
=ISEJ(E~~~~nce\ I, 100,000
MED EXP (Anyone person) I. 10000
PERSONAL & ADV INJURY I. 1 000 000
GENERAL AGGREGATE . 2 000 000
PRODUCTS - COMPfOP AGG . 2 000 000
.
COMBINED SINGLE LIMIT
(Eaaccident) . 1,000,000
BODILY INJURY (Per person) .
BODILY INJURY (Per accident) .
PROPERTY DAMAGE
(Per accident) .
.
2010-19517
7/112010
7/112011
UMBRELLA L1AB
U OCCUR
n ClAlM$-MADE
EACH OCCURRENCE
-
EXCESS L1AB
AGGREGATE
-
~
DEDUCTIBLE
RETENTION $
::,~:~~~~g~E~~~~~~~C:V Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE D N I A
OFFICERfMEMBER EXCLUDED?
(Mandatory In NH)
~~c~~~ ~~gPERATtONS below
B Fosler Care General 41-LX-Q22853075-Q 7/1/2010 1711/2010
liability & Professional
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space is required)
All operations of the Named Insured as provided by the policy terms, conditions & exclusions.
Ciyt of Ashland is additional insured as respects General liability only on the Alliance of Nonprofits for Ins policy.
Blanket Additional Insured by Written Contract ANI-RRG-E25 01/98 attached which is part of the above Generalliablity policy.
CITY OF ASHLAND IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY ONLY.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCElLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN: FINANCE
20 EAST MAIN STREET AUTHORIZED REPRESENTATIVE
ASHLAND OR 97520 G;;q~~
(PORT) Carla Helmer
ACORD 25 (2009/09)
@1966-2009ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
Carla Helmer 6/29/2010 10:35:57 AM Page 1 of 2
CERT NO.' 7696812 (PORT)
.~ ~
/
r; Allianceo!
l , Nonprofits
~ forffi~~!~~~
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
Any person or organization that you are required to add as an additional insured on this policy, under a written contract or
agreement cw-rently in effect, or becoming effective during the term of this policy, in consideration of food contributions
or client referrals you receive from them.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to
this endorsement.)
WHO IS AN lNSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an
insured but only with respect to liability arising out of your operations or premises mvned by or rented to you.
ANI-RRG-E25 (1198)
CERT NO.: 7696812 (PORT) Carla Helmer 6/29/2010 10:35:57 AM Page 2 of 2