HomeMy WebLinkAboutInsurance Certificate: SO Child Study & Tmt Ctr
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ACORD'" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
~ 6/25/2010
PRODUCER (503)293-8325 FAX: (503) 293 5418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
JD Fulwiler & Co, Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5727 SW Macadam Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POt Box .. 69508 - '. I NAIC# 0
.-,- . -' ..
Portland --. . ..-- OR - 97239 -- INSURERS AFFORDING COVERAGE' d.
INSU~ED -, - .. tNSURERAAlliance of Nl?nProfits ,for I
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Souther~ Oregon Child Study & Treatment Center INSURER B: Saif Corpora ti:<;>.n - + -- - -.
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1836 Fremont St: INSURER C: ,:. I
INSURER D: u_ 0 .. I
Ashland I OR 97520 INSURER E: I
COVERAGES
THE POLICIES OF INSURANCE LISTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT\^JITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT \^11TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONOITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS.
II~:: ~~~r ~.< POLICY NUMBER POLICY EFFECTIVE ~~!f.fY EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE . 1,000/000
DAMAGE TO RENTED
X ~lMERCIAL GENERAL LIABILITY PREMlsl;sJf.a_QC5urrenc-ID . 500,000
A X CLAIMS MADE [i] OCCUR 20102130. 7/1/2010 7/1/2011 MED EXP (Anyone person) . 20,000
- PERSONAL & AOV INJURY . 1/000,000
- GENERAL AGGREGATE I. 3,000,000
~'LAGG~EnEILlMIT APnSIPER: PRODUCTS . COMP/OP AGG I $ 3/000/000
X POLICY ~~9T LOC I
I ~TOMOBILE LIABILITY
COMBINED SINGLE LIMIT . 1,000,000
~ ANY AUTO (Ea accident)
A - AlL OVoJNEO AUTOS 201021304 7/1/2010 7/1/2011 BOOIL Y INJURY
(Per person) .
SCHEDULED AUTOS :
- - -
i" ~ HIRED AUTOS : - BODILY INJURY .$,. ._-_.~
H NON.O_EO AUTO~ -:' ".. .- .. .,' - -. ,- - (\~ accident) -- --- .- --
I '. .. .-
" ;~ '.. - . - ,. ---, _. .. -~. --- .. - .. - --
.. - PROPERTY DAMAGE
. ---~- . . --- -'" --- (Pera~jdent) ~-- . :_-$ -. ---
.
I hRAGE UAB'UTY , AUTO ONLY - EA AC=.j . -
ANY AUTO , 'OTHER THAN EA ACC $
AUTO ONLY: AGG I $
i ~.,~_."" EACH OCCURRENCE . 1/000/000
I X OCCUR D CLAIMS MADE
I AGGREGATE . 1/000,000
A I DEDUCTIBLE Ol021304UMB 7/1/2010 7/1/2011 I'
"
i I
X I RETENTION $ 10,000 I,
B i WORKERS COMPENSATION LL'tiC STATU- 1JTtl
AND EMPLOYERS' LIABILITY YIN
_Q8Y_LIMllS_ E
I ANY PROPR'ETOR/PARTNERIEXECUT'V' D EL EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEd $
(Mandatory in NH) 998536 7/1/2010 7/1/2011 500,000
~~Et,~~s~Rb~v1~1~~s below EL. DISEASE POLICY LIMIT I $ 500 000
I OTHER I I
;
,
I I ,
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate Holder is hereby added as an Additional Insured, .. their interest may appear to the operations of the
named insured, subjet to policy terms, conditions, and exclusions, *10 days notice of cancellatiion for non-payment of
premium.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ashland DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
20 E Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Ashland, OR 97520
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE }\:u"'~~ .
Janice Wilson/WILSON rL..':;~L<......~
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ACORD 25 (2009/01)
INS025 (200901)
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