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ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIOONYVYI
~ 7'a'~n10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must bo andorsed. If SUBROGATION IS WAIVED, subject to
the tenns and conditions of the policy, certain policies may require an endorsemenL 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 CONTACT NAME:
220 NW 2nd Avenue, Suite 800 PHONE (AIC, No, Enl: 503.222-1831 I FAX lAIC, No): 503-274-0323
Portland, OR 97209 E-MAIL ADDRESS:
PRODuceR CUSTOMER 10.:
www.beechercarlson.com INSURER 51 AFFORDING COVERAGE NAte I
INSURED Community Works INSURER A : Alliance of Nonorofits for Insurance
900 East Main INSURER B : Lexinaton Insurance Comoanv
Medford OR 97504 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES CERTIFICA TF NUMBER: 7766795
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 $" LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN;: TYPE OF INSURANCE POLICY NUMBER I f:SM5~ &S~~~l LIMITS
A GENERAL LIABILITY I 2010.19517 7/1/2010 7/1/2011 EACH OCCURRENCE I, 1 000 000
~ I PREMISES 'i'E~~~~ence\
:L 3MMERCIAl GENERAL LIABILITY I, 100,000
-:- CLAIMS-MADE C2J OCCUR MED EXP (Any ooe penlon) I, 10000
I Professional Liab PERSONAL & ADV INJURY I, 1 000 000
./ Abuse & Molestation GENERAl AGGREGATE I 2 onn nnn
~1. AGG~En ,LIMIT APBlsIPER: PRODUCTS. COMPIOP AGG I 2 000 000
POLICY ~~,9r r7 LOC I
A ZTOMOBlLE LIABILITY 2010-19517 7/1/2010 7/1/2011 COMBINED SINGLE LIMIT
ANY AUTO (Eaaccldanl) I 1,000,000
- ALL OWNED AUTOS BODilY INJURY (Per penlon) I
- SCHEDULED AUTOS BODilY INJURY (Per accident) I
- HIRED AUTOS PROPERTY DAMAGE
(Peraccldenl) I
- NON-OWNED AUTOS
I
-
I
UMBRELLA LIAS H OCCUR EACH OCCURRENCE I
-
EXCESS LIAS CLAIMS-MADE AGGREGATE I
DEDUCTIBLE I
- I
f- RETENTION I
I
WORKERS COMPENSA T10N VIN I T"X~,STA1,1;;, I 10TH-
AND EMPLOYERS' LIABILITY 0
N4Y PROPRIETORJPARTNERJEXECUTIVE NI' E.L. EACH ACCIDENT I
OFFICERlMEMBER EXCLUDED?
(Mandatory In NH) E.L. DISEASE - EA EMPlOYEE S
g~;~~~p~~ O~~PERA TIONS below E.L. DISEASE. POLICY LIMIT I
B Foster Care General 41-LJ(-022853075-D 7/1/2010 7/1/2011 Each Occurrence: $1,000,000
Liability & Professional Aggregate: $3,000,000
Deductible: None
DESCRIPT10N OF OPERA T10NS IlOCA T10NS I VEHICLES (Attach ACORD 101, Additional Remai1l. Sehedule, If more .pact! I. required)
All operations of the Named Insured as provided by the POliCf; terms, conditions & exclusions.
Ciyt of Ashland is additional insured as respects General Lia ility 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 General Liablity 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 DEUVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN: FINANCE
20 EAST MAIN STREET AUTI-lORlZEO REPRESENTATIVE
ASHLAND OR 97520 ~,<;. c9)~~
(PORT) Carla Helmer
ACORD 25 (2009/09)
@ 1988-2009 ACORD CORPORATION.
The ACORD name and logo are registered marks of ACORD
Carla Helmer 1/6/2010 7;39:4.4. AM Page 1 or 2
All rights reserved.
CERT NO.' 1766195 (PORT)
(J Allianceo!
lJ !i;~~~~;
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON
OR ORGANIZA nON
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 currently in effect, or becoming effective during the tenn 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 INSURED (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 owned by or rented to you.
ANI-RRG-E25 (1/98)
CERT NO., 7766795 (roRT) Carla Helmer 7/6/2010 '1,39,44. AM Page 2 of 2