HomeMy WebLinkAboutInsurance Certificate: Community Works (2)
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ACORD- CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDOIYYYY)
I.........---'
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{les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, 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 CONTACT NAME:
220 NW 2nd Avenue, Suite 800 PHONE (AIC, No, Ext): 503-222 1B31 I FAX (AIC, No): 503.274-{)323
Portland, OR 97209 E-MAIL ADDRESS:
PRODUCER CUSTOMER 10.:
www.beechercarfson.com INSURERISl AFFORDING COVERAGE NAle.
INSURED Community Works INSURER A : Alliance of Nonorofits for Insurance
900 East Main INSURER B : LexinQton Insurance Company
Medford OR 97504 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGE" CFRTIFICATF NIIMRER: 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. NOlWlTHSTANDING 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 REOUCEO BY PAlO CLAIMS,
INM TYPE OF INSURANCE POUCY NUMBER 11:~}5g~ ~~T6g~ UMITS
A GENERAlUABILlTY I 2010-19517 7/1/2010 7/1/2011 EACH OCCURRENCE I. 1 000 000
~
.L pMMERCIAL GENERAl LIABILITY ' PREMISES Ea _".~, ,. 100,000
CLAIMS MADE [L] OCCUR MED EXP (Anyone person) '. 10000
-c - .
I Professional Liab PERSONAL /I, ADV INJURY 1 000 000
:z ? 000 nnr
Abuse & Molestation GENERAl AGGREGATE .
~N'l AGG~EnE,L1MIT AP~tIPER: PRODUCTS - COMPfOP AGG . 2 000 000
POLICY ~~,9; LOC .
A ~TOMOBILE LIABILITY 2010-19517 7/1/2010 7/1/2011 COMBINED SINGLE LIMIT
ANY AUTO (Eaaccldenl) . 1 000,000
r---- AlL OWNED AUTOS BODILY INJURY (Per person) .
r---- SCHEDULED AUTOS BODILY INJURY (per accldent) .
r---- HIRED AUTOS PROPERTY DAMAGE
(Peraccidenl) .
r---- NON-OWNED AUTOS
.
-
.
UMBRElLA L1AB H OCCUR EACH OCCURRENCE .
-
EXCESS LIAS CLAIMS-MADE AGGREGATE .
DEDUCTIBLE .
r---- .
f-- RETENTION .
.
WORKERS COMPENSATION V,N WC STATU- IOJ~'
AND EMPlOYERS' UABIlITY D
N4Y PROPRIETORIPARTNERlEXECUTIVE N'A E.L. EACH ACCIDENT .
OFFICERlMEMBER EXCLUDED?
(Mandatory In NHI E.L. DISEASE - EA EMPLOYEE S
g~~~~~p'iI~ cr~~PERA TIONS below E.L. DISEASE - POLICY LIMIT .
B Foster Care General 41.LJ(-022B53075-O 7/1/2010 7/1/2011 Each Occurrence: $1,000,000
Liability & Professional Aggregate: $3,000,000
Deductible: None
DESCRIPTION OF OPERA nONS I LOCA TTONS I VEHICLES (Attach ACORO 101, Additional Remar1<s Schedule, If more .pace Is nlqulnldl
All operations of the Named Insured as provided by the POliC~ 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 Wri<<en Contract ANI-RRG-E25 01/98 attached which is part of the above General LiabJily policy.
CITY OF ASHLAND IS ADDITIONAL INSUREO AS RESPECTS GENERAL LIABILITY ONLY,
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POUCY PROVISIONS.
ATTN: FINANCE
20 EAST MAIN STREET AUTHORIZED REPRESENTA TlVE
ASHLAND OR 97520 ~q~~
(PORT) Carla Helmer
ACORD 25 (2009/0g)
@1988-2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Carla Helmer 7/6/2010 7:39:44. AM Page 1 of 2
CERT NO.' 7766795 (PORT)
Cl Allianceof
U Nonprofits
fa, Insurance
R/.k RdttnliOIl Group
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 currently 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 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 afyouc operations or premises owned by or rented to you.
ANI-RRG-E25 (1/98)
CERT NO.: 7166795 (PORT) Carla Helmer 7/6/2010 7:39:44 AM Page 2 of 2