HomeMy WebLinkAboutInsurance Certificate: SO Adolescent Trn & Trtmt Ctr
ACORD. CERTIFICATE OF LIABILITY INSURANCE OPIO ME I DATE (MMlOONYYY)
9S0AST1 07/21/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hart Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 1240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grants Pass OR 97528 I NAlC #
Phone: 541-479-5521 Fax:541-474-1890 INSURERS AFFORDING COVERAGE
"---.--- ---~ I
INSURED .INSURER A" SAIF Cog>
INSURER B: Philadelphia. Ins. Companies 60348
Southern ore~n Adolescent INSURER c. I
StUds & Trea ant Center Inc.
715 .W. Ramsey Avenue ~~~-- I
Grants Pass OR 97527 i
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABQVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OClCUMENTWITH RESPECT TQWH1CH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR-ADD'[ ~- POLICY NUMBER I POU~rJFFECT!XE1POLlCrlrPIRATli?N I LIMITS
LTR1NSRD TYPE OF INSURANCE DATE MMJDDlYY DATE MMJDDlYY
, ~ERAL LIABILITY ' , I EACH OCCURRENCE I . 1,000,000
I PHPK594235 07/01/10 07/01/11 -OAMAGETORENTEO 1'100,000
B X X COMMERCIAL GENERAL LIABILITY I PREMISES (Ea occurenceJ
I o=J CLAIMS MADE [)U OCCUR f I. 5, 000 --
MEa EXP (Anyone person)
~prOf Liability I PERSONAL & ADV INJURY I. 1,000,000
GENERAL AGGREGATE Is 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS -COMP/OPAGG I $ 3,000,000
X nPRO. I Prof Liab I 1,000,000
POLICY JECT LOC
I AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT I. 1,000,000
I - I
B ~ ANY AUTO PHPK594235 07/01/10 07/01/11 (Eaaccident)
,
, ALL OWNED AUTOS BODILY INJURY
- .
SCHEDULED AUTOS (Per person)
1- -
HIRED AUTOS BODILY INJURY
,.-- .
NON.QWNED AUTOS (Peraccidenl)
---j
---j PROPERTY DAMAGE S
(Peraccidenl)
I HRAGE LIABILITY I I I AUTO ONLY - EA ACCIDENT I $
, ANY AUTO OTHER THAN EAACC I $
I AUTO ONLY: AGG I.
I ~---- , EACH OCCURRENCE I.
OCCUR 0 CLA'MSM~DE , AGGREGATE ].
I.
DEDUCTIBLE I.
RETENTION $ Is
I WORKERS COMPENSA TlON AND I ITORYLIMITS I xluJ~'1
A EMPLOYERS' LIABILITY 953977 07/01/10 07/01/11 1.1000000
I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E,L"DISEASE - EA EMPLOYEE! $ 1000000
~p~clits~~~Jm?6NS belOW , POLICY LIMIT I $ 1000000
E.L. DISEASE
! OTHER I I I I
I ,
I I
DESCRIPTION OF OPERATIONS I LOCA TlONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
The City of Ashland, its officers, employees & agents are listed as
additional insureds
CERTIFICATE HOLDER
CANCELLATION
CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ OAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Ashland IMPOSE NO OBLIGATION OR llABlllTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
20 E. Main Street REPRESENTATIVES.
Ashland OR 97520 AUTHORIZED REPRESENTATIVE
Michelle L. E1v
ACORD 25 (2001/08)
@ACORDCORPORATION 1988