HomeMy WebLinkAboutInsurance Certificate: Ashland Community Hospital
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RD. I 0 '.,'., I
~ EVIDENCE OF PROPERTY INSURANCE ( 09/20/201 0 ),
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS U1>ON THE
ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE OF PROPERTY INSURANCE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW.
A.GENCY I :::18":[, Ed, 541-779-1321 COMPANY
Western States Ins. - MeoToru Affiliated FM Ins Co
38 N. Central Ave Suite 100
Medford, OR 97501
Scott Sherbourne
I f:,~ N,,541-779-9187 I ~~D~~SS:
COOE: I Sl.8 CODE: .
~3~~ERIO#:. ASHlA~H
INSUREO Ashland Community Hospital lOAN NUMBER /1P01..ICYNUMBER
280 Maple Street TT820
Ashland, OR 97520 EFFEClTVE DATE I EXPIRATION DATE
In ,fONTINUED UNTIL
09/01/10 09101111 TERMINATED IF CHEO<ED
THIS REPlACES PRIOR: EVIDENCE DATED:
OP 10: 4M
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PROPERTY INFORMATION
LOCAno~ESCRlPTION
78 - 280 Maple Street
IIshland, OR 97520
Hospital
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS
SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAlO CLAIMS.
COVERAGE INFORMATION
COVERAGE/PERILS/fORMS AMOUNT OF INSLRANCE OEOUCTlBLE
PreJrise 1 Building 1 10.001
Building 50,000.000
Premise 4 Building 1 10.001
Building 2,250,000
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REMARKS (lncludlna SDeclal Condttlonsl
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WilL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE ADDITIONAL INTEREST NAMED BELOW, BUT FAILURE TO MAIL SUCH NOnCE SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ADDITIONAL INTEREST (
NAME AND ADDRESS . H MORTGAGEE M IAOOITlONAlINSURED
LOSS PAYEE X Lessor of Premises
LOAN'
City of Ashland
Risk Management Division AUTHORIZED REPRESENTAllVE
20 E Main St
Ashland, OR 97520 /;Jr~~C/G
ACORD 27 (2006107)
@ACORDCORPORATION 1993-2008. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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EVIDENCE OF PROPERTY INSURANCE
PROPERTY SCHEDULE
PROPERTY ~FORMATION
t.OCATIO~ESCRlPTION
560 Catalina
Ashland, OR 97520
IT, 1M Clinic
PROPERTY INFORMATION
LOCATIONotlESCRlPTION
PROPERTY INFORMATION
lOCATIONIDESCRlPTlON
PROPERTY INFORMATION
lOCAT10NotlESCRlPTlON
PROPERTY INFORMATION
LOCATIONltlESCRIPTION
PROPERTY INFORMATION
LOCATIOOOESCRlPTlON
PROPERTY INFORMATION
LOC TIONIDESCRJ N
PROPERTY INFORMATION
LOCATlOOOESCRlPTtON
ATTACH TO EVIDENCE OF PROPERTY APPLICATION