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Home My WebLink AboutInsurance Certificate: Mt Ashland Association ~ ACORd' CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY) ~ 10/1/2010 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 s)~IICles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s . - PRODUCER Commercial lines 206-701-5900 CONTACT NAME: Wells Fargo Special Risks, Inc. CAL# OG13561 I rA~~N.t C:wn. -I f~ No': E-MAIL 520 Pike Street, Suite 2100 ADDRESS: PRODUCER SK131499 Seattle, WA 98101 INSURERfS\ AFFORDING COVERAGE HAle # INSURED INSURER A : NOVA Casualty Company Mt. Ashland Association INSURER B ; P.O. Box 220 INSURER C : INSURER D : Ashland, OR 97520 INSURER E : INSURER F : - COVERAGES CERTIFICATE NUMBER- 1865180 REVISION NUMBER- See below 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE !~~.?~ I~~ :~Exw" I/~~~~ LIMITS LTR POLICY NUMBER A ~NERAl LIABILITY WFR-GL-Q010050-1 10/01/10 10/01/11 EACH OCCURRENCE . 1,000,000 X COMMERCIAL GENERAl LIABILITY . ~~~~~~OE~=~nce\ . 1,000,000 CLAIMS-MADE 0 OCCUR MED EXP (Any one person) . NolCoveffld '-- PERSONAl & AnV INJURY . 1,001),000 "- GENERAL AGGREGATE . None n'L AGG~En LIMIT AP~.~t PER: PRODUCTS - COMPfOP AGG . 2,000,000 POLICY ~~,9; LOC . AUTOMOBILE LlABILlTY COMBINED SINGLE LIMIT . "- (Ea accident) '-- ANY AUTO BODILY INJURY (Per person) . '-- ALL OWNED AUTOS BOalL Y INJURY (Per accident) . "- SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) . '-- '-- NON-DWNED AUTOS . . '-- UMBRELLA UAB H OCCUR EACH OCCURRENCE . EXCESS UAB CLAIMS-MADE AGGREGATE . "- DEDUCTIBLE . RETENTION . S 'WORI<ERSCOMPENSATlON I WC STATU- 10J);'. AND EMPLOYERS' LIABilITY Y'N ANY PROPR1ETOR/PARTNERlEXECUTIVE D E.L EACH ACCIDENT . OFFICER/MEMBER EXa.UDED? NI' (Mandatory In NH) E.L. DISEASE - EA EMPLOYE . g~c~(~~ ~~PERATIONS below EL DISEASE. POLICY LIMIT . . E.:o::cessUability WFR.XS-0010008-1 10101110 10/01111 $5,000,000 Occur./ $10,000,000 Agg. - Products. CompiOp Agg: $10,000,000 Personal & Adv Injury: S5,OOO,OOO DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark, Schedule, If more space Is required) City of Ashland, Its Officers & Employees are Additional Insured when required by written contract, agreement, lease, or permit, solely as respects liability arising from operations of Named Insured Re: Interest in Owned assets acquired 07/01192. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland, its Officers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. & Employees 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 9(-4t- , ACORD 25 (2009/09) @1988-2009ACORDCORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ;::'''1,)1'''''' if' -A"C" "Om'R"'D' "'r'fE,';" '1"'iii'e~i~'~l7:l:-:\;iE:',:,'~, n,"'D"e:'it8"':~":"""""'" f. M TN ~~~'tVJi LI~'J:t,~~\1!'~.IT::.~~n~r,;;; , ~_ ....~=>%To::....Efl.!im~~~' ,,",;.:~~':Y-'-""'':S''''";,,';t~'!>.ji:;~,-_ik;'''-,,ii;;<:~;!~l'' THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. ;1;;'r"''lr''''~~"''''W,"''i;:''';;;::~''''~"t'"';,;''''','Co:!';1;~i""-'''':iH'i!i1;:;'~;C'~~;;f~,;:'o"li7;':1;:~ _""'~.."""'"";'W"M="C";,,",U. N-S W RAN G E,,"ii(_,~,~,t""""",","-i,! DATE IMMIODIYY) i.':i.1 -,-~, ' ':~~~c,~~;;-~;:l.;.~~~"~~~~~~1W~~1 10/112010 PRODUCER PHONE AJC No Ext: 206-701-5000 COMPANY Commercial Lines 206-701-5900 Wells Fargo Special Risks, Inc. CAL# OG13561 520 Pike Street, Suite 2100 Seattle, WA 98101 AIX Specialty Ins Co. CODE: AGENCY CUSTOMER 10.: INSURED Mt. Ashland Association SUB CODE: P.O. Box 220 Ashland, OR 97520 . EFFECTIVE DATE 10/01110 WFZ-CL-0020037.1 lOAN NUMBER POUCY NUMBER 10/01/11 CONTINUED UNTIL TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: lOCATION/DESCRIPTION PROPERTY & INLAND MARINE COVERAG~PERI~FORMS AMOUNT OF INSURANCE DEDUCTIBLE Property/Inland Marine Scheduled Equipment $6,823,892 $742,374 $5,000 $5,000 Re: Interest in owned assets acquired 07101192. ~~gErr~TiON~&;flBJl~~tJj,~g~~~g~~,~~~o.!~!~~,!~,(nJ;"~~1J~;.~~~]~r~~a~#~~:~1;~~~~~i11~~~~~~jJ~~~~}I~I~S:.~1i~~f.''i~~~ THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD, SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW. NAME AND ADDRESS City of Ashland, Its Officers & Employees 20 E. Main Street Ashland, OR 97520 MORTGAGEE X LOSS PAYEE LOAN # ADDITIONAL INSURED AUTHORIZEO REPRESENTATIVE 9(~- WCO~RB127,[{3~3j1l;[99S:Z8-"--'-"----"~ljf!~1t~~lj~~~~r~,~~~~!~i1~~~~i~&rmil~~}};~~~~~~~~~~i'rI~1~~~lt1~~'-~jAcPRDTcoRffOMTi~'r199