HomeMy WebLinkAboutInsurance Certificate: Youth Symphony
~
ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY)
,~ 10/18/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
aELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT aETWEEN 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 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 endorsementlsl.
PRODUCER . ~2=1~CT Phyllis Bite
Beecher Carlson Insurance Agency LLC J~N: Ext\: (541)772-1111 I FAX
;A/C No): (541)772-3785
707 Murphy Rd ~DMDA~~ss:phyllis. hite@beechercarlson.com
I ~~~~~,CER 00005178
T ME;B.IDJ':
Medford OR 97504 INSURER/S\ AFFORDING COVERAGE NAle.
INSURED INSURER A :American States Insurance Co 19704
INSURER B :
YOUTH SYMPHONY OF SOUTHERN OREGON INSURER C :
PO BOX 4291 INSURER D ;
INSURER E :
MEDFORD OR 97501 INSURER F :
COVERAGES
CERTIFICATE NUMBER:GL 10-11
REVISION NUMBER:
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.
l~f:1 TYPE OF INSURANCE 1~2.?; ~~I POLICY EFF I.':OLlCY EXP LIMITS
POLICY NUMBER MMfDDIYYYY MMIDDIYYYY
GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000
A I CLAIMS-MADE W OCCUR 01-CH-652304-4 11/24/2010 11/24/2011 MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 1,000,000
-ii~AGG~EnE~lIMrr API~~~tIPER: PRODUCTS - COMP/OP AGG $ 1,000,000
X POLICY ~~RT LOC $
AUTOMOBILE I..IABII..ITY COMBINED SINGLE LIMIT $ 1,000,000
- (Eaaccident)
- ANY AUTO BODILY INJURY (Per person) $
A ALL OWNED AUTOS 01-CH-652304-4 11/24/2010 11/24/2011
- BODILY INJURY (Per accident) $
- SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS (Per accident) $
X NON-QWNED AUTOS $
-
$
UMBRELLA I..IAB H OCCUR EACH OCCURRENCE $
-
EXCESS L1AB CLAIMS-MADE AGGREGATE $
- DEDUCTIBLE $
RETSNTION $ $
B WORKERS COMPENSATION #729229 10/1/2010 10/1/2011 X I T"A~,r;~I,~"c I IOJbl-
AND EMPLOYERS' I..IABILlTY V,"
ANY PROPRIETOR/PARTNER/EXECUTIVE D EL. EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? ",.
(Mandatory In NH) EI... DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below EI... DISEASE - POLICY LIMIT $ 500 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarill Schedule, If more Ipace II required)
Re: 2010-2011 fiscal year/season grant award -
Certificate holder included as additional insured as respects general liability as per attached form #CG2026 (07/04) .
This form is subject to policy terms, conditions. and exclusions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS.
FINANCE DEPARTMENT
20 EAST MAIN STREET AUTHORIZED REPRESENTATIVE
ASHLAND, OR 97520
Phyllis Hite/PHYLHI ~~
ACORD 25 (2009/09)
INS025 (200909)
@1988-2009ACORD CORPORATION. All right. ro.orvod.
The ACORD name and logo are registered marks of ACORD
_.~ Liberty COMMERCIAL GENERAL LIABILITY
\p North{yest. CG 20 26 07 04
_..,......'''''......'1)'.'10:'''''''''''1'
POLICY NUMBER: 01-CH-652304-4
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 Additional Insured Person(s) Or Organlzatlon(s)
CITY OF ASHLAND
CITY HALL
ASHLAND, OR. 97520
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodily injury", "property
damage" or "personal and advertising injury" caused,
in whole or in part, by your acts or omissions or the
acts or omissions of those acting on your behalf:
A. In the performance of your ongoing operations;
or
x
~
B. In connection with your premises owned by or
rented to you.
I1llS0 Properties, Inc., 2004
..
CG 20 26 07 04
EP
C.AG.01-PRI NTOO1-205Z-Q020.W