HomeMy WebLinkAboutInsurance Certificate: Snowberry Brook
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ACORD- CERTlFICA TE OF LIABILITY INSURANCE I DATE (MMtDDfYVYV)
\........--- 11/30/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHlS 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 CONlRACT BElWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDI110NAL INSURED, the pollcy(les) must be endorsed. If SUBROGATlON IS WAIVED, subject to
the teoos and conditions of the policy, certain policies may require an endorsement. A statement on this certlftcate does not confer r1ghts to the
certificate holder In lieu of such endorsementfs), .
PRODUCER Susan Wilson, AAI, AlC ,',
NAME:
Beecher car~son Xnsurance Aqency LLC ~g~o Elrtl: (541) 772 111.1 I ~~ Nol: (541) 712-3795
707 Murphy Rd %~~ss:susan.wilson@beechercarlson.com
~~g~~~~ID .POO89278
Medford OR 97504 INSURER(S) AFFORDING COVERAGE NAtCt/.
INSURED "<SURER A ,Capital Insurance Group (CIG)
INSURER B :
snowberry Brook LLC INSURER C :
2251 Tablerock Road INSURER D :
INSURERE:
Medford OR 97501 INSURERF:
COVERAGES
CERTIFICATE NUMBER:CL10H3095540
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. NOlWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Willi RESPECT TO I"otiICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAJMS.
INSR TYPE OF INSURANCE &~M&~ &S~
lTR POLICY NLMBER LIMITS
GENERAL LIABILITY I =~rRRENCE I 2,000,000
f--
X COMMERClAL. GENERAl... LL4BILlTY REM I co..urence I 100,000
A I CLAIM&MADE [i] OCCUR ~'7BOP2161'76'75 2/1/2010 2/1/2011 MED EXP (Anyone person) I 5,009
f-- PERSONAl... & KJV INJJRY I 2,000,000
f-- GENERAl AGGREGATE I 4,000,000
~t. AGG~E~~r tIMlT .APAS PER" PRODUCTS - COMPIOP AGG I 4,000,000
X POLICY :fg: LOC I
AUTOMOBILE LIABILITY COMBt.lED SINGLE LIMIT I
f-- (Eaaccident)
f-- ANY AUTO
OOOIL Y IN.JJRY (Per person) I
f-- ALL OIhNED AUTOS
BODILY tUJRY (Per accidert) .
f-- SCHEDULED AUTOS PROPERTY D.AMAGE
.
f-- HIREDflJJTOS (Peracddent)
f-- NON-OW'IJED AUTOS .
I
UMBRELLA L.IAS H ~CCUR EACH OCCURRENCE .
- EXCESS LIAS .. .' -.-
ClAlMS4v1ADE AGGREGATE .
f- DEDUCTIBLE .
RETENTION . I
WORMERS COMPENSATION ~ STATU- IOJ,i<-
AND EMPLOYERS' LIABILITY Y I N
ANY PROFRIETORrPARTNERiEXEOJTIVE D EL EACH ACCIDENT .
OFFICERlMEt.'BER EXCLUDED? N/A
(Mandatory In NH) E.l. DISEASE. EA EMPLOYEE $
II yes, deSOlbe lXIder
DESCRIPTION OF OPERATIONS below E.l. DISEASE - POLICY LIMIT .
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schldult.lfmore spactls rtqull'ld)
Certificate holder included as additional insured per attached endorsement BP04070400 where required by written
contract. Subject to policy terms, conditions and exclusions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main
Ash1and, OR 97520 AUTHORIZED REPRESENTATIVE
S Wilson, MI, AIC/SU S', . ~ ~. H/YL-...
ACORD 25(2009/09)
INS025 (200909)
@ 1988-2009 ACORD CORPORATION. All rights reserved,
The ACORD name and logo are registered marks of ACORD
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POLICY NUMBER: 27-BOP-2-1617675
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OREGON ADDITIONAL INSURED - STATE OR POLITICAL
SUBDIVISION - PERMITS RELATING TO PREMISES
(INCLUDES RESTRICTIONS OR ABRIDGMENTS)
This endorsement modifies insurence provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE"
State or Political Subdivision: City of Ashland
" Information required to complete this Schedule, If not shawn an this endorsement. will be shawn in the Declarations,
The following is added to Paragraph C. WHO IS AN
INSURED in the Businessowners Liability Coverage
Fo"":
4. Any state or pOlitical subdivision shown in the
Schedule Is also an insured, subject to the
following additional provisions:
This insurance epplles only with respect to the
following hazards for which the state or political
subdivision has Issued a permit in connection
with premises you own, rent, or control and to
which this insurance applies:
a. The existence, maintenance, repair,
construction, erection, or removal of
advertising signs, awnings, canopies, cellar
entrances, coal holes, driveways, manholes,
marquees, hoistaway openings, sidewalk
vaults, street banners, or decoration and
similar exposures;
b. The construction, erection, or removal of
elevators; or
c. The ownership, maintenance, or use of any
elevators covered by this insurance,
BP 04 07 04 00
Pagelofl
Copyright, Insurance Service. Ollice, lnc.. 2000