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ACORDTM CERTIFICATE OF LIA
f(t:.l;t:.l v t.u JU
Lockton Risk Services I
P.O. Box 410679
Kansas City, MO 64141-0679
V INSURANCE
PRQDUCER
THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED Ashland Gun Club
P. O. Box 953
INSURER A: Certain Underwriter I s at Lloyd 's,
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
As land, OR 97520
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~SR INo,.~; TVPI' POLICY NUMBER POLICY EFFECTIVE Pg~;Jt~~~I~~!$N LIMITS
TR
A GENERAL LIABILITY L200617419 09/05/2006 09/05/2007 EACH OCCURRE~ICE $ ? 111111 000
I--- ~t~~~~s T~aR~~~'Jr~nceJ
X COMMERCIAL GENERAL LIABILITY $ <1111 111111
I CLAIMS MADE IX] OCCUR MED EXP (Anyone person) $ c; nnn
V
~. PERSONAL & ADV INJURY $? I1l1n nnn
-
GENERAL AGGREGATE $ ? nnn non
-
GEN'L AGGREF1E LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ ? nnn nnn
:;l POLICY P,~,2.;. n LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
=:J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
I ~~,STAT~s I IOJ~'
WORKERS COMPENSATION AND T YlIMIT
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes. describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate Holder is an Additional Insured as respects: 66 acres, Jackson County, OR
CERTIFICATE HOLDER
CANCELLATION
City of Ashland
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOFI TO MAIL .l...O....- DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lI:FT. BUT FAILURE TO DO SO SHALL
ACORD 25 (2001108)
DS#4997676
110312
20 E. Main St.
Ashland, OR 97520