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A CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YY)
09/13/2005
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lockton Risk Services ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICA TE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 410679 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Kansas City, MO 64141-0679
PH:1-800-472-7771 INSURERS AFFORDING GOVERAGE
INSURED Ashland Gun Club INSURER A: Northland Insurance Company
INSURER B:
P. O. Box 953 INSURER C:
c/o Rick Georgeson INSURER D:
Ashland, OR 97520 INSURER E:
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.
INSR POLICY NUMBER ~9S~Yri~~6%T~~~ POLICY EXPIRATION LIMITS
LTR TYPE OF INSURANCE DATE IMM/DD/YYI
A GENERAL LIABILITY NC023825 09/05/2005 09/05/2006 EACH OCCURRENCE $ 2,000,000
r-
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100,000
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $ 1,000
f---------f--
X Shooting Club PERSONAL & ADV INJURY $ 2,000,000
-
SCGL GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Included
Xl n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGI_E LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODIL Y INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODIL Y INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMJ~GE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
-=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
=1 OEOUCTIBlE $
RETENTION $ $
I WC STATU- I IOTH-
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
r----- -- -- -- -- ---- - - ---..------------ _.-
E.L. DISEASE - Et\ EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATlONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is Additional Insured as respects: 66 acres in Jackson County, OR.
Broad Form excluding coverage for Tree Stands and Raised Platforms.
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ashland DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
20 E. Main St. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLlGATI~ITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
Ashland, OR 97520 REPRESENTATIVES. ~
AUTHORIZED REPRESEN~E -LL. ~~ ---
I ~l .A. ----
ACORD 25-S (7/97) / ~ / ~,RiJC'CfRPORATION 1988
110312
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