HomeMy WebLinkAboutInsurance Certificate: Youth Symphony of Southern Oregon
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. _OROe, CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDfYYYY)
~ 10/18/2010
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 BElWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an AODITlONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATlON IS WAIVED, subject to
the terms and conditions ofthe policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certlflcate holder In lieu of such 8ndorsementl~l.
PRODUCER NAME: Phyllis Rite
Beecher carlson Insurance Agency LLC ~g~o E~l; (541) 772-1111 I r~~ NOl; (541)172-3785
707 Mlu:phy Rd ~~&~ss: phyllis. hi te@beechercarlson.com
~~~~~~~ID,p00051. 78
Medford OR 97504 INSURER(S) AFFORDING COVERAGE NAIC;f
INSURED INSURER A :American states Insurance CO 9704
INSURERB:
YOUTH SYMPHONY OF SOUTHEllN OREGON INSURER C :
PO BOX 4291 INSURER 0 :
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
INDICATEO, NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO \MilCH 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 ~~ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~i: lYPEOFINSURANCE ~~ POLlCYNLNBER ~~}-~~ ~3~~~ LIMITS
GENERAL LIABILIlY EACH OCCURRENCE $
r-;- COMMERCLAlGENERPJ..LIABILITY I ~~EM~~~= e $
I ClAlM$-MAOE W OCCUR lU-CH-652304-4 1/24/2010 1/24/2011 MED EXP {.Ally one person) $
PERSONPJ.. & /JDV IN.uRY $
GENERPJ.. AGGREGATE $
PRODUCTS - COMPIOP AGG $
$
A
1,000,000
1,000,000
10,000
1,000,000
1,000,000
1,000,000
f-
f-
~'l AGGRE~E ,LIMIT AP~S PER:
IXlpOLlCyl IPJW,: I ILOC
AlITOMOBILE LIABILITY
f-
f-- ANY AUTO
A f-- PJ..L O~ED AUTOS
f-::- SCHEDULED AUTOS
~ HIRED AUTOS
~ NON-O\o\NED AUTOS
1-CH-652304-4
B
UMBRELLA L.IAB HOCCUR
r- EXCESS LIAS CLAIM$-MAOE
~ DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION
AND EMPL.OYERS' L.IABILllY Y I N
Am PROPRrETORiPARTNERB<EOJTlVE 0
OFFICER/MEMBER EXCLUDED?
(Mandatory In NHI
rfyes. describe under
DESCRIPTION OF OPERATIONS below
*729229
NIA
DESCRIPTION OF OPERATIONS' LOCATIONS I VEHICLES (Attach ACORD 101, AdditIonal Remarks Schedule, If more ,plcels required)
Re: 2010-2011 fiscal yearlseason grant award -
Certificate holder included as additional insured as respects general liability as per attached form #CG2026 (07104).
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 DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVlSIONS.
FINANCE DEPAR~
20 EAST MAIN STRI!:I!:T AUTHORIZED REPRESENTATIVE
ASHLAND , OR 97520
Phyllis Hite/PHYLHI {).'1fL,.;~j "t1:&:~
ACORD 25 (2009/09)
INS025 (2009091
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
~
~ Liberl)'
\p" N()rthw(,,~liit.
....."""'''''#w-nJ~....'~''''I''
COMMERCIALGENER}l.L LIABILITY
CG2026 07 04
POLICY NUMBER:
Of-CH~652304-4
THIS'ENDORSEME:NTCHANGES THE POLICY, PLEASE READ IT CAREFULLY.
AD[)1l10NALINSURED - DESIGNATED
PERSON Oil ORGANIZATION
This~endorsement rilodffies insurance provided, under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Addlllonallnsured person(s) OrOrganlzallon(s)
CITY OF ASHLAND
CITY HALL
ASHLAND; OR. 97520
Informaiion required to complete this Schedule, ifnolsho.w'n,above, wiTI be shown in the Declarations.
Secllon II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(~) shown i~ ,the S,chedule, 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 CJmissionsor the
atts or omissions of those acting on your behalf:
A. In the performance of your 'ongoing operations;
or
.
E
B. In connection with your premises owned by or
rented to you.
11>150 PrOperties, Inc., 2004
e
CG 20 260704
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