HomeMy WebLinkAboutInsurance Certificate: Lithia Arts Guild of OR
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ACORD
N CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
06/04/2011
THIS CERTIFICATE.IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICp;r;;-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 BETWEEN 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 tenns 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 endorsement{s).
PRODUCER ~2AA~~CT Diane Dragt
Pacific Benefit Consultants, Inc. r,(jg'11'o Ext" 541.484.6624 I fffc No" 541. 686.2726
450 Country Club Road #330 E-MAIL
ADDRESS:
Eugene, OR 97401 PRODUCER
CUSTOMER 10 #:
Diane Dragt INSURER(S) AFFORDING COVERAGE NAlC .
INSURED INSURER A : Sentinel Insurance Company 11000
LITHIA ARTS GUILD OF OREGON, INC. INSURER B :
265 N MAIN STREET #2 INSURER C :
Suite 2 INSURER 0 :
ASHLAND, OR 97520 INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 2011-12 Certs
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 ClAJMS.
INSR lYPE OF INSURANCE ADDL SUB 1,&aM~~ ~~~~ UMITS
LTR INSR WVO POUCY NUMBER
GENERAL UABIUTY 52SBMVYOO51 06/17/2011 06/17/2012 EACH OCCURRENCE $ 1,000,000
'-
X COMMERCIAL GENERAL LIABILITY ~~:~~~?E~~~~~ence\ $ 1,000,000
l CLAIMS-MADE [K] OCCUR MED EXP (Anyone person) $ 10,000
A '- X PERSONAl & MJV INJURY $ 1,000,000
f- GENERAL AGGREGATE $ 2,000,000
n'L AGG~EnE LIMIT APPlS PER: PRODUCTS - COMPIOP AGG $ 2,000,000
PRO- $
POLICY JECT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Eaeccident)
f- ANY AUTO BODILY INJURY (Per person) $
'- AlL OWNED AUTOS BODILY INJURY (Per accident) $
'- SCHEDULED AUTOS PROPERTY DAMAGE
$
f- HIRED AUTOS (Peraccidant)
NON-OWNED AUTOS $
'-
. $
f- UMBRELLA L1A8 H OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MAOE AGGREGATE $
'- DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION I T'Xg~m~s I I OJ~-
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETORlPARTNERlEXECUT1VED E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L DISEASE - EA EMPLOYEE $
g~~~~~~~ ~nFdOPERATIONS below E.L DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requIred)
CERTIFICATE HOLDER
CANCELLATION
FAX: 541.552.2059
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISlqNS.
City of Ashland AUTHO~EDREPRESENTAT1VE [y.MU_ hr,,~t"
Attn: Bryn Morrison
2~hE. Main Street
As land, OR 97520 Diane Draat/WSC
ACORD 25 (2009/09)
@1988-2009ACORDCORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
. ,.~:-"
City of Ashland
Certificate,issued to City of Ashland 06/04/2011
PacifiGcBenefit Consultants, Inc.
06/04/2011
The City of Ashland, it's officers, employees and agents are listed as an Additional Insured per written
contract and policy conditions.