HomeMy WebLinkAboutInsurance Certificate: Proactive Health Resources LLC
...---..,
OP 10: AS
ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
~. 06/16/11
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: II the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms 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 360-514-9550 CONTACT
NAME:
Davidson Insurance 360-514-9551 PHONE xiI: I rt~ Nol:
501 SE Columbia Shores BI #525 I~~ext:
Vancouver, WA 98661 E-MAIL ....
ADDRESS:
Susan M Chambers ~~~~g~~: 10 fI: PROAC-1
INSURERI51 AFFORDING COVERAGE NAIC#
INSURED Proactive Health Resources LLC INSURER A: Nationwide Mutual Insurance Co
Phyliss VanderVeer INSURER 8 :
4077 Jefferson Parkway INSURER C :
Lake Oswego, OR 97035 INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
. CERTIFICATE NUMBER:
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 CLAIMS.
INSR TYPE OF INSURANCE ~~;'~ I~~':- ,&OllCY E ~ I f~gM%~1 LIMITS
LTR POLICY NUMBER MMfDDfYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,OOO,OO~
I-
A X COMMERCIAL GENERAL LIABILITY ACP7561854462 07/11/11 07/11/12 P~;SES TE~~~ence\ $ 300,OOC
I CLAIMS-MADE 00 OCCUR MED EXP (Anyone person) $ 5,OOC
~ Business Owners PERSONAL & ADV INJURY $ 1,OOO,OO~
r- GENERAL AGGREGATE $ 2,000,000
m'l AGG~nE LIMIT APPLIES PER PRODUCTS. COMPIOP AGG $ 2,000,00
X POLICY jfR-i n LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
~ (Eaaccident)
I- ANY AUTO BODILY INJURY (Per person) $
f- All OWNED AUTOS BODilY INJURY (Per accident) $
- SCHEDULED AUTOS PROPERTY DAMAGE
$
4 HIRED AUTOS ACP7561854462 07/11/11 07/11/12 (Per accident)
~ NON-OWNED AUTOS ACP7561854462 07/11/11 07/11/12 $
$
UMBRELLA L1AB H OCCUR EACH OCCURRENCE' $
-
EXCESS L1AB CLAIMS-MADE AGGREGATE $
- DEDUCTIBLE -------.-- ..!..-
RETENTION $ $
WORKERS COMPENSATION TI ~~IED~1Ii I T~g$T~]Ns I jOJ~-
AND EMPLOYERS' LIABILITY VfN
ANY PRQPRIETOR/PARTNER/EXECUTIVE 0 E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? Nf'
(Mandatory In NH) E.L. DISEASE. EA EMPLOYEE $
If yes, describe under - E.L. DISEASE. POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
UU" l U LV'! IIW
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACO D 1 01, ema S.,cnedule, if more space i required)
RE: All Operations of the Insured.
CERTIFICATE HOLDER
CANCELLATION
ASHLAND
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
f ~ ~kA-
ACORD 25 (2009/09)
@1988.2009ACORDCORPORATION. All rights reserved.
The ACORD name and logo are registered marks 01 ACORD