HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Adolescent
eRY CERTIFICATE OF LIABILITY INSURANCE OPID ME I DAT~~M/:=
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), PUTHORIZED _
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER .' _ _ _
llwar.unl ""....: If tne cenmeate nOlaer 1S',an _,' me POllcY(leS) m~st DO enaorsea. II~ nKlY,I;;LI, S~D~ec:t to_ _
the tenns and conditions of the policy, certain policies may require an endorsement A statement on this ce~flcate does nol confer rlgh~ to the.
__certlflcate'holderlnOeu,ofsuchendorsement(s). _ ._'. __ _.._ .__ _' _'- "., :~. -,,1,,___
PRODUCER '''I __' ".;0- ~ _, ''"' I NAME: '" J '/ _ '..
i" "'GC~':;C;"_'.2'r:-- 'f. 'o,b;:r.,:t i;.:;~: ! I ]
Hart- Insurance ATc:'nJo Extl:
p.i -0.- Box- ..1240:: ~-.;:;-::..- ---' : ' ADDRESS:
.Grants' 'Pass' 'OR' 97528 .
Phone: 541-479-5521 Fax:541-474-1890
ITAic, No"
,
t,;'.
.In.~
CUSTOMER ID II:
9SOAST1
:'
Southe~n Oregon Adolescent
Study & Treatment Center Inc.
715 S.W. Ramsey Avenue
Grants Pass OR 97527
INSURER(S) AfFORDING COVERAGE
SAIF Corp
NAlC .
INSURED
INSURERA:
INSURER B :
INSURER C :
INSURER 0 :
INSURER E:
INSURER F:
Phila&.lphia Ina. Coq:>ani..
60348
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTiFY THAT THE POLCtES OF INSURANCE;:.L1STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AOOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONaTION OF ANYCONTR,llCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED 00 MAY PERTAIN, THE INSURANCE AFFCRDED BY THE POLCIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS,
EXClUSK:>NS AND CONDrrlONS OF SUCH POlCIES. LIMITS SHO'vVN MAY HAVE BEEN REDUCED BY PAID CLAIMS
TYPE OF INSURANCE OD LIMITS
LTR INSR WVO POUCY NUMBER (MM/DDfYYYY) (MMlDDfYYYY)
GENERAL UABIUTY EACH OCCLRRENCE .1,000,000
~
B X COMMERCIAL GENERAL LIABILITY PHPK594235 07/01/11 07/01/12 PREMISES Ea ~~nce) .100,000
I CLAIMS-MADE ~ OCCUR. MED EXP (Anyone person) .5,000 u
-! Prof Liabil'i ty " ; PERSONAL & ADV INJURY .1,000,000
. X ., ' . u
.- , :.' " -
-' - ,. GENERAL AGGREGATE_ .3,000.,000__
GEN'lAGCREGATE liMIT APPliES PER: I""'" -- --- -,. u -, PRODUCTS: COMPJO~ AGe; . 3,000.,000
. 'Xl' 1.1.1 PRO. . n, .- >c' "~~ Prof Liab ~ 1,000,000..
: X POlICY_... -JEcr _ .lOC . .. , -
AUTOMOBILE UABIUTY .. '. , ~,,-' ~ ~o , COMBINED SINGLE lIMIT
:--:,,:1;> .'~-U:~' t t.. ',> ...' , '0',- --,' " ..,e t;;~ " ." . " ., (Eaaccic>>nl),- -. ";".~ ,$l !.goo, ,090
B ~ ANY AUTO t.... ',' ,.!. ~, PHPK594235. 07/01)ii. - 0"7/0J1/f2 . BODilY INJURY (Pe~ pe~)- $:",-;:, -'j",
.. - .. .- - ..
C"'- ALL O,^",ED AUTOS , :";,t~_ . BODILY INJURY (Per seddent) .
SCHEDULEDAUTOS ....- PROPERTY DAMAGE
C- .
HIRED AUTOS (Pllfaccident)
C- .
I- NON.QWNED AUTOS
.
UMBRELLA UAB H~UR EACH OCCLRRENCE .
c-
EXCESS UAB CLAIMS-MADE AGGREGATE .
~ DEDUCTIBLE .
RETENTION . .
A WORKERS COMPENSATION 953977 07/01/11 07/01/12 ITORYUMITS I XIU~~-
AND EMPL.OYI:RS' UJI.B!L1TY VIN - - ..
ANY PROPRIETORJPARTNERlEXECUTrv'O " E.L. EACH ACCOENT .1000000
OFFICERlMEMBER EXCLUDEO?
(Mandatory In NH) E,L, DISEASE - EA EMPLOYE .1000000
~~~~fp5.fro~ ~1~PERATlONS below E,L. DISEASE - POLICY LIMIT . 1000000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAttach ACORD 101, Addltiona. RemarksSchedule, If mere space I. required)
The,C;ty of,Ashland, its off~cers, employees & agents are listed as
add~t~onal ~nsureds
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFCRE
CITYASH THE EXPIRATION DATE THEREOF, NOTICE Vt'ILL BE 08JVERED IN
ACCORDANCE WITH THE POUCY PROVISIQIIS,
Ci ty of Ashland
20 E. Main Street
h1and OR 97520
AUTHO~EDREPRESENTAnvE
ACORD 25 (2009/09)
Michelle L~~
@ 1988-2009 ACORD CORPORATION, All rights
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