HomeMy WebLinkAboutInsurance Certificate: ACCESS
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ACORD- CERTlFICA TE OF LIABILITY INSURANCE I DATE (MMJDDIYYYY)
~. 6/22/2011
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 certlflcate holde, Is an ADDI110NAlINSURED, the pollcy(les) must be endo,sed. 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 rtghts to the
certlftcate holder In lieu of such endorsementfs).
PROWCER NAME: Sandy Orr
Beecher CarlsoD Insurance Agency LLC :;:jg~o E><ll, (541) 772-1111 c N~: (541)172-3785
707 Murphy lid ~~~ss: sandy. orr@beechercarlson.com
~~~~~~: 10 .POOO7999
Medford OR 97504 INSURER(S) AFFORDING COVERAGE NAIC.
INSURED INSURER A ,philadelphia Ind.....i tv Ins Co 8058
INSURERS;
ACCESS; conifer Gardens Limi ted Partnership; INSURERC:
Access Development Corporation INSURER 0 ;
3630 Aviation Way INSURERE;
Medford OR 97504 INSURER F ;
COVERAGES
CERTIFICATE NUMBER:2011-12
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. NOlWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 'MilCH 1l11S
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 lYPE OF INSURANCE POLICY EFF ~~~ UMlTS
LTR POLICY NtMBER MMI
GENERAL LIABILITY EACH OCCURRENCE I ~,ooo,ooo
l- I PREMISES ';'E~~~l:.~9nce 100,000
X COMMERClAl GENERAl LIABILITY I
A I CLAIM&-MADE [Xl OCCUR PHPK736736 7/1/2011 1/1/2012 MED EX? (Anyone person) I 5,000
PER80NI\L 8. f'DV INJJRY I 1.,000,000
- 2,000,000
- GENERAl AGGREGATE I
~t. AGG~E~~rILlMIT APnS PER: PRODUCTS - COMP/OP AGG I 2,000,000
X POLICY PRO- LOC I
AUTOMOBILE LIABILITY COMBNED SINGLE LIMIT I 1,000,000
= (Eeeccident)
~ MY AUTO PHPK736736 7/1/2011 7/1/2012 BODILY INJURY (Per person) I
A I- N..L O'ANED AUTOS BODILY INJURY (Per eccident) I
I- SCHEDULED AUTOS PROPERTY DAMAGE
I
HIRED AUTOS (Peraccident)
I-
NON-OVoNED AUTOS Undennsuredmotoris! I
I-
Unin<>urcd motOn:lt oombOnOd ,
X UMBRELLA LlAB M ~CCUR EACH OCCURRENCE , 5,000,000
I-
EXCESS L1AB ClAlM&-MADE AGGREGATE I 5,000,000
ex nFIiI I(:TIAI F I
A RETENTION $ 10 000 PHUB349317 7/1/2011 1/1/2012 I
WORKERS COMPENSATION I T~~T~11~~ I IOJ61-
AND EMPLOYERS' LIABILllY YIN
Am PROPRIETORJPARTNERJEXEOJTIVE D EL EACH ACCIDENT I
OI='I=ICERlMEMBEJ:l EXCLUDED? NIA
(Mandatory!n NH) E.L. DISEASE - EA EMPLOYE ,
Ifyes.desaibe under EL DISEASE - POLICY LIMIT I
DESCRIPTION OF OPERATIONS below
A Property Coverage PHPK136136 1/1/2011 1/1/2012 BlanketBLildings $14,605,054
~1.,OOO Deductib1e Bh",k..IBPP :)827,850
DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark. Schedule, If more .pace II requIred)
Certificate ho1der is an additional insured as respects Genera1 Liability as required by written contract. This form
is subject to po1icy terms, conditions and exc1usions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TlfE EXPlRA 110N DA'Il! THEREOF, NonCE WILL BE DB..IVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
its officers, employees & agents
Attn: Kristen Bakke AUTHORlZEO REPRESENTATIVE
20 E Main Street
Ashland, OR 97520 Pr--Q...---
B Pinkham! SANDOR ,
ACORD 25 (2009/09)
INS025 (200909)
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