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HomeMy WebLinkAboutInsurance Certificate: Jackson County School Dist #4 �1 OP ID:SAW CERTIFICATE OF LIABILITY INSURANCE DATE 61301ttYYY) 06/30/11 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 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 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 CONTACT 541-773-5358 NAME: Protectors Insurance,LLC 541.772.1906 PHONE PAx Pilot Rock Ins Agency LLC(CA) ac No Eat), (AID,No), PO Box 4669 E-MAIL Medford,OR 97501 ADDRESS: PRODUCER pHOEN4 Dennis C.Flenner CUSTOMER,, INSURE S AFFORDING COVERAGE NAIL# INSURED Jackson County School Dist#4 INSURER A:SAIF Corporation Attn: Doug Span! INSURER e: PO Box 698 Phoenix,OR 97535 INSURERC: INSURER D 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 A POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY l (MM/DD1YYYY1 LIMITS GENERAL LABILITY EACH OCCURRENCE $ MA E To COMMERCIAL GENERAL LIABILITY X PREMISES Ea occurrence $ CLAIMS-MADE F—IOCCUR MED EXP(Any one person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ POLICY PRO LOC $ AUTOMOBILE LABILITY COMBINED SINGLE LIMIT $ (Es student) ANY AUTO BODILY INJURY Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNEDAUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU. OTH- AND EMPLOYERS'LABILITY TORY LIMITS ER A ANY PROPRIETORIPARTNER/EXECUTIVE YIN 486679 07101/11 07101112 E.L.EACH ACCIDENT $ 600,00 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 dl...describe under DESCRIPTION OF OPERATIONS belox E.L.DI$FASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Adach ACORD 101,Additional Remarks Schedule,Hmom space Is required) RE the use of Lithia Park Band Shell for Phoenix High School Graduation, CERTIFICATE HOLDER CANCELLATION CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Parks Dept ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Str Ashland,OR 97520 AUTHORIZED REP--R�EESE�NTA/TIVE ° j WGUV ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD GL-AL Certificate Summary Certificate Page 1 of 2 GENERAL LIABILITY and AUTO LIABILITY SUMMARY CERTIFICATE AGENCY/AGENT-ISSUING CERTIFICATE Date:6/30/2011 Print 8i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER Protectors Insurance,L.LC. OTHER THAN THOSE PROVIDED IN THE COVERAGE DOCUMENTS, P.O.Box 4669 THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE Medford,OR 97501 COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS LISTED Sheryl Wlrts sherylw®protectorslns.com HEREIN.THIS CERTIFICATE DOES NOT CONSTIfUE A CONTRACT (541)842-2970 BETWEEN ANY OF THE FOLLOWING PARTIES:THE AGENCY,NAMED PARTICIPANT,CERTIFICATE HOLDER AND/OR COMPANIES AFFORDING COVERAGE. NAMED PARTICIPANT/MEMBER-REQUESTING CERTIFICATE ORGANIZATIONS AFFORDING COVERAGE Phoenix-Talent School District#4 Company A-Property Casualty Coverage for Education(PACE) P.O.Box 698 Phoenix,OR 97535-0698 Company B-Genesis Insurance Company Doug Spanl (541)535-1517 COVERAGES This Is to certify that Coverage Documents listed herein have been Issued to the Named Participant herein for the Coverage Period indicated.Notwithstanding any requirement,term or condition of any contract or other document with respect to which the certificate may be Issued or may pertain,the coverage afforded by the Coverage Documents listed herein is subject to all the terms,conditions and exclusions of such Coverage Documents,Aggregate Umits which are shown may have been reduced by paid Claims,Suits or Actions.The titles referenced under Type of Coverage are Inserted solely for convenience of reference and shall not be deemed in any way to limit or affect me provisions to which they relate. OR/CO Coverage Expiration LTR Type of Coverage Document Date Effective Date Limits General Liability General Aggregate $20,000,000 X Commercial General Uabil&y X Niolk Officials liability 26MM35-78 711/2011 A X Employment Practices Lability B 7/1/2012 X Occvrence Form Each Occurrence $10,000,000 Employment Practices Deductible/SIR:$0 Wrongful Acts Deductible/Slit:$0 General Lability Deduc0ble/SIR:$0 '$5,000 Minimum deductible for terminations If PACE or approved legal counsel Is not consulted prior to an employment termination. Automobile Liability General Aggregate $20,000,000 X Scheduled Autos A X Hired Autos&Non-Owned Autos 26Pfi0035-78 7/1/2011 711/2012 B Each OCCYlROR $10,000,000 X Occurrence form X DeductiNe/$IR:$0 Remarks:When required by an Insured Contract tertincate holder is an additional participant In respects to Use of Uthia Park Band Shell for High Sdwol Graduation,but only with respects to negligence dalms for Bodily Injury,Property Damage or Personal Injury where the Named Certificate T Participant is deemed to have liability.In no event shall coverage extend to any party for any Type: Claim,Suit or Action,however or whenever asserted,arising out of the certificate holder's sole "Additional Participant'Certificate negligence or for any Claim,Suit or Action which occurs prior to the execution of the contract or agreement. 'Information Is provided as of the data this certificate was generated and Issued and Is subject to change. CANCELLATION:Should any of the Coverage Documents herein be cancelled before the expiration date thereof,PACE will endeavor to provide notice in accordance with the PACE Certificate Holder-Requesting Certificate General Liability Coverage Document provisions.Failure to mail such notice shall impose no obligation or liability of any kind upon PACE,its agents or representatives,or the Issuer City of Ashland Parks Dept of this certificate. 20 E Main Str Ashland,OR 97520 Authorized Representative of Named Participant: u,eA„/9i/� Date:O6/30/11 �7fwlu W J �GL-AL Certificate Summary Certificate Page 2 of 2 Applicable Coverage Document Definitions: The following definitions are provided solely for convenience of reference and shall not be deemed in any way to limit or affect the provisions to which they relate,for complete details on the terms,conditions and exclusions of applicable Coverage Documents please refer to the PACE Liability Coverage Document. Participant means: 1.The Named Participant and each of the following while acting within the course and scope of their duties as such: a. Members of the Board; It. Executive Officers; c. Employees; d. Volunteers and Agents; e. Registered Students whose course study includes on-the-job training,but only while acting under directions and within the scope of their activities performed while in training; f. Student Organizations,Parent Teacher Organizations,Booster Clubs and Foundations under the jurisdiction and supervision of the governing board;and g. Any person,entity or any organization the Named Participant is required by an Insured Contract to include as a Participant This coverage will be limited to the extent of coverage and Limits of Liability required by the Insured Contract and will not increase the limits stated In SECTION V.- LIMITS OF LIABILRY or alter any of the terms of coverage stated In this Coverage Document.The Insured Contract must be effective and executed prior to a covered Occurrence or Wrongful Act.In no event shall coverage under this Coverage Document extend to any party for any Claim however or whenever asserted,arising out of such party's sole negligence.(1)The term"Additional Insured"if used in an Insured Contract shall be understood to mean the same as Additional Participant. 2.With respect to: Mobile Equipment or any Auto,any person is a Participant while driving such Auto or Mobile Equipment with a Named Participant's permission.Any person,entity,or organization responsible for the conduct of such person is also a Participant,but only with respect to Bodily Injury or Property Damage arising out of the operation of the Auto or Mobile Equipment.However,the owner or anyone else from whom a Named Participant hires or borrows an Auto is a Participant only if that Auto is a trailer connected to an Auto a Named Participant owns.However,no person,entity,or organization is a Participant under this paragraph 2.with respect to: a. Property Damage to property owned by a Named Participant or the employer of any person who Is a Particlpant under this provision; b. Any Auto a Named Participant hires or borrows from one of a Named Participant's Employees,volunteers or members of their households,if they are the owner of such Auto,unless acting within the scope of their duties on a Named Participant's behalf; c. Any Auto being used by a person employed in the business of selling,servicing,repairing,or parking Autos unless they are a Named Participant's Employees;or d. The movement of property to or from an Auto except a Named Participant,a Named Participant's Employees,lessees or borrowers of such Auto, and any employee of the lessees or borrowers. Insured Contract means: 1.A legally enforceable contract that includes one or all of the following: a. A lease of premises as it relates to tart liabilities assumed by the Named Participant arising out of the lease,such assumption occurring in writing prior to the date of Occurrence; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation,as required by ordinance,to indemnify a Public Body; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to the Named Participant's operations(including an indemnification of a Public Body in connection with work performed by or for a Public Body)under which the Named Participant assume the tort liability of another person or entity to pay for Bodily Injury,Property Damage or Personal Injury to a third person or organization,provided the Bodily Injury,Property Damage or Personal Injury occurs subsequent to the execution of the contract or agreement;and g. Contracts for services with Public Bodies. 2.An Insured Contract does not include that part of any contract or agreement: a. That indemnifies an architect,engineer or surveyor acting as an Independent contractor for Injury or Damages arising out of professional errors or omissions' It. That Indemnifies any person or organization for Damages by fire to premises rented or loaned to the Participant;and c. That involve the purchase or sale of real property or personal property.