HomeMy WebLinkAboutInsurance Certificate: Community Works (3)
ACORD- CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY)
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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 AFFORD EO 8Y THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 8ETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLOER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) 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 Beecher Carlson Insurance Agency, LLC CONTACT NAME:
220 NW 2nd Avenue, Suite 800 PHONE {AlC, No, Extl: 503-222-1831 I FAX (AIC, No,: 503-274 0323
Portland, OR 97209 E-MAIL. ADDRESS:
PRODUCER CUSTOMER ID #:
www.beechercarlson.com INSURERlSl AFFORDING COVERAGE NAle.
INSURED Community Works INSURER A: Alliance of Nonprofits for Insurance
900 East Main INSURER B: Lexinnton Insurance Company
Medford OR 97504 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 7696812 BE'"
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 ~~~J- ~~~ POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MMlDDfYVYV MMlDDIYVYV
A GENERAL LIABILITY ./ 2010-19517 711/2010 7/1/2011 EACH OCCURRENCE 1 000 000
--,- ~~~~:S~sYE~~t:~nce
I COMMERCIAL GENERAL LIABILITY 100,000
I CLAIM5-MAOE C2J OCCUR MED EXP (Any one person) 10 noo
L Professional Liab PERSONAL & ADV INJURY 1 000 000
L. Abuse & Molestation GENERAL AGGREGATE S 2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S 2 000 000
n" POLICy'-n-~~g: ~'n~ LOC S
A ~TOMOBILE LIABILITY 2010-19S17 7/1/2010 7/1/2011 COMBINED SINGLE LIMIT
ANY AUTO (Eaoccidenl) S 1,000,000
r- ALL OWNED AUTOS BODILY INJURY (Per person) S
r- SCHEDULED AUTOS BODILY INJURY (Per accident) S
f- HIRED AUTOS PROPERTY DAMAGE
(Per accident) S
f- NON-GWNED AUTOS
S
f- S
UMSRELLA LIAS H ~CCUR EACH OCCURRENCE S
-
EXCESS LIAS CLAIM5-MADE AGGREGATE S
DEDUCTIBLE S
r- s
f- RETENTION S
S
WORKERS COMPENSATION VIN I, WC STATU-~ I IOJ,tJ-'
AND EMPLOYERS' LIABILITY D
ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED?
(MandatorylnNH) E.L. DISEASE - EA EMPLOYEE S
~~~~~f~ir~ ~~~PERATIONS below E.L. DISEASE. POLICY LIMIT S
B Foster Care General 41-LX-0228S3075-0 711/2010 7/1/2010 Each Occurrence: $1,000,000
Liability & Professional Aggregate: $3,000,000
Deductible: None
DeSCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remllrk. Schedule, If mo,. space Is required)
All operations of the Named Insured as provided by the policy tenns, conditions & exclusions.
Ciyt of Ashland is additional insured as respects General Liability only on the Alliance of Nonf1rofits for Ins policy.
Blanket Additional Insured by Written Contract ANI.RRG-E25 01/98 attached which is part 0 the above General Liablity policy.
CITY OF ASHLAND IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY ONLY.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS,
ATTN: FINANCE
20 EAST MAIN STREET AUTHORIZED REPRESENTATIVE
ASHLAND OR 97520 @a.~~~
(PORT) Carla Helmer
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CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2009/09)
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Carla Helmer 6/29/2010 10;35:57 AM Page 1 of 2
CERT NO.. 7696812 (PORT)
r; Allianceo!
l , Nonprofits
~ for!t1~~~~~~
TillS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
Any person or organization that you are required to add as an additional insured on this policy, under a written contract or
agreement currently in effect, or becoming effective during the term of this policy, in consideration of food contributions
or client referrals you receive from them.
(If no entry appears above, infonnation required to complete this endorsement will be shown in the Declarations as applicable to
this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an
insured but only with respect to liability arising out of your operations or premises owned by or rented to you.
ANI-RRG-E25 (1198)
CERT NO.: 7696812 (PORT) Carla Helmer 6/29/2010 10:35:51 AM Page 2 of 2