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HomeMy WebLinkAboutInsurance Certificate: Ashland Community Theatre A��°® CERTIFICATE OF LIABILITY INSURANCE 12�2�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 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 Iieu of such endorsement(s). PRODUCER NA NTACT Rusty Poehner Gales Creek Insurance Services PHONE (503)977-5632 FAX 1503)977-5832 5727 SW Macadam Ave. AMAIL .rusty@ gale streak.com PO BOX 69508 INSURERS AFFORDING COVERAGE NAIC 4 Portland OR 97239 INSURER ARlver ort Insurance Company INSURED INSURERB:Berkley Life 6 Health Insurance Ashland Community 'Theatre INSURER C: PO BOX 3284 INSURERD: INSURER E Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1112 2 0 72 95 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 rypE OF INSURANCE ADD UBR POLICY EFF POLICY EXP Urn POLICY NUMBER IMIMPOINYYY1 (MWDDfYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY AMMI T ...o ce $ 300,000 A CLAIMS-MADE OCCUR X 152699-00 2/4/2011 2/4/2012 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 X incl Host Liquor GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- X I S IFCT [7 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident) ANY AUTO - BODILY INJURY(Per person) S ALL OWNED F7 SCHEDULED BODILY INJURY(Par accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Persoodent 5 UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE 5 DED I I RETENTIONS Is WORKERS COMPENSATION WC STATU- OTH. AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEKECUTIVE F7 NIA E.L.EACH ACCIDENT S OFFICERVEMBER ErCLUDEDi (Mandatory In NH) E DISEASE-EA EMPLOYEE S Ifyes diewbetmeer DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Volunteer/Participant PAI L00226817-001 2/4/2011 2/4/2012 Medical Payments $15,000 Accident EXCESS COV - $0 DED AD&D $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) The City of Ashland and its officers, employees, and agents are included as Additional Insureds with respect to the operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION (541)552-2059 rossann,grimm@ ashland.or.u 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. att'n: Rossann Grimm 20 E Main St AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Rusty Poehner/RUSTY "`s ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSO25,9n,nr el m The Armmn nemn and Innn aro roniefurcrl mer4a of Aftmmri