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HomeMy WebLinkAboutInsurance Certificate: Ashland Community Theatre (2) A °Ra CERTIFICATE OF LIABILITY INSURANCE °2/2/2 11 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 lieu of such endorsement(s). PRODUCER CONTACT Rusty Poehner Gales Creek Insurance Services PHONE . (503)977-5632 FA% Not. ArC 5727 SW Macadam Ave. UpmgLEss.rugty@galescreek.com PO Box 69508 INSURERS AFFORDING COVERAGE NAIC0 Portland OR 97239 INSURER A Rive ort Insurance Company INSURED INSURER B:Berkley Life a Health Insurance Ashland Community Theatre INSURER C: PO BOX 3284 INSURER D: INSURER E Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1112207295 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 ADDL UBR POLICY EFF POUCYEXP LIMITS LTR POLICY NUMBER MDD GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMN ETO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea omu n $ A CLAIMS-MADE OCCUR X P152699-00 12/4/2011 12/4/2012 MED EXP(Any we person) $ 5,000 PERSONAL B ADV INJURY $ 11000,000 X incl Host Liquor GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY P"- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY IWURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accid n S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATUS DTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICERMEMBER EXCLUDED4 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ d es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E B Volunteer/Participant PAI L00226817-001 12/4/2011 12/4/2012 Medical Payments $15,000 Accident EXCESS COV - $0 DED AD&D $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) The City of Ashland and its officers, employees, and agents are included as Additional Insureds with respect to the operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION (541)552-2059 rossann.grimm @ashland.Or.0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. attrn: Rossann Grimm 20 E Main St AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Rusty Poehner/RUSTY ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD ACORD� CERTIFICATE OF LIABILITY INSURANCE DATE3"OM12 1 PRODUCER JTJEJ( 20.11 RKI INC. Cert#53289 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P.O.BOX 157 HOLDER. THIS OCERT CERTIFICATE DOES NOTOAMEND, EXTEND OR LEBANON,OR 97355 (541)451-1313 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. FAX: INSURERS AFFORDING COVERAGE NAIC# BEAVER TREE SERVICE,INC. INSVRERA: OHIO SECURITY INS.CO. NPP INSURERS: OHIO SECURITY INS.CO.(NPP) 270 WILSON RD INSURER C: CENTRAL POINT, OR 97502 INSURER N COVERAGES SURER E' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' NALIBANCF POLICY NUMBER POUCYEFFECTIVE POLICY EXPIRATION G,TF GENERAL LIABILITY I (MMIDDrm LIMITS X COMMERCIAL GENERAL LIABILITY BK$ 125477967Q `-ACH OCCURRENCE $ 1.000,000 ( ) 5 26 11 5 26 12 PR"MISE (Fa ENT rg- E 1,000000, A CLAIMS MADE ❑X OCCUR MED EXP(My on.Person) $ 15,000 PERSONAL S ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMB APPLIES PER: POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ 2,000,000 AUTOMOBILE LIABILITY COMED X ANYAUTO BAS(12)54779670 MAY 26 11 52612 Ea aB d.rd)INGLE LIMB $ 1000,000 ALL OW NED AUTOS SCHEDULED AUTOS BODILY INJURY $ B (Per Person) HIRED AUTOS NON-OWNEDAUTOS 'BODILY INJURY $ (Par aaidenll PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANYAUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ ' E%CESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ EMPLOY RS'LiAENSATION AND I WC STATU- 1,OTH- - - '- EMPLOYERS'LIABILITY � � � � S_ ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? K s,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICYLIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS REF: FOR CERTIFICATE HOLDER'S INSURANCE FILE. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATTEN: ANNE STREET DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 20 EAST MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ASHLAND, OREGON 97520 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. F#541-488-5314 AUTHORIZED REPRESENTATIVE � -- _ ACORD 25(2001/08) _—_ - ©ACORD CORPORATION 1988