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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Manor a xa° CERTIFICATE OF LIABILITY INSURANCE °"01/03/20012" ' PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Caring Communities Shared Services LTD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1850 W.Winc_hesterRoad j HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 109 , 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Libertyville . - IL 60048 INSURERS AFFORDING COVERAGE'-., NAIC# INSURED Pacific Retirement Services Inc. - INSURERA'. Caring Communities,A Reciprocal RRG --- 12373 Rogue Valley.Manor Community SeNICes Inc. INSURER B: - 1045 Ellendale Drive INSURER C: - Medford OR 97504 INSURERD: INSURER E: ' COVERAGES 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 ADD'L TypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD DATE MMIDDIYYYY DATE MMIDD/'YYYY GENERAL LIABILITY CCRRRG-0015-12 01/0112012 61101/2013 EACH OCCURRENCE $ 1000000.00 A X X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence) X I CLAIMS MADE ❑ OCCUR ME EXP (Any one pennon) S _ X Professional Liability PERSONAL B ADV INJURY $ 1,660,000.60 X Retro Date 011012002 GENERALAGGREGATE $ 3,666,660.00 GEN'LAGGREGATE UNITAPPLIES PER PRODUCTS-COMP/OPAGG S ind X POLICY PRO- LOD S IFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO- - ,. (Ea accident) E - .... ALLOWNEDAUTOS - - BODILY INJURY E SCHEDULED AUTOS (Per Persan) HI RED AUTOS - BODILY INJURY NON-OWNED AUTOS - (Per acddent) $ PROPERTY DAMAGE $ (Per amdent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS I UMBRELLA LIABILITY EACHOCCURRENCE $ 10006006.06 A X OCCUR FX CLAIMS MADE CCRRRG-0015-12 61161/2012 61/01/2013 AGGREGATE $ 15 000 000.00 S S DEDUCTIBLE -.$- RETENTION E is WORKERS COMPENSATION AND I WC STATU- OTH- EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVr� E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY UNIT E OTHER $2,000,000 EACH OCCURRENCE A EXCESS PROFESSIONAL CCRRRG-0015-12 01/01/2012 01/01/2013 $2000,000 AGGREGATE LIABILITY FL,LA,AR SUBLIMIT (INCLUDED IN EXCESS LMTS ABOVE) DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS 01/03/2012 14:33:41 The Certificate Holder is included as an Additional INSURED under this POLICY but only with respect to liability arising out of services rendered by the Named INSURED as outlined within the terms and conditions of the Contractual agreement for the Foster Grandparent program between the City of Ashland and the Named INSURED. CERTIFICATE HOLD CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Ashl DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN 20 East Main St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Ashland JAN - g 2012 OR 20 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUT/ORIMD REPRESENTATIVE .ACORD 25.(2009/0 ©1988-2009 ACORD CORPORATION. All rights reserved. e ACORD name and logo are registered marks of ACORD