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HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Council of Gov ,a. CERTIFICATE OF LIABILITY INSURANCE DATE(MM 0 VYYY) L.-� 1/20/2012 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 i 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 Marcy Baker Ward Insurance Agency PHONE (541)687-1117 FAX (541)342-8280 - -- - A/C No: P O Box 10167 - E-MAIL Blarcy @wardinsurance.net INSURERS AFFORDING COVERAGE NAICe Eugene - OR 97440 INSURER A:S ecial Districts Assn. of Ore INSURED INSURER B Rogue Valley Council of Governments INSURER C: PO BOX 3275 INSURER D: NSU RER E Central Point OR 97502-0011 INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 GL/AL/EX-AI 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 ADDL SUbm POLICY EFF POLICY UP LTR TYPE OF INSURANCE JULIE ima POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A GENERAL LIABILITY 7P44372-429 /1/2012 /1/2013 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY ED PREMISES Ea occurrence $ I CLAIMS-MADE FX1 OCCUR MED UP(Arty one person) $ _ PERSONAL a ADV INJURY $ GENERAL AGGREGATE $ None GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMNOP AGG $ POLICY PRO- 'LOC $ I IFCT A AUTOMOBILE LIABILITY 7P44372-429 /1/2012 /1/2013 COMBINED SINGLE LIMIT 500,000 ' X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (Per accident AUTOS AUTOS )BODILY INJURY(P $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ IAUTOS Per eccidant Underinsured motorist $ A UMBRELLA UAB X OCCUR 7P44372-429 /1/2012 /1/2013 EACH OCCURRENCE $ 5,000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN z TORY LIMITS ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICERNEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandate,in NH) - E.L.DISEASE-EA EMPLOYEE $ I(Yes,descM,a Under DESCRIPTION OF OPERATIONS tea. E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is required) CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECTS TO WORK PERFORMED BY THE RO RMS S CONDITIONS. D EGEOV JAN 3 0 2011 CERTIFICATE HOLDER U CANCELLATION 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. KATHY GRIFFIN CITY HALL AUTHORIZED REPRESENTATNE ASHLAND, OR 97520 Paul Jensen/DANAK ACORD 25(2010/05) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025(201005),01 The ACORD name and logo are registered marks of ACORD , h..R CERTIFICATE OF LIABILITY INSURANCE OATE(Mw2Do YYY) `.� 1/20/2012 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 NAME: Marcy Baker Ward Insurance-.Agency PHONE (541)687-1117 - No:(541)342-8280 _ P O. Box 10167 E-MAIL ADDRESS:mercy @wardinsurance:net INSURERS AFFORDING COVERAGE NAICd Eugene OR 97440 INSURER A:S ecial Districts Assn. of Ore INSURED INSURER B: Rogue Valley Council of Governments INSURER C: PO BOX 3275 INSURER D: INSURER E: Central Point OR 97502-0011 INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 GL/AL/EX - ALL OPS 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 ADOL SUam POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS - A. GENERAL LIABILITY 7P44372_429 /1/2012 /1/2013 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY - PREMISES Ea,NH,U nrs $ CLAIMS-MADE FxI OCCUR MED EXP(Airy one person) _ $ - - PERSONALBADVINJURY W$ N010-1 GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO POLICY PRO- LOC A AUTOMOBILE LIABILITY 7P44372-429 /1/2012 F/1/2013 13 OMBINEDt SINGLE LIMIT X ANY AUTO BODILY INJURY(Per person)ALL OS SCHEDULED BODILY INJURY Per aooidenl AUTOS AUTOS ( )X HIRED AUTOS X AUTOS NED Per amid Y DAMAGE AUTOS Per a¢ideM Underinsured moumst $ A UMBRELLA LIAR X OCCUR 7P44372-429 /1/2012 EACH OCCURRENCE $ 5,000,000 }[ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ " WORKERS COMPENSATION VJC STATUS OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERJMEMBER EXCLUDED? F_J' N/A -- E.L.EACH ACCIDENT $ (Mandatory in NH) E DISEASE-EA EMPLOYE $ Use,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,B more space Is required) RE: USING PROPERTY FOR MEAL SITE. ALL OPERATIONS OF THE NAMED INSURED UNDER WRITT RACT AGREEMENT. FR GC� C� UNIC� oil CERTIFICATE HOLDER ANCELLATION 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. KATHY GRIFFIN CITY HALL AUTHORIZED REPRESENTATIVE ASHLAND, OR 97520 Paul Jensen/DANAK ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(20(005)_01 The ACORD name and logo are registered marks of ACORD