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HomeMy WebLinkAboutInsurance Certificate: Ashland Community Hospital AC 0� OP ID: Pt EVIDENCE OF PROPERTY INSURANCE D0 910 512 0 1 2Y) 09/05/2012 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE OF PROPERTY INSURANCE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AGENCY PHONE 541-779-1321 COMPANY AIC No Eat: Western States Ins.-Med ord Lexington Insurance 38 N.Central Ave Suite 100 Medford,OR 97501 Scott Sherbourne FAX ac Na 541-779-9187 ADDRESS: CODE: SUB CODE: AGENCY ASHLA-H CUSTOME D#: INSURED Ashland Community Hospitall LOAN NUMBER POLICY NUMBER Attn: Karen Herwig 1 014498276 280 Maple Street EFFECTIVE DATE EXPIRATION DATE CONTNIJED Ashland,OR 97520 09/01/12 09/01/13 TERM;NAT DI IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATIOMDESCRIPTION 278-280 Maple Street Hospital Ashland,OR 97520 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION COVERAGEIPERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE Special Form-Replacement Cost Blanket Buildings,Personal Property 8 Bus.lnc. 78,757,000 10,000 REMARKS(including Special Conditions Locations include:1. Hospital,278-280 Maple St.,Ashland 2.Medical Office,287 Maple SL,Ashland 3.Medical Office, 600 Chestnut St.,Ashland 4,Office Bldg-On Call,560 Catalina,Ashland 5.Vacant Office,323 Maple St.,Ashland 5.Home Health,1970 Ashland St.,Ashland r.YMCA(Aquatic Physical Therapy),540 YMCA Way,Ashland 3.Maint/Storage-101 Sunny St.,Talent,OR 3.Business Office,49 Talent Ave.,Talent,OR IO.Medical Office,628 N.Main St.,Ashland CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE ADDITIONAL INTEREST NAMED BELOW,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ADDITIONAL INTEREST NAME AND ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN# City of Ashland Attn: Charlene, Risk Mgmt AUTHORIZED REPRESENTATNE 20 E. Main St. Ashland,OR 97520 ACORD 27(2006107) ©ACORD CORPORATION 1993-2006. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTES. - INSURED'S NAME PAGE OP ID: PH DATE 915/2012 Locations continued... 11.Medical Office-21 Maple St.,Ashland 12. Medical Office -731 N. Main St.,Ashland 13.Storage -317 Maple St.,Ashland,OR