HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Automatic Door 08/23/2012 THU 14: 13 FAX 5415361568 Bancorp Insuran a ���� �� ..,,,, „_____„0001/004,
CERTIFICATE OF LIABILITY INSURANCE ei23i2o°2”'
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 la an ADDITIONAL INSURED, the policy(les)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 andoreement(s).
PRODUCER GOA MNT
E�CT Pam Dressler
Little River Investments PNONB (Sal)536-1726 FAX NA.(Sel)5l8-1966
51477 Hey 97 ,pem@ ba:acorpinsurance.corn
P.O. Box 327 INSURERa AFFORDING COVERAGE NAICA
La Pine OR 97739 INSURERAAm Hallmark Ins Cc of TX
INSURED INSURER B:
Robert Jerome Keller, DBA: Southern Oregon INSURERC:
Automatic Door INSUneno:
200 Rogue Rim Dr INSURER E:
Merlin OR 97532 INSURER F!
COVERAGES CERTIFICATE NUMBER:CL1282312835 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.
LTR
TYPE OF INSURANCE I=J= CY NUMBER POLICY EFF MMUCy UP LIMITS
GENERAL LIABILITY / EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY $ 100,000
A CLAIMS�MADE OOCCUR X 44CL446596 1011012012 0/1012013 HIED EXP an. S 5,000
PERSONAL$ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000
X POLICY PRO LOC $COMBINED SINGLE CW AUTOMOBILE LIABILITY occiderd), 1,000,000
A ANY AUTO BODILY INJURY(Per pemon) $
X ALL OWNED SCHEDULED X 4CL446596 1 10/10/2012 0/10/2013 BODILY INJURY(Per molderd) $
AUTOS X HIREDAUTOS X AUOSWNED PR R $
PIP-Balk $ 15,00
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CWMS-MADE AGGREGATE $
ED I I RETENTIONS $
WORKERS COMPENSATION OTH-
AND EMPLOYERS'LIABILnY
ANY PROPRIETORJPARTNERIUECUTIVE O NIA
A E L.EACH ACCIDENT $
OFFICERNEMBER EXCLUDED?
(M.nd.bryln NH) E,L.DISEASE-EA EMPLOYEEI $
II yye. ender
DESCRIPTION OF OPERATIONS Eelow E DISEASE•POLICY LIMB S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A".h ACORD 101,Adeleon.I Remarks S hedul.,It man spec.1. oculnd)
Certificate holder is listed as an Additional Insured per BN#MP9767 10 10 attached.
CERTIFICATEI•IOLDtR - CANCELLATION
(541)460-5320 SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
Purchasing Representative
Attn: Kari Olson AUTHORIZED REPRESENTATIVE,
90 N Mountain Avenue
Ashland, OR 975201.
I= Dressler/CLK _
ACORD 26(2010/06) ®1968-2010 ACORD CORPORATION. All rights reserved.
.INS025(soi4 nci The ACORD name and logo are registered marks of ACORD
08/23/2012 TH❑ 14: 14 FAX 5415361568 Bancorp Insurance__ _ _ _ 2002/004
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-� (5) Vandalism and malicious mischief;or
(5) Theft.
c. The following is added to A.2. Property Not Covered of the BUILDING AND PERSONAL PROPERTY
COVERAGE FORM: _
r. Property while stored or operated underground In connection with any mining operations,
d. The following is added to Paragraph 2.of B. Exclusions of the CAUSES OF LOSS-SPECIAL FORM:
n. We will not pay for loss or damage caused by puncture,blowout and road damage to tires and tubes mounted
on vehicles. However,we do pay for puncture, blowout or road damage caused by a specified peril,
o, We will not pay for loss caused by humidity,dampness,dryness or changes in or extremes of temperature.
p. We will not pay for loss caused by the weight of a load which, under the operating conditions at the time of a
loss,exceeds the registered lifting capacity of any equipment or machine.
j q. We will not pay for loss due to theft or mysterious disappearance from any vehicle or attached container. We
will pay for loss due to burglary when there are signs of forcible entry to a locked vehicle or container.
e. E.7.Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM Is deleted and replaced by the
following:
7. Valuation
We will determine the value of covered property in the event of loss or damage as follows:
a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in
Paragraphs b, and c.following.
j b. Pair or Set. The value of a lost or damaged article which is part of a pair or set Is based on a reasonable
proportion of the value of the entire pair or set. The loss is not considered a total loss of the pair or set.
c. Lose to Parts. The value of a lost or damaged part of an Item that consists of several parts when It Is
complete is based on the value of only the lost or damaged part or the cost to repair or replace ti.
2. Rental Reimbursement
In the event of loss by a covered peril to covered contractors'equipment that you own,we will reimburse you for your
expense to rent similar equipment while your equipment Is inoperable. The most we will reimburse you for rental
reimbursement expanses is$1,000. We will continue to reimburse you for the rental of equipment after the expiration
date of this coverage provided the loss occurred before the expiration date.
We will not reimburse you:
a. If you can continue or resume your operations with similar equipment that is available to you at no additional
expense to you;or
b. For the rental expense of any equipment unless you make every reasonable effort to repair, replace or rebuild the
inoperable equipment after the covered loss occurs.
3. With respect to this Additional Coverage,Contractors Equipment Coverage,Section D.Deductible of the BUILDING
AND PERSONAL PROPERTY COVERAGE FORM Is deleted and replaced by the following:
D. Deductible
f We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds$500.We will
1 then pay the amount of lass or damage in excess of$600 up to the applicable limit of insurance.
We will not reimburse you for the rental of equipment until after 72 hours have passed since the covered property
was rendered Inoperable. After 72 hours have passed,we will only reimburse you for the rental expense that you
actually incur.
The deductible of$500 does not apply to rental reimbursement expenses.
General Liability Additional Coverages
The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM.
A. Blanket Additional Insured Coverage
i. SECTION II—WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM Is amended to
Include as an Insured any person or organization(referred to as Additional Insured)whom you are required to add as an
Additional Insured on this policy under:
e. A written contract or agreement;and
b. Where a cerdf sate of insurance showing that person or organization as an additional insured has been issued;and
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c. When the written contract or agreement and certificate of insurance are currently In effector becoming in effect
j during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and
advertising Injury."
2. The insurance provided to the Additional Insured is limited as follows:
a. The Additional Insured is only an additional insured for:
(1) "Bodily Injury,'"property damage,"or"personal and advertising Injury"caused in whole or In part by negligent
acts or omissions of the Named Insured or anyone directly or Indirectly employed by the Named Insured or for
whose acts a Named Insured may be liable.
(2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or
organization's status as an insured under this coverage ends when your operations for that insured are
completed.
b. The Limits of Insurance applicable to the Additional Insured are those specified in the written contractor agreement
l but not more than the Limits of Insurance specified In the Declarations for this policy. The Limits of Insurance
applicable to the Additional insured are Inclusive of and not In addition to the Limits of Insurance shown in the
Declarations for the Named Insured.
3. In addition to the other excluslons applicable to Section 1,Coverages A.,B.and C.of the COMMERCIAL GENERAL
i LIABILITY COVERAGE FORM,the Insurance provided to the Additional Insured does not apply to:
C a. "Property damage"to:
(1) Property owned, used, occupied by,loaned or rented to the Additional Insured;
(2) Property in the care,custody or control of the Additional Insured or over which the Additional Insured are for any
purpose exercising physical control;or
(3) "Your work"performed for the Additional Insured,
b. "Bodily injury,""property damage,"or"personal and advertising Injury'arising out of an architect's,engineer's or
surveyor's rendering or failure to render any professional services for you,for the Additional Insured or for others,
Including,but not limited to:
(1) The preparing,approving or failure to prepare or approve maps,drawings,opinions,reports,surveys,change
orders, designs or specifications;or
(2) Supervisory,Inspection or engineering services.
c. "Bodily Injury'or"property damage"occurring after.
l (1) All work, Including materials, parts or equipment furnished in connection with such work,on the project(other
than service,maintenance or repairs)to be performed by or on behalf of the additional insured at the site of the
covered operations has been completed;or
(2) That portion of"your work"out of which the injury or damage arises has been put to its Intended use by any
person or organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the some project.
4. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,Paragraph 4.Other Insurance,is amended to
l add the following subparagraph:
l d. Additional Insured's Other Insurance As Excess Insurance
To the extent required by an"insured contract,"this Insurance Is primary on behalf of the Additional Insured;and any
other insurance maintained by the Additional Insured Is excess and not contributory with this Insurance. If the
"Insured contract"does not require this provision,then Paragraph a.above will apply.
S. Mobile Equipment Broadened Coverage
V.12.f.(1)of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following:
(1) Equipment designed primarily for:
i (a) Snow Removal;
(b) Road maintenance, but not construction or resurfacing;or
(c) Street cleaning.
Except the above provisions do not applyto self-propelled vehicles of less than 1,000 pounds gross vehicle,weightwhich,
are not Intended for use on a highway.
C. Aggregate Limit Per Project
The General Aggregate Limit under SECTION III—LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you.
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D. Blanket Waiver Of Transfer Of Rights Of Recovery Against Others To Us
The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV— COMMERCIAL GENERAL
LIABILITY CONDITIONS)is amended by the addition of the following:
We waive any right of recovery we may have against any person or organization to whom you by written contract or written
agreement have waived your own right or recovery for loss caused by that person or organization because of payments we
make for injury or damage arising out of your ongoing operations or"your work"done under a written contract or written
agreement with that person or organization and included In the"products-completed operations hazard."
This provision does not apply unless the written contract orwritten agreement has been executed prior to the"occurrence"or
offense giving rise to the"bodily Injury'or"property damage."
E. Voluntary Property Damage Coverage
1. We will,at your request,paybut not defend any claim for"property damage"to the propertyof others otherwise excluded
1 under A.2.j.(4),(5)and (6)of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that:
a. Such"property damage'takes place while such property is in your care,custody or control,or is property of others
over which you,for any purpose,are exercising or have exercised physical control;and
b. Such"property damage"takes place away from any premises you own, rent or lease;and
c. Such"property damage"takes place within the"coverage territory"and during the policy term;and
d. Such"property damage"takes place only during your operatlons that are known to us,are scheduled on the policy
and for which a premium has been charged.
2. The Insurance under this additional coverage does not apply to"property damage"to property:
a. Held by you for servicing,repair,storage or sale at premises owned by, rented or leased to you;
b. While being transported by or caused by the ownership,maintenance,operation,use,"loading or unloading"of any
"auto,"watercraft or aircraft;or +
c. Owned or occupied by or rented to you.
3. Deductible
This additional coverage will apply only to that amount of any lose in each"occurrence"that exceeds$500.
The terms of the policy with respect to your duties in the event of"occurrence,"claim or"suit"and the Company's right to
I Investigate,negotiate and settle any Balm or"suit"apply Irrespective of the application of the deductible amount of$500.
We may payany part or all of the deductible amount of$500 to effect settlement of any claim or"suit"Upon notification
of the action taken,you must promptly reimburse us for such part of the deductible amount as has been paid by us.
4. Limits of Liability
The Limit of Liability for this additional coverage shall not exceed$2,500 for each"occurrence"and Is the limit of the
Company's liability for all damages on account of each claim or"suit"covered herein. The annual aggregate Limit of
Liability Is$2,500 and Is,subject to the above provisions respecting each claim,the total.11mit of the Companys liability
for sit damages.
6. Settlement
In the event of loss covered by this additional coverage,you shall,if requested by us,replace the property or furnish the
labor and materials necessary for repairs thereto at actual costto you,excluding prospective profit oroverhead charges
of any nature. Any property so paid for or replaced shall,at our option,become the property of the Company. Payment
hereunder shall not constitute an admission of liability of you or,except as stated herein, of the Company.
j Additional Conditions
A. Insurance Under Two Or More Coverages
The following is added to Paragraph C. Insurance under Two or More Coverages of the COMMERCIAL PROPERTY
CONDITIONS:
If a Coverage Form Is attached to this policy that provides a limit for any coverage provided by this endorsement;the limit
shown In the SCHEDULE and the coverage provided by this endorsement are deleted and replaced by the limit and
coverage provided by the Coverage Form.
B. Limits Of insurance
Regardless of the numberof buildings at a location covered bythis endorsement the most we will pay under this Coverage
Enhancement endorsement In any one occurrence lathe applicable Limits of Insurance shown in the SCHEDULE on page 1
of this endorsement.
1 Page 22 of 25 Includes copyrighted material of Insurance SeNioes office,Inc.and MP 97 67 10 10
I American Association of insurance services,Ino.,wlth their permission