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HomeMy WebLinkAboutInsurance Certificate: Keller Associates (3) KELLE-4 OF ID: NW ,acoRO° CERTIFICATE OF LIABILITY INSURANCE 1 DATE 1 12/07112 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). CONTACT PRODUCER 208-459-1678 N AME' The Hartwell Corporation - Cal 208-454-1114 PHDNE FAX _ PO Box 400 ac No Ezt : A/C No : Caldwell, ID 83606 E-MAIL _ ADDRESS: Jeremy Kroll - INSURERS AFFORDING COVERAGE NAIC# INSURER A: Travelers Indemnity Co of Am. 25658 INSURED Keller Associates, Inc. INSURER B: Travelers Indemnity of CT 25682 131 SW 5th Avenue, Suite A INSURERC:XL Specialty Insurance Co. 37885 Meridian, ID 83642 INSUaERD:Travelers Indemnity Co 25666 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 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 SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY INSR Min GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 68078771-118 12/01/12 12/01113 PREMISES DAMA S( RocwDurrence $ 1,000,00 Ea CLAIMS-MADE OCCUR MEDEXP(Anyoneperson) $ 10,00 X CGD381 PERSONAL BADV INJURY $ 1,000,00 X 6GD379 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY EOMaBI'EED,SINGLE LIMIT $ 1,000,00 B X ANY AUTO X BA78771_468 12/01/12 12101113 BODILY INJURY (Per person) S ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NAUTOS ON OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccidenl X CAT353 $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,00 D EXCESS LIAR CIAIMS-MADE CUP8961X179 12/01/12 12101113 AGGREGATE $ 4,000,00 DED X RETENTION $ 10000 $ WORKERS COMPENSATION X WC STATU- OTH- - AND EMPLOYERS' LIABILITY RY C ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N NIA UB9722YO81 05/01/12 05101113 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 0000313 E1 . DISEASE-EA EMPLOYEE $ 1,000,00 It yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 1,000,00 C Profes Liability DPR9704373 12101112 12/01113 Ea. Claim 2,000,00 $100,000 Deduct Annl Aggr 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ASHLA02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE POLICY PROVISIONS. WILL BE DELIVERED IN W WITH DATE City of Ashland ACCORDANCE 25 E Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE ASHLA02 KELLE-4 PAGE2 INSURED'S NAME Keller Associates, Inc. OP ID: NW DATE 12/07112 The City of Ashland, Oregon, its elected officials, officers and employees are additional insureds for 4eneral liability and auto liability as provided by policy forms COD381 and CAT353. COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED INSURANCE (Section III) for this Coverage (Section II): Part. Any person or organization that you agree in a B. The following is added to Paragraph a. of 4. "contract or agreement requiring insurance" to in- Other Insurance in COMMERCIAL GENERAL clude as an additional insured on this Coverage LIABILITY CONDITIONS (Section IV): Part, but only with respect to liability for "bodily in- However, if you specifically agree in a "contract or jury", "property damage" or "personal injury" agreement requiring insurance" that the insurance caused, in whole or in part, by your ads or omis- provided to an additional insured under this Cov- sions or the acts or omissions of those acting on erage Part must apply on a primary basis, or a your behalf: primary and non-contributory basis, this insurance a. In the performance of your ongoing opera- is primary to other insurance that is available to tions; such additional insured which covers such addi- b. In connection with premises owned by or tional insured as a named insured, and we will not rented to you; or share with the other insurance, provided that: c. In connection with "your work" and included (1) The "bodily injury" or "property damage" for within the "products-completed operations which coverage is sought occurs; and hazard". (2) The "personal injury" for which coverage is Such person or organization does not qualify as sought arises out of an offense committed; an additional insured for "bodily injury", 'property after you have entered into that "contract or damage" or "personal injury" for which that per- agreement requiring insurance". But this insur- son or organization has assumed liability in a con- ance still is excess over valid and collectible other tract or agreement. insurance, whether primary, excess, contingent or The insurance provided to such additional insured on any other basis, that is available to the insured is limited as follows: when the insured is an additional insured under d. This insurance does not apply on any basis to any other insurance. any person or organization for which cover- C. The following is added to Paragraph 8. Transfer age as an additional insured specifically is Of Rights Of Recovery Against Others To Us added by another endorsement to this Cover- in COMMERCIAL GENERAL LIABILITY CON- age Part. DITIONS (Section IV): e. This insurance does not apply to the render- We waive any rights of recovery we may have ing of or failure to render any "professional against any person or organization because of services". payments we make for "bodily injury", "property f. The limits of insurance afforded to the addi- damage" or 'personal injury' arising out of "your tional insured shall be the limits which you work" performed by you, or on your behalf, under agreed in that "contract or agreement requir- a "contract or agreement requiring insurance" with ing insurance" to provide for that additional that person or organization. We waive these insured, or the limits shown in the Declara- rights only where you have agreed to do so as Lions for this Coverage Part, whichever are part of the "Contract or agreement requiring insur- less. This endorsement does not increase the ance" with such person or organization entered limits of insurance stated in the LIMITS OF into by you before, and in effect when, the "bodily CG D3 81 09 07 C 2007 The Travelers companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission. W2219 COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- erage Part„ provided that the "bodily injury" and sonal injury" offense is committed. "property damage" occurs, and the "personal in- D. The following-definition,is added to _DEFINITIONS jury" is caused by an offense committed: 1. 1 (Section'V)r ' a. After you have entered into that contract or "Contract or agreement requiring insurance" agreement, means that part of any contract or agreement un- b. While that part of the contract or agreement•is der which you are required to include a person or in effect: and organization as an additional insured on this Cov- c. Before the end of the policy period. I J£34 (S _f ^r'• R'.-, .l t• i.7z- r; Page 2 of 2 ® 2007 The Travelers Companies, inc. CG D3 81 09 07 Includes the copyrighted material of Insurance Services Office, Inc., voth its permission. COMMERCIAL AUTO -THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ'IT CAREFULLY.- AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: - ' BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE - INCREASED LIMIT B. BLANKET ADDITIONAL INSURED I. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT C. EMPLOYEE HIRED AUTO J. PERSONAL EFFECTS D. EMPLOYEES AS INSURED K. AIRBAGS E. SUPPLEMENTARY PAYMENTS - INCREASED L. NOTICE AND KNOWLEDGE OF ACCIDENT LIMITS OR LOSS F. HIRED AUTO - LIMITED WORLDWIDE M. BLANKET WAIVER OF SUBROGATION COVERAGE - INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE - GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED executed by you before the "bodily injury" or " The following is added to Paragraph A.1., Who Is property damage" occurs and that is in effect An Insured, of SECTION II - LIABILITY COV- during the policy per od, to be named as an addi- ERAGE: tional insured is an "insured" for Liability Cover- N_ age, but only for damages to which this insurance Any organization you newly acquire or form dur- applies and only to the extent that person or or- ing the policy period over which you maintain ganization qualifies as an "insured" under the 50% or more ownership interest and that is not Who Is An Insured provision contained in Section separately insured for Business Auto Coverage. II Coverage under this provision is afforded only un- C. EMPLOYEE HIRED AUTO tit the 180th day after you acquire or form the or- ganization or the end of the policy period, which- 1. The following is added to Paragraph A.1., ever is earlier. Who Is An Insured, of SECTION II - LI- B. BLANKET ADDITIONAL INSURED ABILITY COVERAGE: The following is added to Paragraph c. in A.1., An "employee" of yours is an "insured" while Who Is An Insured, of SECTION II - LIABILITY operating an "auto" hired or rented under a COVERAGE: contract or agreement in that "employee's" name, with your permission, while performing Any person or organization who is required under duties related to the conduct of your busi- a written contract or agreement between you and ness. that person or organization, that is signed and CA T3 53 03 10 02010 The Travelers Indemnity Company. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc with its permission. 004367 COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., within such' country or jurisdiction., for Liability .•'.Otherrinsurance,. of, SECTION IV - BUSI- NESS, Coverage' for "any covered' "auto" that you AUTO.CONDITIONS; . lease: hire, rent or borrow without a driver for b. For Hired Auto Physical Damage Cover- a period:of 30.days,or less and that is not an age, the following are deemed to be cov- "auto"- you lease,, hire,-;rent, or borrow from ered "autos" you own: any of your "employees",: partners (if you are (1) Any covered "auto" you lease, hire, a partnership), members (if you are a limited liability company) or members of their house- rent or borrow: and holds. (2) Any covered "auto" hired or rented by (a) With respect to any claim made or "suit" your "employee" under a contract in brought outside the United States of that individual "employee's" name, with your permission, while perform- America, the territories and possessions of the United States of America, Puerto ing duties related to the conduct of Rico and Canada: your business. However, any "auto" that is leased, hired, (I) You must arrange to defend the "in- sured" against, and investigate or set- rented or borrowed with a driver is not a tle any such claim or "suit" and keep covered "auto". us advised of all proceedings and ac- D. EMPLOYEES AS INSURED tions. The following is added to Paragraph A.1., Who Is (ii) Neither you nor any other involved An Insured, of SECTION II - LIABILITY COV- "insured" will' make any settlement ERAGE; without our consent. Arty :e`mployee" of'yours'is an "insured" while us- (iii),We may, at:our;discretion, participate ing a covered "auto" you don't own, hire or borrow in defending the "insured" against, or in your business or your personal affairs in the- settlement of, any ,claim or, E. SUPPLEMENTARY PAYMENTS - INCREASED "suit". - LIMITS (iv) We will reimburse the "insured" for 1. The following replaces Paragraph A.2.a.(2), sums that the "insured" legally must of SECTION II - LIABILITY COVERAGE: pay as damages because of "bodily injury" or "property damage" to which (2) Up to $3,000 for cast of bail bonds (in- this insurance applies, that the "in- cluding bonds for related traffic law viola- sured" pays with our consent, but tions) required because of an "accident" only up to the limit described in Para- we cover. We do not have to furnish graph C.. Limit Of Insurance, of SEC- these bonds. TION II - LIABILITY COVERAGE. 2. The following replaces Paragraph A.2.a.(4), (v) We will reimburse, the "insured" for of SECTION 11 - LIABILITY COVERAGE: the reasonable expenses incurred (4) All reasonable expenses incurred by the with our consent for your investiga- "insured" at our request, including actual tion of such claims and your defense loss of earnings up to $500 a day be- of the "insured" against any such cause of time off from work. "suit", but only up to and included F. HIRED AUTO -LIMITED WORLDWIDE COV- within the limit described in Para- of - INDEMNITY BASIS graph C., Limit Insurance, SECTION II - LIAABILITY COVER- The following replaces Subparagraph (5) in Para- AGE, and not in addition to such limit. graph B.7., Policy Period, Coverage Territory, Our duty to make such payments of. SECTION IV, - BUSINESS, AUTO CONDI- ends when we have used up the' ap- .JTIONS:~. plicable limit of insurance :1in7pay- - (5) Anywhere in the world, except any country or - ments. for damages, settlements or jurtsdiction.while=any trade sanction, em- defense, expenses,.;;-_; i.' bargo, or, similar. regulation imposed, by the (b), This-insurance is-eiccess'over any valid United States of America applies to and pro- 'and' collectible other,msurance available hibits the transaction of business with or Page 2 of 4 ® 2010 The Travelers Indemnity Company. CA T3 53 03 10 Includes copyrighted material of Insurance services Office, Inc. with its permission. COMMERCIAL AUTO to the "insured" whether,primary, excess J. PERSONAL EFFECTS „ „ ..c contingenjor;on any other basis. The-following is'added to Paragraph A.4:, Cover- c (c),This insurance is not',a substitute for re- age Extensions, of SECTION 111 PHYSICAL r. quired or compulsory insurance in any DAMAGE COVERAGE:., _ r country outside the United States, its ter- personal Effects mories and possessions, Puerto Rico and Canada. We will pay up to $400 for "loss" to wearing ap You agree to maintain all required or pare) and other personal effects which are: compulsory insurance in any such coun- (1) Owned by an "insured"; and try up to the minimum limits required by (2) In or on your covered "auto". local law. Your failure to comply with This coverage applies only in the event of a total compulsory insurance requirements will theft of your covered "auto". not invalidate the coverage afforded by this policy, but we will only be liable to the No deductibles apply to this Personal Effects same extent we would have been liable coverage. had you complied with the compulsory in- K. AIRBAGS surance requirements. The following is added to Paragraph B.3., Exclu- (d) It is understood that we are not an admit- sions, of SECTION III - PHYSICAL DAMAGE ted or authorized insurer outside the COVERAGE: United States of America, its territories Exclusion 3.a. does not apply to "loss" to one or and possessions, Puerto Rico and Can- more airbags in a covered "auto" you own that in- ada. We assume no responsibility for the flate due to a cause other than a cause of "loss" or furnishing of certificates of insurance or -c. for compliance in •any way with the la set forth in.Paragraphs,A.t.b. and A.1.c., but of other countries relating to insurance. °Dly' J,t G: WAIVER 'OF DEDUCTIBLE -GLASS a. If that "auto", is.a covered ''auto" for Compre- hensive Coverage underthis policy; The following is added to Paragraph D., Deducti- ble, b. The airbags are not covered under any war- ranty; and COVERAGE: No deductible for a covered "auto" will apply to c. The airbags were not intentionally inflated. glass damage if the glass is repaired rather than We will pay up to a maximum of $1,000 for any replaced. one "loss". H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF L. NOTICE AND KNOWLEDGE OF ACCIDENT OR USE - INCREASED LIMIT LOSS The following replaces the last sentence of Para- The following is added to Paragraph A.2.a., of graph AA.b., Loss-Of Use Expenses, of SEC- SECTION IV - BUSINESS AUTO CONDITIONS: TION 111- PHYSICAL DAMAGE COVERAGE: Your duty to give us or our authorized representa- However, the most we will pay for any expenses tive prompt notice of the "accident" or "loss" ap- for loss of use is $65 per day, to a maximum of plies only when the "accident" or "loss" is known $750 for any one "accident", to: 1- PHYSICAL DAMAGE - TRANSPORTATION (a) You (if you are an individual); EXPENSES - INCREASED LIMIT (b) A partner (if you are a partnership); The following replaces the first sentence in Para- (c) A member (it you are a limited liability com- graph A.4.a., Transportation Expenses, of pany); SECTION 111 -.PHYSICAL DAMAGE COVER- (d) An executive officer, director or insurance AGE: manager (if you are a corporation or other or- We will pay up 10'$50 per day to a maximum of ganization); or $1,500 for temporary-transportation expense in- (e) Any "employee" authorized by'youto give no- curred by you;because,of, the, total theft of a cov- rice of the "accident" oi"lass"' ered "auto" of the private passenger type. CA T3 53 03 10 02010 The Travelers Indemnify Company. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. OOa38a COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION such contract. The waiver applies only to the The following replaces Paragraph A.S., Transfer person or organization designated in such Of Rights Of Recovery Against Others To Us, contract. of SECTION IV - BUSINESS AUTO CONDI- N. UNINTENTIONAL ERRORS OR OMISSIONS TIONS: The following is added to Paragraph B.2., Con- s. Transfer Of Rights Of Recovery Against cealment, Misrepresentation, Or Fraud, of Others To Us SECTION IV - BUSINESS AUTO CONDITIONS: We waive any right of recovery we may have The unintentional omission of, or unintentional against any person or organization to the ex- error in, any information given by you shall not tent required of you by a written contract prejudice your rights under this insurance. How- signed and executed prior to any "accident" ever this provision does not affect our right to col- or "loss", provided that the "accident" or "loss" lect additional premium or exercise our right of arises out of operations contemplated by cancellation or non-renewal. Page 4 of 4 02010 The Travelers Indemnity Company. CA T3 53 03 10 Includes copyrighted material of Insurance Services Office, Inc. with its permission.