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HomeMy WebLinkAboutInsurance Certificate: Day Wireless Systems i~ DAYMANA-01 MELODYK CERTIFICATE OF LIABILITY INSURANCE DATE 1 51/281228/2013 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 CONTACT NAME: Durham and Bates A encies, Inc. PHONE &U,(503)224-5170 ac No : (503) 221-0540 720 SW Washington It. Ste250 Alc No FA% Portland, OR 97105 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICN INSURER A: OneBeacon America Ins. Co INSURED INSURER B: Hartford Day Management Corporation dba: Day Wireless Systems INSURER C : 4700 SE International Way INSURER D: Milwaukie, OR 97222 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 CONTRACTOR 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 TYPE OF INSURANCE ADDLISUbm POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 7110099180006 10/112012 1011/2013 PREMISES (Ea $ 1,000,00 CLAIMSJAADE ~ OCCUR MED EXP (Anyone Person) $ 10,00 X $1,000,000 Umbrella I PERSONAL B ADV INJURY $ 1,000,00 X Washington Stop Gap I; GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER'. ;i - PRODUCTS - COMP/OP AGG $ 2,000,00 Poucv PRO- 1FCT X LOC A Empire Liab $ 500,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Et $ 11000,00 A X ANY AUTO .7110099180006 10/1/2012 10/1/2013 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accitlenQ $ $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LWBIUTY T RV LIMITS B ANY PROPRIETORIPARTNER)EXECUTIVE YIN 52WELN9641 10/112012 1011/2013 E L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N N/A (Mandaory in NH) E.LDISEASE-EA EMPLOYEE$ 1,000,00 If yes, DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Attach ACORD 101, AddUlonel Remarks Schedule, If more space Is required) See attached forms VCG245 02 05 Additional Insured-Designated Person or Organization; VCG207 07 09 Vantage for General Liability Technology Companies; VCA 201 01 09 Vantage for Automobile; and CA0001,0310 Business Auto Coverage (Other Insurance). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: DAYMANA-01 MELODYK LOC 1 A`ORO` ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Durham and Bates Agencies, Inc. Day Management Corporation dba: Day Wireless Systems 4700 SE International Way POLICYNUMBER Milwaukie, OR 97222 SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Remarks: Workers Compensation Companies Hartford Insurance Co of the Midwest (NAIC 37478) - Applies to State of Nevada Hartford Accident and Indemnity (NAIC 22357) - Applies to States of CA and OR 4 d ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 711009918 00006 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modes insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION It - WHO IS AN INSURED, 2. is amended to include as an additional insured: i a. The certificate holder, but only as respects its liability arising out of your activities. b. The person or organization shown in the Schedule as an additional insured but only with respect to liability arising out of your operations or premises owned by or rented to you. SCHEDULE' The City of Ashland, Oregon, and its elected officials, officers and employees 20 East Main Street Ashland, OR 97520 Insured: Day Management Corporation DBA: Day Wireless Systems i bfmTkdmtequhdtocmpleteftSdradule,ifrotshownonthisendassnai,wdlbesh wnmtheEedatmws VCG 2* 02 05 Includes copyrighted material of Insurance Services Office, Inc. Page I of I Copyright 2004 POLICY NUMBER 711009918-0006 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE, READ IT CAREFULLY. WANTAGE FOR GENERAL LIABILITY TECHNOLOGY COMPANIES This eridorsemenf modifies insurance provided under the folknrvingt COMMERCIAL GENERAL LIABILITY COVERAGE FORM The 'following schedule fists the coverage•'eztensions provided by this endorsement. Refer to the individual provisions to determine the extent of your coverage, SCHEDULE OF COVERAGE EXTENSIONS, 1. Additional Insured - Broad Form,Vendors 8. Coverage Territory - Worldwide --flo 2. AdditionaHnsured - by-,Contract, Agreement or 9. Duties in Event of'Occurrence,.Claim or-Suit. Permit,relating to:, 1R _ Expected.or Intended Injuy (PD) o Work:performed by you, 11. ;Incidental Medical Malpractice o Premises you own;, rent; lease or occupy 12, Medical Payments _ o Equipment you lease 13. ;Mobile Equipment Redefined 3. .AggregateAjrnit Per Location 14. Newly Acquired'orFormed'Organizations 4. Blanket Waiver of Subrogation 15. Non-Owned Aircraft 5. Bodily, Injury-Redefined„Mental Anguish 16. '.Non-Owned Watercraft 6. Broadened Named Insured 17. Personal and Advertising Injury' 7. Broadened Property Damage 18. Product Recall Expense o' Borrowed Equipmentll 19. Supplementary Payments,lnaeased Limits .o' Customers! Goods o. Use-of Elevators 1.. ADDITIONAL INSURED- BROAD FORM VENDORS' Section II -Who Is An lasured is amended to include as an additional insured.any person(p) or organization(s) (referred to below as vendoo with whom you agreed in-8 written contract or agre-ementto provide-insurance, but only with respect_to "bodily injury" or "property damage""arising out of yourpreoucts"which are distributed or sold in the regular course of themendoes busineiss,,subject to the'foUaW ng additional exclusions: a. This provision-,. does not apply to: ,(1), "Bodily mjury"`or "property.damage-4or: which t ie vendor'is obligated to, pay"damages_by reason of the assumption of liabilky.in. a contract or agreement., This exclusion does not. appy to liabiltyfor,damages that the vendor would'have in the absence:oi the contractor agreement;-, (2) Anyezpress warranty:not authorized by you;. -(3j Any physical or Chem pal;change In, the product made.inteintbrially'by the vendor; (4) Repackaging, except when unpacked .s6lely,fo(the purpose of inspection;,demonstration, testing or the substitution of :parts, under :instructions from the, manufacturer, and then repackaged, in the original container; (5) Any failure to makwsuch inspections, adjustments, tests or servicing as.the vendor.has agreed to make or'normally undertakes to make, in the usual course of business, In connection with the distribution or sale of the products-, j6) Demonstration;: installation, servicing or repair. operations: incept such operations performed at the vendor's premises in,connection with the sale of the product;, (7). Products which,- afterdistribution or sale by.you, have been labeled or relabeled 'or used as a container, part or ingredient of.ahy other thing or substanceby or for the vendor; or act s:or (8) "bodily injury" or"'property damage" arising. out of the sole negligence of the vendor for its own omissions:or those offs employees or anyone also acting on its behalf. However, this ezclusion-does not applyto (a) The:excepti6n6 contained in Subparagraphs 4. orS ; or :VC6,20710709. !nqudes copydgntad matedaiof lnsumnee,SmIoes Office. Inc. Page I of 7 00py,ght:2009, 11111111!I llltlll111!IIIIIIi111111Fl!!Iltll!IIIIII.' 1111111!Inl111I !II. (b) Such' inspections, adjustments, tests or servictng'as the'vendorhas'agreed'to make or normally undertakes.to'make In the,usual course of business, in connection with"~the distribution or sale of the products. (9) Any vendor, person `or organization If the-"products-completed operations hazard"'is excluded either by the provisions of the Coveragge;Form or by endorsement. b. This insurance does* not apply to any insured person or: organization,' from whom you have acquired such products, or any ingredient; part or container, entering into, scbornpanying or Containing such products: 2: ADDITIONAL' INSURED - CONTRACT; AGREEMENT OR PERMIT a. Section II - Who Is An Insured' isamended'to include-as an additional insured any person(s) or organi- zation(s) with whom you agreed in a written contract, written agreement orpemiit to provide insurance such as is afforded under this Coverage Part, but only with respect to liability for "bodily Injury', "property damage" or "personal and advertising injury" caused,. in whole or in part, by your` acts or omissions or the acts :or omissions of those:acting,on your behalf; 1. In the performance of•'your work" for the addidonel'lnsured(s) atthe location designated in the contract; agreement or permit; or' 2. In the maintenance;' operation or use of equipment leased to you by such person(s);oi organization(s), or "'3: 'In connection wfth.premisesyou own, rent; lease or occupy:,. _ This insurance appliWon'a primary or primary and non-contributory basis If that is required in writing by the contract, agreement: or permit. b. The Insurance provided to the additional insured herein is[limited. This,.insurance does not apply; 1. Unless (a) 'the written contract; agreement orpermit is currently,in,effect or becomes effective during the term of this policy; and (b) the contract or agreement was executed or permit issued prior 30, the "bodily injury", "property damage", or "personal and edvertising'injury"; 2. To any person or organization included as an insured under the Addilional'Insured - Broad Form Vendors provision of this endorsement; 3. To any person ororganization included as an insured by an endorsement issued.by us and made pad of this Coverage Part; 4. To any person or organization if'?the' "bodily Injury", '-'property.damage;or "personal and advertising injury' arises out of the rendering of~or failure-to render any professional architectural, engineering or surveying services by or for you including: (a) The preparing„approving, or failing to prepare or approve,. maps, shop:drawings,-opinions, reports, surveys, fiektorders, change orders or'drawings "and specifications; or (b) Supervisory; inspection, architectural or engineering activities. S. 'To any: .(a) Lessor'of equipment after the-equipmenf lease terminates.or expires; or (b) Owners or other:interests-from whom land has been leased;'or (c) Managers or lessors of premises it. (1) The "occurrence"'takes place after you cease to be a tenant in that premises; or (2) The "bodily injury", "property damage", "personal and advertising injury"' arises out of structural alterations, new construction or demolition operations' performed by or on behalf of the manager or'Wssor. To'bodiy injury,. "property damage" occurring after. (a) All work on the projsct*)tlier than'service, maintenance or repairs) to be performed by or on behalf of the additional:insured atthe,site ofthe covered operations'has been completed; or (b). That, portion of, "your work:' out. of which the injury or damage srisss has beemput to its intended use, try' any person or 'organization other than another contractor-,$r subcontractor engaged :in performing operations fora prind.pal:as pad of the same project; Page 2. of 7 Includes copyrighted material of Insurance Services Ollie„ Inc. VCG 207 07 06- Copyright 2ooe, .I I I I I I I I l 11111 II!! 11 I I II I I I I III I I I n r1101I111111 c Limits of Insurance applicable to ttie additional insured are thosespecifed in the contract,, agreement or permit or in the.Declarations of this policy', whichever is less', and.fix the most we will pay regardless of the number ofi 1. Insureds; 2. Claims made Or; "suits" brought; or 3. Persons or:organizations.making claims or bringing "suits"., These, Limits of Insurance are inclusive of and not:in addition 'to the,Urnits of Insurance shown in the Declarations. 3. AGGREGATE LIMIT PERIILOCATION a. Under Section III -.Limits of Insurance; the General Aggregate. Limit applies: separately:to.- each of your; "locations"'owned.0y pr rented or leased to you.. .b. Under Section V- Definitions, the folloyAng.definition.is added: "Location" means premises involving the same or connecting lots, of premises whose connection is interrupted only by a street, roadway,-waterway or right-of-way of a railroad. It. BLANKET WAIVER OF SUBROGATION Section IV - Transfer of Rightsi of Recovery Against Others to Us..Conditiom is amended to add the following: We will waive any right of recovery we may..have agalnst;any person' or organization because of payments we . make.forinjury:or damage arising out of your ongoing operations done under a written'contract *or agreement with 'that person or organization and included in "your work" or the "products-completed operetions hazard". This waiver applies only: to persons, or organizations with whom you have a written,contract, 'executed prior'to -the "bodily injury" or "property damage", thatrequires you to waive,your rights of recovery. 6. BODILY INJURY REDEFINED - MENTAL ANGUISH Under Section V„theidefinition;of "bodily injury" is replaced, by the following; "Bodily injury" means bodily injury„sickness, or disease sustained by. a person, including mental anguish or death resu'king 'from anyof these at any time., S. BROADENED.NAMEDINSURED Section h - Who Is An Insured is amended.to include as an insured the following; Any organization which is, a legally incorporated entity in which you own a financial', interest of,more, than 50 percent.Iof the:voting stock;on.thIieffective date of this endorsement will be a Named Insured until the 180th day or the and of the policy period, whichever comes first, provided there is'no other similar insurance available to that organization. The insurance afforded herein does not apply to:any entity which is also an insured under another policy or would be an insured undei,such policy but forits:terrntnabonbr the exhaustion of ifs limits of insurance. 7. BROADENED PROPERTY DAMAGE'- BORROWED EQUIPMENT, CUSTOMERS' GOODS AND USE OF ELEVATORS The_jnsurance for "property damage" liability is subject to theifollowing; a. The Damage To Property exclusion under Sectiowl!Coverage A is amended as followsi The, exclusion. for personal properly In the care, custody or control of the insured does' not apply to property damage" to equipment you borrow while at a job:site;and.provided Cis not being used by anyone to perform operations at the time of loss. 2. The,exclusions for, (a) Property ioaned'tqyou; (b) Personal property In the care, custody or control of the insured;.and: (c) That particular part of any property. that must be, restored; repaired or replaced because "your work' was incorrectly performed on: it do,not apply to property damage" to "customers' goods"-while on your premises nor do they, apply to "prope.rty:damag' !arising from the use:of,elevators atpremises you own,,rent, lease or occupy; Subject to :the. Each Occurrence Limit, the most we will pay for "property damage"'to °Customers` Goods" is $35,000'per'"occurrence YCO'201 OT 09, ,Includes copyrighted material of insumnce~services Office,~ Inc. Page 3af 7' ;Copyright 2009 Ii Ii 11'.1111 I I III I II It, II I II I II I III I III I I I IIIit,II POLICY NUMBER: 711009918-0006 Ir THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i VANTAGE FOR AUTOMOBILE 0 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provi- sions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured By Contract 12. Employee Hired Autos 2. Airbag Discharge 13. Fellow Employee Exclusion 3. Auto Theft Reward 14. Glass Repair -Waiver of Deductible 4. Blanket Waiver of Subrogation 15. Hired Auto Physical Damage Coverage 6. Bodily Injury Redefined - Mental Anguish 16_ Lease Gap Coverage 6. Broad Form Named Insured 17. Liability Coverage - Supplementary Payments 7. Communications Equipment 18. Newly Formed or Acquired Organizations 8. Diminution in Value 18. Physical Damage - Transportation Expenses 9. Drive Other Car - Executive Officers 20. Rental Reimbursement - Private Passenger 10. Duties In The Event of Accident, Claim, Suit or Loss VehWes 11. Employees As insureds 21. Towing - An Covered Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is An InsurI provision under SECTION 0 - LIABILITY COVERAGE is amended to include as an additional insured" any person or organization with whom you agreed in a written contract, written agreement or permit, to provide Insurance such as is afforded under this Coverage Form. Such parson or organization is an "insured" only with Sespect to liability for "bocilly injury" or "property damage" caused, in whale or in pan by your maintenance, optilradon or use of your covered "autos". With respect to the insurance afforded to these additional 'insureds", this insurance does not apply: a. Unless the written contract or agreement has been executed or the permit has been issued prior to the "bodily injury" or "property damage"; b. To any person or organization Included as an "insured" by endorsement or in the Declarations; or c. To any lessor of "autos" when their contractor agreement with you for such leased "auto" ends. 2. AIRBAG DISCHARGE If you purchased physical damage coverage for a covered "auto" under this policy, we Will pay to reset or re place an airbag that accidentally discharges without the vehicle being involved in an accident. No deductible applies to this additional coverage. However, this coverage only applies it the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and con- viction of anyone stealing a covered "auto% A reward will not be paid to you, a family member, employee or any public official while performing their duty. 4. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights of Recovery Against Others To Us condition under SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A. LOSS CONDITIONS is replaced by the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or,,."property damage" under an "insured contract", provided the contract is in wrifing and executed prior to the "bodily injury" or "property damage". i:. 5. BODILY INJURY REDEFINED-MENTAL ANGUISH The definition of "bodily injury" under SECTION V - DEFINITIONS is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time. VCA 2010100 Includes copnigHed material of Insurance Services Once, Inc. Pape 1 of 5 Copyright 2004, POLICY NUMBER: 711009918-0006 ~i i b. Retum the stolen property, at our expense. S. Other Insurance We will pay for any d'amaga that results to a. For any c0veieri"aul0".you own, this cov- the "auto" from the theft; or i, erage form provides primary insurance. c. Take all or any partfof the damaged or For any-covered "auto" you don't own, the stolen property at anjagreed or appraised insurance provided by this coverage form .value.. is excess over any other collectible insur- If we pay for the "loss", our payment will ance. However, while a covered "auto" include the applicable sales tax for the which is a'trailer" is connected to another damaged or stolen property. vehicle, the Liability Coverage this cov- 5, Transfer Of Rights Of ' Recovery Against erage form provides for the "bailer" is: Others To Us (1) Excess, while it is connected to a If any person or organization to or for whom motor vehicle you do not own. we make payment under this coverage form (2) Primary while it is connected to.a cov- has rights to recover damages from another, erad "auto" you own. those rights are transferred to us. That person b. For Hired Auto, Physical Damage Cover or organization must do everything necessary age, any covered "auto" you lease, hire, to secure our rights and must do nothing after rent or borrow is deemed to be a covered "accident" or "loss" to impair them. "auto" you own: However, any "auto" that B. General Conditions is leased, hired, rented or borrowed with 1. Bankruptcy o a driver is not a covered "auto?. Bankruptcy. or insolvency of the "insured" or P, arraa of the provisions of Paragraph aph. a. above, this coverage form's the Insured's"estate will'not relieve us of any ,j Liatxlity.Covefage'is primary for any liability obligations under this coverage form. assumed under an "insured contract". 2. Concealment, Misrepresentation Or Fraud d. When this coverage form and any other This coverage form is void in any case of fraud. coverage form or policy covers on the by you at any time as it relates to this coverage same basis; either excess or primary, we form. It is also' void if you or any other will pay only our share. Our share Is_the Insured", at any time, ntentionally conceal or. proportion that the .Limit of Insurance of misrepresent a material fact concerning: our coverage form bears to the total of a. This coverage form;. the limits of all the coverage forms and policies covering on.the same basis. b. The covered "auto"; c: Your interest in the covered "auto"; or S. Premium. Audit; a. The estimated premium for this coverage d: A claim.under this coverage form. form.is based on the exposures you told 3. Liberalization us you would have when this policy If we revise this coverage form to provide began. We will compute the final premium more coverage' without .additional premium due when we determine your actual charge, your policy will automatically provide exposures. The, estimated total premium the, additional envarage as of the day the will credited against the final premium revision is effective, In your state. due: :a and the first Named insured will be billed for the balance, if any. The due 4. No Benefit To Bailee Physical Damage, date for the final premium or retrospective Coverages premium is the date shown as the duo We will not recognize; any assignment or date on the bill. If the estimated total grant any coverage for the benefit of any premium exceeds the final. premium due, person or organization. holding, 'storing or the first Named Insured will get a refund. transporting property fo'r a fee regardless of b. If this policy is issued for more than one any other provision ofttiiscoverage form. year,. the premium for this.coverage form is will' be computed annually based on our rates or premiums in effect at the beginning ii.. of each year of the policy. CA 00 0103 10- ®.Insurance services OHiCe,,inc,2009 Page 9 of 12