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HomeMy WebLinkAboutInsurance Certificate: Day Wireless Systems i-~ DAYMANA-01 MELODYK ACORO" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE - 9130/2013 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 NAMEpCT Melody Kirkendall Durham and Bates Agencies, Inc. PHONE FAX 720 SW Washington St. Ste250 - MN., E.t: (503) 224-5170 ac No: (503) 221-0540 Portland, OR 97205 _ ADDRESS: melody k dbates.com INSURER(S) AFFORDING COVERAGE NAIC9 INSURER A: Atlantic Specialty Iris. CO. INSURED INSURER B: Hartford Day Management Corporation dba: Day Wireless Systems INSURERC: 4700 SE International Way INSURER D: Milwaukie, OR 97222 INSURER E: NSURER 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 TYPE OF INSURANCE POLICY NUMBER MM/DO/YYYY MM/DD/YYP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 711014061-0000 8/20/2013 10N/2014 PREMISES Ea occurrence $ 1,000,00 CLAIMS-MADE Fx_1OCCUR MED EXP (Any one person) $ 10,00 X $1,000,000 Umbrella PERSONAL B ADV INJURY $ 1,000,00 X Washington Stop Gap GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 E] .15C.T PRO- X LOC WA Emplrs Liab $ 500,00 POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Eaaccident $ A X ANY AUTO 711014061-0000 8120/2013 10/1/2014 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accitlent UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMSWADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNEREXECUTIVE YIN 52WEL.N9641 101112013 1011/2014 EL. EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? FN-] N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASEPOLICY LIMIT $ 1,000,00 ITI DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark, Schedule, if more space is required) See attached forms VCG246 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 26 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: DAYMANA-01 MELODYK Page 1 of 1 . hkt.~' 0 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Day Management Corporation dba: Day Wireless Systems Durham and Bates Agencies, Inc. 4700 SE International Way POLICY NUMBER Milwaukie, OR 97222 SEE PAGE 1 CARRIER NAIL 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 Workers Compensation Companies: Hartford Insurance Co of the Midwest - Applies to State of Nevada Hartford Accident and Indemnity - Applies to States of CA and OR Twin City Fire Insurance Company -Applies to Sate of ID ACORD 101 (2008101) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 711014061-0000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION lI - WHO IS AN INSURED, 2. is amended to include as an additional insured: 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 * InfomrabonmWiredto omTleteihis Schedule, ifnotshown on thisendorsement will be shown in the Declarations. VCG 745 02 05 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of I Copyright 2004 POLICY NUMBER: 711014061-0000 THIS'ENDQRSEMENt CHANGES THE'POLICY. ,PLEASE,READ IT CAREFULLY. @VANTAGE FOR GENERAL LIABILITY 'TECHNOLOGY COMPANIES This endorsement modifies insurance, providedundertheifollowing: COMMERCIAL GENERAL LIABILITY-COVERAGE FORM The following schedule' lists the -coverage extensions provided by this "endorsement: Refer to the individual provisions to determinelthe extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured - Broad. Form Vendors 8. Coverage Territory - Worldwide 2; Additional insured - by Contract,^Agreement or`.9: Duties in Event of Occurrence; Claim or Suit Permit relating to: - 10. Expected or.Intencled Injury (PD) o Work performed byyou 11. Incidental Medical Malpractice o Premises you own,,reni; lease or,occupy, 72. Medical Payments, o Equipment you lease 13. Mobile Equipment Redefined 3. Aggregate' Limit Per Location 14. NewlyAcquired or Formed 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 Equipment 19. Supplementary 'Paymenis'Increased Limits o Customers`Goods • 'Use of Elevators 1. ADDITIONAL INSURED-'BROAD FORWVENDORS' Section II - Who Is An Insured is amended to include as,an additional insured any person(s) or organization(s) (referred to below as vendor) with whom you agreed in a written contract or agreement to provide insurance, but 11 only with respect to "bodilyinjury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendors business, subject to the following additional exclusions: a. This provision 1:;does not apply to; (t) '"Bodily injury" or "property damage" for which the vendor is obligated 4o pay damages by reason of the assumption of liability in ,a contract or agreement. This exclusion does not apply to liability for damages that the vendorwould have in the absence of the contract. or agreement; (2)' Any express warranty;not authorized byyou; (3) Any physical or chemical change in the product made' intentionally bythevendor; (4)' Repackaging, except when unpacked solely for 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 make such inspections,:adjustments, tests or servicing as thevendor 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; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution:or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any'other thing or substance by or forthe vendor; or (8) "Bodily injury' or "property damage":arising out of the sole negligence of the vendor for its own acts or omissions orthose rof its employees or anyone; else acting. on its behalf. However, this exclusion does not apply to: (a) The exceptions'contained in Subparagraphs 4. or 6., or VCG 207o709 Includes copyrighted material of Insurance"'Services Office, Inc.. Page 1 of 7 Copy right 2009, OneBeacon Insurance Group. LLC E=INSURED (b) :Such inspeclions, 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 thel products: (9) Any vendor Orson or organization if the "products-completed operations hazard" is ezcluded,eitherby the provisions of,the Coverage;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,, accompanying orcontaining such products- Z ADDITIONAL ,INSURED -CONTRACT„AGREEMENTOR.PERMIT a. Section II Who Is An Insured is amendedAo include as an additional insured any person(s) or organi- zation(s):with whom you agreed' in-a written contract; written agreement or permit to provide insurance;such as,is afforded under this Coverage Part, butionly 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:addlfional insured(S) at the location designated in the contract;. agreement or permit; or 2. In the maintenance,,-operation or use of equipment leased'to yogi-bY'such person(s) of organization(s), or 3. In connection with premisas you,own rent lease or occupy.- This insurance applies on"a primary or primary and noncontributory 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 or, ppermit is currently in effect or becomes effective during the term of thispolicy;.and (b)' the contract or agreement, was executed or permit 'issued prior to the "bodily injury", "property_ damage", or "personal and advertising injury"; 2. To any person or organization included.. as :an, insured under the Additional. Insured Broad Form Vendors provision of thls;endor`sement; 3. TO any person or OrganlzatlOn;lnchrded asan Insured.by an endorsement issued by us and made part of this Coverage Part; 4. To'any person of organization if the "bodily injury", "property damage,", or "personaland advertising injury" arises out of the rendering of or failure to render any professional architectural, engineering,. or surveying services by or foryou including: (a) The preparing, approving, or,failing to prepare or approve, maps;. shop drawings, opinions, reports; surveys, field ;orders, change orders ordrawings,and specifications; or (b) Supervisory, inspection, 9rchitectural or engineering activities. 5. To any: (a) Lessor of equipment after the equipment. lease; terminates or-expires;. or (b) Owners or other interests' from"wliom land has been leased, or (c) Managers or lessors of pre,mise,s if: (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 performedby or on behalf of the-manager -or lessor. 6. To "bodilyin)'u ry,;or "property damage" occumrig"after: (a) All work,on the project (other thamservice; 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 (b) That portion of'your work" out of which the injury or damage arises has been'putto its intended use by any person or organization ;other than.: another contractor or subcontractors engaged in performing operations for a'pdncipal as part of the same project. Paget of 7 Includes copyrighted material of Insurance Sewices Office; Inc. VCG 207 0769. Copyright 2009, OneSeacon Insurance Group LLC c Limits of Insurance;"applicable to the addltioriinsured are those,specjUed in the contracf;'agreement or permit or in the Declarations of thispollcy, whichever is less; and fix the most we will pay, regardless of the numbenof; ft. 'Insureds; 2. Claims made or"suits" brought; or 3. Persons 6r_orgafizations inaking'dlaii6s 6r.bd6ging "suits". These Limits. of Insurance: are inclusive of•.and not in addition 'to-the Limits. of Insurance..shown in the Declarations. 3; AGGREGATE LIMIT PER LOCATION a. Uri derSection III - Limits.of Insurance; the Gerieraf.Aggiregate:Limit applies separately to eabh:6f.'y'6ur "locations" owned by or. rented or leased 1:6,9od. b. Under 'Section V_- Definitions, the following definition is added:' "Uooatlon' means premises involving the same orconnecting lots, or premises whose conriection'it interrupted only by a street, roadway, waterway or, right-of-way:of,a_ railroad. 4. BLANKET.WAIVER OF SUBROGATION Section' IV - Transfer of Rights of Recovery Against Others to,Us Condition is amended to add the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury ordamage arising out of your ongoing operations done.under a written contract oragreemenkwith that person or.organization and included in "your work" or the "productscompleted operations 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", that requires you to waive your rights of recovery. 5. BODILY INJURY`REDEFINED-MENTAL ANGUISH Under:Section V, the.definition 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 resulting from anyof these at anytime. 6. BROADENED NAMED IN§URED Section 11= 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 of the voting stock?on the effective date of this endorsement will be a Named Insured until'the 180th the policy period, whichever comes first; provided there Is no other similar insurance day or the end o, f' I available'to that organization. The insurance afforded-, fforded herein does not apply to any entity which is also an insured under another policy or would be an'insured under such polcybut for its termination or the exhaustion of its limits of insurance.. 7. BROADENEDPROPERTY.DAMAGE - BORROWED EQUIPMENT, CUSTOMERS' GOODS AND USE OF ELEVATORS The insurance for "property damage" liability is subject to the following: a. The Damage To Property exclusion under Section 1 Coverage A is amended as follows: 1. The exclusion for personal property in the care, custody or control of the insured does' not apply to "propertydamage" to equipment you borrow while at a job site and provided it is not being used by 'anyone to perform operations~at the time of loss. 2. The exclusions for ;(a) Property loaned to you; .(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 notapplyto "property damage" to "customers' goods" while on your premises nor do they apply to "property damage' arising from the use of elevators at premises 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". VCG207.07.09! Includes copyrighted material of Insurance' Services Office, Inc. Page 3 of 7 Copyright 2009, OneBeacon Insurance Group LLC POLICY NUMBER 71014061-0000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. @VANTAGE FOR AUTOMOBILE 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 5. 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 19. 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 Vehicles 11. Employees As Insureds 21. Towing -Any Covered Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is An Insured provision under SECTION II - 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 person or organization is an "insured" only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part by your maintenance, operation 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 contract or 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 if 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 writing and executed prior to the "bodily injury" or "property damage": 5. BODILY INJURY REDEFINED -MENTAL ANGUISH The definition of "bodily injury;underSECTION 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. UCA 20101 09 Includes copyrighted material of Insurance Services. Office. Inc. Page 1 of 5 Copyright. 2004. One Beacon Insurance Group LLC E-INSURED POLICY NUMBER: 711014061.0000 b. Return the stolen property, at our expense. S. Other Insurance We will pay for any damage that results to a. For any covered "auto' you own, this cov- the "auto" from the thef ; or erage form provides primary insurance. c. Take all or any part.of the damaged or For any covered "auto" you don't own, the stolen property at an agreed 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 ante. However, while a covered "auto" Include the applIcable sales tax for the which is a "trailer" is connected to another damaged orstolen 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 forwhom 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, ered "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 a driver is not a covered "auto c Bankruptcy or insolvency of the "insured" or . Regardless of the provisions of Paragraph a. above, this coverage form's the 'insured's"estate will not relieve us of any Liability Coverage 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 cuvm aye same basis, either excess ur piinialy, we torn. It is also void if you or any other will pay only our share. Our share is the "insured", at any time, intentionally conceal or proportion that the Limit of Insurance of misrepresent a material fact concerning: our coverage form hears 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"; Premium Audit c. Your interest in the covered "auto"; or 6. 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 ooficy If we revise this coverage forth 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 coverage as of the day the will be credited against the final premium revision is effective in your state. due and the first Named Insured will be billed for the balance, if any. The due 4. No Benefit To Bailee - Physical Damage date fnr the final premium or retrospective Coverages premium is the date shown as the due 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 for a :fee regardless of b. If this policy is issued for more than one any other provision of this coverage form. year, the premium for this coverage form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. CA 00 0103 10 0 Insurance services office, Inc,201)9 Page 9 of 12