HomeMy WebLinkAboutInsurance Certificate: Standing Stone Brewery (2)
°RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY)
7/26/2013
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' o{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).
CONT: CT
NEAFaY a Deeming PRODUCER - -
- - -
Michael Ehrenfeld Company PHONE ; (760) 730-2939 FAX No%. (760)730-2936
2333 State Street, Suite 201 E-MAIL .fayed@ehrenfeldinsurance.com
INSURERS AFFORDING COVERAGE NAIC9
Carlsbad CA 92008 INSURERA:WeSt American Insurance Company 44393
INSURED INSURERB:Ohlo Security Insurance Company 4082
Standing Stone Brewery INSURERC:Ohlo Casualty Insurance Company 4074
101 Oak Street INSURERD:Nationwide Agribusiness 8223
1 INSURER E,
_ Ashland OR 97520 INSURER F:
COVERAGES CERTIFICATE NUMBER.CL1372638373 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 ADD SUBR POLICY EFF POLICY EXP UNITS
TR TYPE OF INSURANCE POUCYNUMBER JIM Iffla GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES lEa AMA T o nceS 1,000,000
A CLAIMS-MADE a OCCUR X KW1455665053 /24/2013 /24/2014 MED EXP are pmsm%) S 5,000
PERSONAL 6 ADV INJURY S- 1,000,000
GENERAL AGGREGATE . E . 2,000,000,
GEN'L AGGREGATE LIMIT APPLIES PER:,,, PRODUCTS -COMP/OP AGG 5'. 2 i 000.i 000
'POLICY - PRO- LOC - . _ . ' Lquor Liability 5 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMB accident) 1 000 000
B X ANY AUTO BODILY INJURY (Per person) 5
ALL OWNED SCHEDULED X 55665053 /24/2013 /24/2014 BODILY INJURY (Per accident) S
AUTOS NAUTOS
ON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS par lo $
abbam, Uninsured mWOnst combined $ 1,000,000
000
X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000
C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED X RETENTIONS 10,00 X 5055665053 /24/2013 /24/2014 $
WORKERS COMPENSATION WC STAN- OTH-
ANDEMPLOYERS'LIBILITY YIN
ANY PROPRIETORIPARTNER,EXECUTIVE❑ NIA E.L. EACH ACCIDENT $
OFFICERIMEMSER EXCLUDED?
(Mandamry In E.L. DISEASE - EA EMPLOYE $
e Yes, dssalbe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
D Farm Liability X PK7806334608 /24/2013 /24/2014 General Liability 124/2
Farm Umbrella PKFMN7806334608 0/30/2013 /24/2014 Umbrella 4,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remark, Schedule, N mom space Is mquimd)
The City of Ashland is Additional Insured as respects their interests
subject to policy terms, conditions and exclusions. RE:101 Oak Street,
89-93 Oak Street, Ashland, OR 97520 - - - -
RE:38 IE 32 IT 100, IE 33 Lot 200 Ashland, OR 97520 - 265 Acres for Farm Liability per attached GL form
CG8810 10/09 and Auto form CA8810 01/10. Additional Insured on Farm Liability per attached form FL706.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland - ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main Street
Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE
Royce Sheetz/FAMED
ACORD 25 (2010105) ®1988.2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
CG 88 11 10 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
. (Oregon)
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
SUBJECT PAGE
NON-OWNED AIRCRAFT 2
NON-OWNED WATERCRAFT 2
e
raas~ PROPERTY DAMAGE LIABILITY - ELEVATORS 2
25E4 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2
MEDICAL PAYMENTS EXTENSION 3
a EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 3
" ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 3
PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5
ADDITIONAL INSUREDS- EXTENDED PROTECTION OF YOUR °LIMITS OF INSURANCE" 5
WHO IS AN INSURED - INCIDENTIAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN INSURED - 6
FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 6
s FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7
d-
e KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7
LIBERALIZATION CLAUSE 7
s
° BODILY INJURY REDEFINED 7
EXTENDED PROPERTY DAMAGE 7
WAIVER OFTRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 7
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
020101.IbeM Mutual Insurance Company. All rights reserved.
CG 88 11 10 09 Includes copyrighted material 01 Insurance Services Office Inc., with its permission. Page 1 of 7
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by
the endorsement.
A. NON-OWNED AIRCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided:
1. It is not owned by any insured;
2. It is hired, chartered or loaned with a trained paid crew;
3. The pilot in command holds a currently effective certificate. Issued by the duly constituted authority of
the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It is not being used to carry persons or property for a charge.
However, the insurance afforded by this provision does not apply If there is available to the Insured other
valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically
in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under
this provision.
B. NON-OWNED WATERCRAFT
Under Paragraph 2. Exclusions of Section 1- Coverage A - Bodily Injury And Property Damage Liability,
Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or property for a charge;
C. PROPERTY DAMAGE LIABILITY - ELEVATORS
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property DamageLlabll-
Ity, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply it such p oPerty
damage' results from the use of elevators. For the purpose of this provision, elevators do no include
vehicle lifts. Vehicle rifts are lifts or hoists used In automobile service or repair operations.
2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other
Insurance, Paragraph b. Excess Insurance:
The Insurance afforded by this provision of this endorsement Is excess over any property insurance,
whether primary, excess, contingent or on any other basis.
? D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part:
1. Under Paragraph 2. Exclusions of Section I - Coverage A- Bodily Injury and Property Damage Liability:
$ a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow-
ing: _
Paragraphs (1), (3) and (4) of this exclusion do not apply to 'property damage', other than damage
by fire, lightning, explosion, smoke or leakage from automatic fire protection system) to:
(1) Premises rented to you for a period of 7 or fewer consecutive days; or
(11) Contents that you rent or lease as part of a premises rental or lease agreement for a period of
more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to 'property damage' to contents of
premises rented to you for a period of 7 or fewer consecutive days.
02010 uberty mutual insurance Company. All rights reserved.
CG 88 11 10 09 Includes copyrighted material of Insurance Services Office Inc., with Its permission. Page 2 of 7
A separate limit of insurance applies to this coverage as described in Section III - Limits of
Insurance.
b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage
from automatic fire protection systems to premises while rented to you or temporarily occupied by
you with permission of the owner. A separate limit of Insurance applies to Damage To Premises
Rented To You as described In Section III - Limits of Insurance.
m 2. Paragraph 6. under Section III - Limits of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of 'property damage' to:
G
a. Any one premise:
0
(1) While rented to you; or
(2) While rented to you or temporarily occupied by you with permission of the owner for
damage by fire, lightning, explosion, smoke or leakage from automatic protection sys-
tems; or
o b. Contents that you rent or lease as part of a premises rental or lease agreement.
As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU
ffig~ (Tenant's Property Damage). Paragraph 9.a. of Definitions Is replaced with the following:
l~
9.a. A contract for a lease of premises. However, that portion, of the contract for a lease of premises
that indemnities any person or organization for damage by fire; lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporarily
occupied by you with the permission of the owner, or for damage to contents of such premises
that are included in your premises rental or lease agreement, is not an 'Insured contract'.
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy
are amended as follows:
Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph
(b) of Paragraph a. Is replaced by the following:
(b) The expenses are Incurred and reported within three years of the date of the accident and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS • COVERAGES A AND B
1. Under Supplementary Payments - Coverages A and B, Paragraph 1.4. Is replaced by the following:
a
b. Up to $3,000 for cost of ball bonds required bemuse of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have
to fumish these bonds.
• 2. Paragraph 1.d. Is replaced by the following:
d. All reasonable expenses incurred by the Insured at our request to assist us In the investigation or
defense of the claim or 'suit', Including actual loss of earnings up to $500 a day because of time
oil from work.
G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section 11 - Who Is An Insured is amended to Include as an Insured any person or
organization whom you have agreed to add as an additional Insured in a written contract, written
agreement or permit. Such person or organization is an additional Insured but only with respect to
liability for 'bodily Injury', 'property damage' or 'personal and advertising injury' caused by:
02010 Liberty Mutual Insurance Company. Ali rights reserved.
CG 88 11 10 09 Includes copyrighted material of Insurance Services Office Inc., with Its permission. Page 3 of 7
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided that the 'bodily injury' or 'property damage' occurs, or the 'per-
sonal and advertising Injury' is committed, subsequent to the signing of such written contract or
written agreement; or
b. Premises or facilities rented by you or used by you; or
c. The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or
d. Operations performed by you or on your behalf for which the state or political subdivision has
Issued a permit subject to the following additional provisions:
(1) This Insurance does not apply to 'bodily Injury', "property damage', or 'personal and ad-
vertising Injury' arising out of the operations performed for the state or political subdivision;
(2) This insurance does not apply to 'bodily Injury' or 'property damage' Included within the
'completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this Insurance.
With respect to Paragraph 1.a. above, a person's or organization's status as an additional Insured
under this endorsement ends when:
(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(s) at the location 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 same project.
With respect to Paragraph t.b.above, a person's or organization's status as an additional Insured under
this endorsement ends when their written contract or written agreement with you for such premises or
facilities ends.
s
With respects to Paragraph 1.c. above, this insurance does not apply to any 'occurrence" which takes
place after the equipment rental or lease agreement has expired or you have returned such equipment
a to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement
Is signed prior to the "bodily Injury' or 'property damage'.
We have no duty to defend an additional insured under this endorsement until we receive written
notice of a "suit" by the additional Insured as required in Paragraph b. of Condition 2. Duties In the
Event Of Occurrence, Offense, Claim Or Suit under Section N - Commercial General Uablllty Condi-
tions.
2. With respect to the Insurance provided by this endorsement, the following are added to Paragraph 2.
Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Uabllity;
02010 Liberty Mutual Insurance Company. Ali rights reserved.
CG 88 11 10 09 Includes copyrighted material of Insurance Services Office Inc., with Its permission. Page 4 of 7
This insurance does not apply to:
a. 'Bodily injury' or 'property damage" arising from the sole negligence of the additional insured. .
b. "Bodily Injury" or "property damage" that occurs prior to you commencing operations at the
location where such "bodily Injury" or "property damage" occurs.
c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render-
ing of, or the failure to render, any professional architectural, engineering or surveying services,
including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications: or
-cam
~ (2) Supervisory, inspection, architectural or engineering activities.
t~
e d. "Bodily Injury" or "property damage" occurring after.
e (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(s) at the location of the covered operations has been completed; or
f~
(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 same project.
f~
e. Any person or organization specifically designated as an additional insured for ongoing operations
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is-
sued by us and made a part of this policy.
$ H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
This provision applies 10 any person or organization who qualifies as an additional Insured under any form
or endorsement under this policy.
Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend-
ed as follows:
a. The following is added to Paragraph a. Primary Insurance:
If an additional Insured's policy has an Other Insurance provision making its policy excess, and you
have agreed in a written contract or written agreement to provide the additional Insured coverage on a
primary and noncontributory basis, this policy shall be primary and we will not seek contribution from
the additional insured's policy for damages we cover.
a b. The following Is added to Paragraph b. Excess Insurance:
s
When a written contract or written agreement, other than a premises lease, facilities rental contract or
agreement, an equipment rental or lease contract or agreement, or permit Issued by a state or political
subdivision between you and an additional Insured does not require this insurance to be primary or
° primary and non-contributory, this Insurance is excess over any other insurance for which the addi-
tional Insured is designated as a Named Insured.
Regardless of the written agreement between you and an additional Insured, this Insurance is excess
over any other Insurance whether primary, excess, contingent or on any other basis for which the
additional insured has been added as an additional Insured on other policies.
1. ADDITIONAL INSUREDS- EXTENDED PROTECTION OF YOUR 'LIMITS OF INSURANCE"
This provision applies to any person or organization who qualifies as an additional Insured under any
form or endorsement under this policy.
1. The following Is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit:
02010 Liberty Mutual Insurance Company. Ali rights reserved.
CG 88 11 10 09 includes copyrighted material of Insurance Services Office Inc., with Its permission. Page 5 of 7
An additional insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence' or an offense, that may result in a claim or 'suit' under
this Insurance to us;
b. Tender the defense and Indemnity of any claim or 'suit' to all insurers whom also have
Insurance available to the additional insured; and
c. Agree to make available any other insurance which the additional insured has for a loss we
cover under this Coverage Part.
d. We have no duty to defend or indemnify an additional Insured under this endorsement until
we receive written notice of a'suir by the additional Insured.
2. The limits of Insurance applicable to the additional insured are those specified in a written contract
or written agreement or the limits of Insurance as stated In the Declarations of this policy and
defined in Section III - Limits of Insurance of this policy, whichever are less. These limits are
inclusive of and not in addition to the limits of insurance available under this policy.
J. WHO IS AN INSURED- INCIDENTIAL MEDICAL ERRORS/ MALPRACTICE
WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION- MANAGEMENT EMPLOYEES
Paragraph 2.a.(1) of Section II - Who Is An Insured is replaced with the following:
(1) 'Bodily Injury' or *personal and advertising injury":
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (H
you are a limited liability company), to a co-"employee" while in the course of his or her employ-
ment or performing duties related to the conduct of your business, or to your other 'volunteer
workers' while performing duties related to the conduct of your business;
(b) To the spouse, child, parent, brother or sister of that co-'employee' or "volunteer worker° as a
consequence of Paragraph (1) (a) above;
(c) For which there Is any obligation to share damages with or repay someone else who must pay
damages because of the injury described in Paragraphs (1) (a) or (b) above; or
(d) Arising out of his or her providing or failing to provide professional health rare services. However,
if you are not in the business of providing professional health care services or providing profes-
sional health care personnel to others, or if coverage for providing professional health care ser-
vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not
apply.
Paragraphs (a) and (b) above do not apply to "bodily Injury" or 'personal and advertising injury" caused by
an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means
the "employee's" job responsibilities assigned by you, Includes the direct supervision of other 'employ-
ees" of yours. However, none of these 'employees' are Insureds for 'bodily Injury' or "personal and
g advertising Injury" arising out of their willful conduct, which Is defined as the purposeful or willful intent to
" cause "bodily injury' or "personal and advertising Injury", or caused in whole or in part by their Intoxica-
tion by liquor or controlled substances.
a The coverage provided by provision J. Is excess over any other valid and collectable insurance available to
your 'employee".
K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
Paragraph 3. of Section 11- Who Is An Insured Is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
Interest, will qualify as a Named Insured if there is no other similar Insurance available to that
organization. However
a. Coverage under this provision is afforded only until the expiration of the policy period in
which the entity was acquired or formed by you:
b. Coverage A does not apply to 'bodily injury" or "property damage" that occurred before you
acquired or formed the organization; and
020101-lbeny Mutual Insurance Company. All rights reserved.
CG Ball loop includes copyrighted material of Insurance Services Office Inc., with its permission. Page 6 of 7
. I
COMMERCIAL AUTO
CA 88 10 01 10
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
o With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified
by the endorsement.
COVERAGEINDEX
PROVISION NUMBER
~ SUBJECT
" ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3
ACCIDENTAL AIRBAG DEPLOYMENT 12
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 18
AMENDED FELLOW EMPLOYEE EXCLUSION 5
AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13
BROAD FORM INSURED 1
BODILY INJURY REDEFINED 21
EMPLOYEES AS INSUREDS (Including employee hired auto) 2
EXTENDED CANCELLATION CONDITION 22
EXTRA EXPENSE - BROADENED COVERAGE 10
GLASS REPAIR- WAIVER OF DEDUCTIBLE 15
HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) 6
HIRED AUTO COVERAGE TERRITORY 20
LOAN / LEASE GAP 14
PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16
PERSONAL EFFECTS COVERAGE 11
PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8
RENTAL REIMBURSEMENT 9
SUPPLEMENTARY PAYMENTS 4
TOWING AND LABOR 7
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 19
SECTION 11 - LIABILITY COVERAGE Is amended as follows:
1. BROAD FORM INSURED
x
SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED Is amended to include
the following as an Insured:
d. Any legally Incorporated entity of which you own more than 50 percent of the voting stock
during the policy period. However, 'Insured' does not include any organization that:
(1) Is a partnership or joint venture: or
(2) Is an Insured under any other automobile policy; or
(3) Has exhausted Its Limit of Insurance under any other automobile policy.
Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in
excess of this policy.
e. Any organization you newly acquire or form, other than a partnership or joint venture, of which
you own more than 50 percent of the voting stock. This automatic coverage is afforded only for
180 days from the date of acquisition or formation. However, coverage under this provision
does not apply:
(1) It there is similar Insurance or asell-Insured retention plan available to that organization;
02010 Liberty Mutual Insurance Company. All rights reserved.
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