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HomeMy WebLinkAboutInsurance Certificate: Park Avenue Turf [:George Petersen Insurance Agency To:Renewal CertiFicates For Park Avenue TurF (15414885320) 13:23 12/30/13 EST P9 2-5 PARKAVE-01 SFRUSHOUR a►coao CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `Isa/ 1213012013 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: George Petersen Insurance Agency, Inc. PHOC AINE 800 236-9046 FAX P.G. B ox 3539 No E#: Ac No: 707 5254175 Santa Rosa, CA 95402 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICA INSURER A: Allied Insurance 42579 INSURED INSURER B: Pacific Compensation Insurance Company Park Avenue Turf, Inc. INSURER C P.O. BOX 2198 INSURER 0'. Sebastopol, CA 95473 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. ILTR POUCY EFF POLICY EXP UNITS TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDNYYY GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X FPK7815544318 04/08/2013 04/0812014 PREMISES Ea mcurrence S 100,00 CLAIMS-MADE OCCUR MED EXP(Any no pormn) E 5,0DD PERSONAL S ADV INJURY E 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG S 2,000,000 POLICY X PRO- LOC S AUTOMOBILE LIABILITY COMBINED 1 $ 1,000,000 A X ANY AUTO FPK7815544318 0410812013 04108/2014 BODILY INJURY (Per Pion) S ALL OWNED SCHEDULED BODILY IN.ILIRY(P., arri0ent) S AUTOS AUTOS NON-OWNED + S PER ACCIDENT E HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS -MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION X WCSTATU OTR AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPRIETORRPARTNERIEXECUTIVEY NIA A-000511-00 01101/2014 01/0112015 E.L. EACH ACCIDENT $ 1,000,000 OFFICE11MEMBER EXCLIIOED'+ 1-1 (Manaelory In NH) E.L. DISEASE - EA EMPLOYE S 1,000,000 If ycs dnsrriho Maier 00 000 DESCRIPTION OF OPERATIONS helnw E.L. DISEASE - POLICY LIMIT $ ,T I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace Is required) RE: Oak Knoll Golf Course - Proof of Coverage The city of Ashland, Oregon, and its elected officials, officers and employees are named as Additional Insured with respect to General Liability per form CG 71 57 08 04, attached. Cancellation wording applies per form IL 00 17 It 98, attached. 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. Attn: Karl Olson Purchasing Representative 90 N. Mountain Rd 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 :George Petersen Insurance Agency To:Renewal Certificates For Park Avenue TurF (15414885320) 13:22 12/30/13 EST Pg 1-5 Attached are the renewal certificates for Park Avenue Turf. Thank you, Shelley Frushour Certificate Manager George Petersen Insurance Agency .sfrushour@gpins.com www,gpins.com Phone: 707-525-2701 Fax: 707-546-4518 George Petersen Insurance Agency and its Affiliates Note: The information in this E-Mail message is confidential. It is intended solely for the use of the individual(s) named above. if you are the intended recipient, be aware that vour use of any confidential, proprietary and/or personal information may be restricted by state and federal privacy laws. If you are not the intended recipient, you should not distribute or forward this E-mail message. If you have received this E-mail in error, please immediately notify the sender and delete the material from any computer and/or server. :George Petersen Insurance Agency To:Renewal CertiFicates For Park Avenue TurF (15414885320) 13:25 12/30/13 EST Pg 5-5 IL0017 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation b. Give you reports on the conditions we find; 1. The first Named Insured shown in the Declara- and tions may cancel this policy by mailing or deliv- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any inspections, tion. surveys, reports or recommendations and any 2. We may cancel this policy by mailing or deliv- such actions we do undertake relate only to in- ering to the first Named Insured written notice surability and the premiums to be charged. We of cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of cancel- dertake to perform the duty of any person or lation if we cancel for nonpayment of pre- organization to provide for the health, or safety mium, or of workers or the public. And we do not warrant that conditions: b. 30 days before the effective date of cancel- lation if we cancel for any other reason. a. Are safe or healthful; or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known to standards. us. 3. Paragraphs 1, and 2. of this condition apply not 4. Notice of cancellation will state the effective only to us, but also to any rating, advisory, rate date of cancellation. The policy period will end service or similar organization which makes in- on that date. surance inspections, surveys, reports or rec- ommendations. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we 4. Paragraph 2. of this condition does not apply to cancel, the refund will be pro rata. If the first any Inspections, surveys, reports or recom- Named Insured cancels, the refund may be mendations we may make relative to certifica- less than pro rata. The cancellation will be ef- tion, under state or municipal statutes, ordi- fective even if we have not made or offered a nances or regulations, of boilers, pressure ves- refund. sels or elevators. 6. If notice is mailed, proof of mailing will be suffi- E. Premiums cient proof of notice. The first Named Insured shown in the Declara- B. Changes tions: This policy contains all the agreements between 1. Is responsible for the payment of all premiums; you and us concerning the insurance afforded. and The first Named Insured shown in the Declara- 2. Will be the payee for any return premiums we tions is authorized to make changes in the terms pay. of this policy with our consent. This policy's terms F. Transfer Of Your Rights And Duties Under This can be amended or waived only by endorsement Policy issued by us and made a part of this policy. Your rights and duties under this policy may not C. Examination Of Your Books And Records be transferred without our written consent except We may examine and audit your books and re- in the case of death of an individual named in- cords as they relate to this policy at any time dur- sured. ing the policy period and up to three years after- If you die, your rights and duties will be transferred ward. to your legal representative but only while acting D. Inspections And Surveys within the scope of duties as your legal represen- 1. We have the right to: tative. Until your legal representative is appointed, anyone having proper temporary custody of your a. Make inspections and surveys at any time; property will have your rights and duties but only with respect to that property. IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 :George Petersen Insurance Agency To:Renewal CertiFicates For Park Avenue TurF (15414885320) 13:24 12/30/13 EST Pg 4-5 CG 71 57 08 04 a. Primary Insurance When this insurance is excess over other This insurance is primary except when it is insurance, we will pay only our share of the excess as provided under part b., below. amount of the loss, if any, that exceeds the When this insurance is primary, we will not sum of: seek contribution from other insurance (1) The total amount that all such other in available to the person or organization surance would pay for the loss in the shown in the Schedule of this endorsement. absence of this insurance; and b. Excess Insurance (2) The total of all deductible and self- This insurance is excess over: insured amounts under all that other in- (1) Any of the other insurance, whether surance. primary, excess, contingent or on any We will share the remaining loss, If any, with other basis: any other insurance that is not described in (a) That is Fire, Extended Coverage, this Excess Insurance provision and was not Builder's Risk, Installation Risk e, bought specifically to apply in excess of the similar coverage for "your work"; Limits of Insurance shown in the Declara- tions of this Coverage Part. (b) That is Fire insurance for premises rented to you or temporarily occu- c. Method Of Sharing pied by you with permission of the owner, If all of the other insurance available to (c) That is insurance purchased by you the additional insured permits contribu- to cover your liability as a tenant for lion by equal shares, we will follow this "property damage" to premises method also. Under this approach each rented to you or temporarily occu- insurer contributes equal amounts until it pied by you with permission of the has paid its applicable limit of insurance or none of the loss remains, whichever owner; or comes first. (d) If the loss arises out of the mainte- If any of the other insurance available to nance or use of aircraft, "autos" or the additional insured does not permit watercraft to the extent not subject contribution by equal shares, we will to Exclusion g. of Section I - Cov- contribute by limits. Under this method, erage A - Bodily Injury And Prop- each insurer's share is based on the ra- erty Damage Liability do of its applicable limit of insurance to When this insurance is excess, we will have the total applicable limits of insurance of no duty under Coverages A or B to defend all insurers. the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the addi- tional insured's rights against all those other insurers. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 Includes copyrighted material of ISO Properties. Inc., with its permission. - CG 71 57 08 04 :George Petersen Insurance Agency To:Renewal CertiFicates For Park Avenue TurF (15414885320) 13:23 1Z/30/13 tsl Pg 3-b COMMERCIAL GENERAL LIABILITY CG 71 57 08 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION CONTRACT PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to 1. "Bodily injury", "property damage" or "personal include as an additional insured any person or or- and advertising injury" arising out of the ren ganization for whom you are performing opera- dering of, or the failure to render, any profes- tions when you and such person or organization sional architectural, engineering or surveying have agreed in a written contract that such person services, including: or organization be added as an additional insured a. The preparing, approving, or failing to pre- on your policy. Such person or organization is an pare or approve, maps, shop drawings, additional insured only with respect to liability for opinions, reports, surveys, field orders, "bodily injury", "property damage" or "personal and change orders or drawings and specifica- advertising injury" caused, in whole or in part, by: tions; or 1. Your acts or omissions; or b. Supervisory, inspection, architectural or 2. The acts or omissions of those acting on your engineering activities. behalf; 2. "Bodily injury" or "property damage" occurring in the performance of your ongoing operations after: for the additional insured. a. All work, including materials, parts or A person's or organization's status as an addi- equipment furnished in connection with tional insured under this endorsement ends such work, on the project (other than ser- when your operations for that additional in- vice, maintenance or repairs) to be per- sured are completed. formed by or on behalf of the additional in- No such person or organization is an addi- sured(s) at the location of the covered tional insured for liability arising out of the operations has been completed; or , 'products-completed operations hazard". b. That portion of "your work" out of which the injury or damage arises has been put to its intended B. The following is added to SECTION III -LIMITS use by any person or organization other than another contractor or subcon- OF INSURANCE: tractor engaged in performing operations The limits of insurance applicable to the additional for a principal as a part of the same project. insured are those specified in the written contract D. With respect to the insurance afforded to these between you and the additional insured, or the lim- additional insureds, Condition 4. Other Insur- its available under this policy, whichever are less. ance is replaced by the following: These limits are part of and not in addition to the limits of insurance under this policy. 4. Other Insurance If other valid and collectible insurance is avail- abl C. With respect to the insurance afforded to these e to the insured for a loss we cover under additional insureds, the following additional exclu- Coverages o of this Coverage Part, our obligations are limited as follows: sions apply: This insurance does not apply to: CG 71 57 08 04 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 2