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HomeMy WebLinkAboutInsurance Certificate: Integrity Pest & Home Repair CERTIFICATE OF LIABILITY INSURANCE D"Tsis/ o,D4 YY) 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 TE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE THE R(S), HE POLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poilcy(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 Centralized Service Unit NAME: Commercial Lines - (415) 541-7900 PHONE ~ FAX .(A/C, No, EXt): 4'I5-541-7900 INC, No): 866-930-6996 Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 E-MDAIL sanfrancisco.certs@wellsfargo.com 45 Fremont Street, Suite 800 INSURER(S)AFFORDING COVERAGE NAILO San Francisco, CA 94105-2259 INSURERA: Impenum Insurance Company 35408 INSURED INSURER B : Randall Baldwin dba Integrity Pest & Home Repair NSURER C 548 Hogan Avenue INSURER D: INSURER E : Medford OR 97504 INSURER F COVERAGES CERTIFICATE NUMBER: 7805934 REVISION NUMBER: See below 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 AODL BURR YIYYYYTMMIDDIYYEXP YY LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD A X COMMERCIALGENERALLABILITY IICGLO180700 8/12/2013 8/12/2014 EACH OCCURRENCE $ 1,000.000 F-v -1 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occugwm f 100,000 MED EXP (Any one person) f 5,000 PERSONAL S ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f 2,000,000 X POLICY ❑ JECT LOC PRODUCTS-COMP/OP AGG f 2.000.000 OTHER: f AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f (Ea awident)- ANY AUTO _ BODILY INJURY (Per person) S ALL OWNED H SCHEDULED BODILY INJURY (Par accidem) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE f HIRED AUTOS AUTOS (Per=Id.M $ UMBRELLA LAB OCCUR EACH OCCURRENCE f EXCESS LAB CLAIMS-MADE AGGREGATE f DED RETENTIONS f A WORKERS COMPENSATION IIC-WC-00255-01 06112J2014 06I12I2015 X STATUTE ERH _ AND EMPLOYERS'LABILffY YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S _ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NN) E.L. DISEASE - EA EMPLOYEE f 1,000,000 If yes, describe uMer 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT f I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUonal Remarks Schedule, may Ine attached If more space Is required) City of Ashland is included as additional insured per blanket policy endorsement. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E. Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 ' AUTHORIZED REPRESENTATNE The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) I VIII I I II I III II II II I II I IIII II ( II II (II II II I I II II II I III -CYBDPBe~.Ja000p5D]AlrayaLe' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY DECLARATION In addition to words and phrases contained in the III. Commercial General Liability Coverage Form, other words and phrases that appear in quotation marks have special meaning. Refer to Paragraph VII. DEFINITIONS of this endorsement. For the purposes of the coverage provided by this endorsement these definitions apply in place of their definitions stated elsewhere in the policy. The following provisions apply only with respect to the coverage provided by this endorsement. However, the coverage expansions provided throughout this endorsement do not apply if coverage is excluded either by the provisions of the Coverage Part or by endorsement. 1. COVERAGE A (Bodily Injury and Property B. The limit for loss of earnings is increased Damage) from $100 a day to $500 a day. A. Non-Owned Watercraft WHO IS AN INSURED Paragraph 2.g. (2)(a) of Section I- A. Paragraph 2. Under Section II is Coverage A is replaced with the expanded to include the following: following: 1. Additional Insured by Contract, (a) Less than 51 feet long; and Agreement or Permit B. Property Damage Extension Any person(s) or organization(s) is The following is added to Exclusion j. an additional insured when you have agreed, in a written contract, written 1. Borrowed Equipment agreement or because of a permit issued by a state or political Paragraph (3) and (4) of this subdivision, that such person(s) or exclusion does not apply to "property organization(s) be added as an damage" to borrowed equipment additional insured on your policy, while not being used to perform provided the injury or damage occurs operations at the job site. subsequent to the execution of the contract or agreement. 2. Elevators The following is added to Exclusion j. A person or organization is an additional insured under this Paragraph (3) and (4) of this provision only for that period of time exclusion does not apply to "property required by the contract or damage" arising from the use of agreement. elevators. However, no such person or If. SUPPLEMENTARY PAYMENTS- organization is an insured under this COVERAGES A AND B provision if such a person or organization is included as an In the Supplementary Payments- Coverage insured by an endorsement issued A and B: by us and made part of this Coverage Part. A. The limit for the cost of bail bonds is increased from $250 to $1,000; and IICGL50040410 1of7 40052 II II II I III I II VIII II II III II VIII II IIIIIIIII II II III III 'CYB02BOYDOBWSN]gBlYM19N' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. a. Vendors any other thing or substance by or for the vendor. Any person(s) or organization(s) (h) "Bodily Injury" or "Property (referred to herein as vendor) with whom Damage" arising out of the sole you agreed, because of a written contract negligence of the vendor for its or agreement to provide insurance, but own acts or omissions or those only with respect to "bodily injury" or of its employees or anyone else "property damage" arising out of "your acting on its behalf. However, products" which are distributed or sold in this exclusion does not apply to: the regular course of the vendor's (i) The exceptions contained in business, subject to the following contained in Subparagraphs(d) additional exclusions: or (f); or (ii) Such inspections, adjustments, (1) The insurance afforded the vendor tests or servicing as the vendor does not apply to: has agreed to make or normally (a) "Bodily injury" or "property undertakes to make in the usual damage" for which the vendor is course of business, in connection obligated to pay damages by with the distribution of sale of the reason of the assumption of products. liability in a contract or agreement. This exclusion does (2) Any insured person or organization, not apply to liability for damages from whom you have acquired such that the vendor would have in products, or any ingredient, part or the absence of the contract or container, entering into, agreement: accompanying or containing such (b) Any express warranty products. unauthorized by you; (c) Any physical or chemical b. Lessors or Equipment change in the product made intentionally by the vendor; (1) Any person(s) or organization(s) from (d) Repackaging, unless unpacked whom you lease equipment; but only solely for the purpose of with respect to liability for "bodily inspection, demonstration, injury", "property damage" or testing, or substitution of parts "personal and advertising injury" under instructions from the caused, in whole or in part, by your manufacturer, and then maintenance, operation or use of repackaged in the original equipment lease to you by such container: person(s) or organization(s). (e) Any failure to make such inspections, adjustments, tests (2) With respect to the insurance or servicing as the vendor has afforded to these additional insureds, agreed to make or normally this insurance does not apply to any undertakes to make in the usual "occurrence" which takes place after course of business, in the equipment lease expires. connection with the distribution or sale of the products; c. Lessors of Land or Premises (f) Demonstration, installation, services or repair operations, Any person(s) or organization(s) from except such operations whom you lease land or premises, but performed at the vendor's only with respect to liability arising out of premises In connection with the the ownership, maintenance or use of sale of the products; that part of the premises leased to you; (g) Products which, after distribution and subject to the following additional or sale by you, have been exclusions: labeled or relabeled or used as a container, part or ingredient of This insurance does not apply to: IIC GL 50 04 04 10 2of7 (VIII IIIIIIIIIIIII IIII III II III IIIIIIIIIIII II VIII •creazeosooooosm~memrono• THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. political subdivision has issued a permit or (1) Any "occurrence" which takes place authorization. after you cease to be a tenant in that premises. The insurance does not apply to: (2) Structural alterations, new construction (1) "Bodily injury", "property damage" or or demolition operations performed by "personal and advertising injury" arising or on behalf of such person or out of operations performed for the organization. federal government, state or municipality; or d. Architects, Engineers or Surveyors (2) "Bodily injury" or "property damage" (1) Any architect, engineer, or surveyor included within the "products completed engaged by you but only with respect operations hazard". to liability for "bodily injury" "property damaged" or "personal and advertising f. Any Other Party injury" caused, in whole or in part, by your acts or omissions or the acts or Any other person(s) or organization(s) who omissions of those acting on your is not an insured under Paragraph a. through behalf: e. above, but only with respect to liability for "bodily injury", "property damaged" or (a) In connection with your premises; "personal and advertising injury" caused, in or whole or in part, by your acts or omissions or (b) In the performance of you ongoing the acts or omissions of those acting on your operations behalf: (2) With respect to the insurances afforded (1) In the performance of your ongoing to these additional insureds, the operations; following additional exclusion applies: (2) In connection with your premises owned This insurance does not apply to by or rented to you; or "bodily injury" or property damage" or "personal and advertising injury" arising - (3) In connection with "your work." and out of the rendering of or the failure to included within the "products completed render any professional services by or operation hazard", but only if: for you, including: (a) The written contract or agreement (a) The preparing, approving, or failing requires you to provide such a to prepare or approve, maps, shop coverage to additional insureds; and drawings, opinions, reports, (b) The Coverage Part provides surveys, field orders, change coverage for "bodily injury" or orders or drawings and "property damage" included within specifications; or products-completed operations (b) Supervisory, inspection, hazard". architectural or engineering activities. With respect to the insurance afforded to these additional insureds, this coverage does e. Permits Issued By State or Political not apply to: Subdivisions "Bodily injury", "property damage" or "personal Any state or governmental agency or and advertising injury" arising out of the subdivision or political subdivision by only rendering of, or failure to render, any with respect to operations performed by you professional architectural, engineering or or on your behalf for which the state or surveying services, including: governmental agency or subdivision or IIC GL 50 04 04 10 3of7 "oW" IIII IIIII VIII I II II I I II II II IIII I IIIIIII I II IIIIII IIIII I VIII I II II •creoxaasroooaasmsmewomm THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. (1) The preparing, approving, or filing to prepare or approve, maps, shop Paragraph 6. Of Section III - Limits Of drawings, opinions, reports, surveys, Insurance is replaced with the following: field orders, change orders or drawings and specifications; or 6. Subject to Paragraph 5. Above, the Damage To Premises Rented To You Limit is. (2) Supervisory, inspections, architectural the most we will pay under Coverage A for or engineering activities. damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or The limit of insurance that apply to temporarily occupied by you with permission of additional insureds under this extension is the owner. described in Section III - Limits of insurance. The most we will pay in any one "occurrence" is the higher of the following: How this Insurance applies when other insurance is available to the additional (a) $300,000; or insured is described in the Other Insurance (b) The amount shown in the Declarations Condition in Section IV - Commercial for Damages to Premises Rented to You Limit. General Liability Conditions. B. Medical Payments 2. Subsidiaries Paragraph 7. Of Section III - Limits Of Any subsidiary and subsidiary thereof, Insurance is replaced with the following: of yours which is a legally incorporated entity of which is a legally incorporated 7. Subject to Paragraph S. Above, the entity of which you own a financial Medical Expense Limit is the most we will interest of more than 50% of the voting pay under Coverage C for all medical stock on the effective date of the expenses because of 'bodily injury' Coverage Part. The insurance afforded sustained by any one person. herein for any subsidiary not named in this Coverage part as a named insured The most we will pay because for "bodily does not apply to injury or damage with injury" sustained by any one person is respect to which an insured under this the higher of the following; Coverage Part is also an insured under another policy or would be an insured (a) $10,000; or under such policy but for its termination (b) The amount shown in the or the exhaustion of its limits of Declarations for Medical Expense Limit. insurance. V. SECTION IV- COMMERCIAL GENERAL 3. Newly formed Or Acquired LIABILITY CONDITIONS Organizations The following items are amended: In Paragraph 3.a. of Section II -Who Is An Insured, is increased from 901n A. Duties In The Event Of Accident, Claim, day to 180'" day. Suit Or Loss However, this expansion does not The following items are added to Paragraph 2. apply if coverage for newly formed or Of Section IV- Commercial General Liability acquired organizations is excluded Conditions: either by the provisions of the Coverage Part or by endorsement. e. Additional Insurance Other Insurance IV. LIMITS OF INSURANCE If we cover a claim or "suit" under this Coverage Part that may also be covered A. Damage to Premises Rented To You by other insurance available to an IICGL50040410 4of7 VIII VIII I IIII IIII IIII IIIIIII III II IIIIII III II III III IIIIII IIII •CYBD3BWi900005N6A&U9N9' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. additional insured, such additional If the loss arises out of "property damage" insured must submit such claim or "suit" to borrowed equipment or the use of to the other insurer for defense and elevators to the extent not subject to indemnity. Exclusion j. of Section I - Coverage A - Bodily Injury And Property Damage However, this provision does not apply to Liability; the extent that you have agreed in a written agreement that this insurance is (b) When You Are Added As An Additional primary and non-contributory with the Insured To Other Insurance additional insured's own insurance. Any other insurance available to you f. Knowledge Of An Occurrence, covering liability for damages arising out of Offense, Claim or Suit the premises or operations, or products and completed operations, for products and Paragraph a. and b. apply to you or to completed operations, for which you have any additional insured only when such been added as an additional insured by "occurrence", offense, claim or "suit" is that insurance; or known to: (c) When You Add Others As An Additional (1) You or any additional insured that is an Insured To This Insurance individual; Any other insurance available to an (2) Any partner, if you or an additional additional insured. insured is a partnership; However, the following provisions apply to (3) Any manager, if you or an additional other insurance available to any person or insured is a limited liability company; organization who is an additional insured under this coverage part. (4) Any "executive officer" or insurance manager, if you or an additional insured I. Primary Insurance When Required is a corporation; By Contract (5) Any trustee, if you or an additional - This insurance is primary it you have insured is a trust; or agreed in a written contract or written agreement that this insurance be (6) Any elected or appointed official, if you primary. If other insurance is also or an additional insured is a political primary, we will share with all that subdivision or public entity. other insurance by the method described in c. Method of Sharing, in This duty applies separately to you and any the policy. additional insured. ii. Primary And Non-Contributory To B. Other Insurance Other Insurance When Required By Contract The following items are added to paragraph 4.b. of Section IV - Commercial General If you have agreed in a written Liability Conditions: contract, written agreement, or permit that this insurance is primary and non- (1) This insurance is excess over any of the contributory with the additional other insurance, whether primary, insured's own insurance, this excess, contingent or on any other basis; insurance is primary and we will not seek contribution from that other (a) Property Damage to Borrowed insurance. Equipment or Use of Elevators Paragraphs a. and b. do not apply to other insurance to which the IIC GL 50 04 04 1.0 5of7 omou IIIIIII I I III I II I IIIII IIIII IIII VIII III II I IIIII II I II II I III VIII IIII III •creoseowoaoosuiAS.womro- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. additional insured has been added as an additional insured. VI. DEFINITIONS A. Amended Definitions C. Representations 1. Advertisement Paragraph 6. Of Section IV - Commercial General Liability Conditions is replaced with the The following is added to the definition of following: "advertisement". a. When You Accept This Policy However, 'advertisement" does not include: By accepting this policy, you agree: The design, printed material, information (1) The statements in the Declarations are or images contained in, on or upon the accurate and complete; packaging or labeling of any goods or products; or (2) Those statements are based upon representation you made to us; and An interactive conversation between or among persons through a computer (3) We have issued this policy in reliance network. upon your representations. 2. Coverage Territory b. Unintentional Failure to Disclose Hazards Final paragraph in the definition of "coverage territory" is replaced by the If you unintentionally fail to disclose any following: hazards existing at the inception date or your policy, we will not deny coverage Provided the insured's responsibility to under this Coverage Part because of pay damages is determined in the United such failure. However, you must report States of America (including its territories such error or omission to us as soon as and possessions), Puerto Rico or practicable after its discovery. - - Canada, in a "suit" on the merits according to the substantive law in such D. Transfer Of Rights OF Recovery Against territory or in a settlement we agree to. Others To Us 3. Insured Contract Paragraph 8. Of Section IV - Commercial General Liability Conditions is replaced with the (1) Paragraph a. in the definition of following: "insured contract" is replaced by the following: If the insured has rights to recover all or part of any payment we have made under this A contract for a lease of premises. Coverage Part, those rights are transferred to However, that portion of the contract us. The insured must do nothing after loss to for a lease of premises while rented impair them. At our request, the insured will to you or temporarily occupied by bring "suit" or transfer those rights to us and you with permission of the owner is helps us enforce them. subject to the Damage to Premises Rented To You Limit described in However, we waive any right of recovery we Section III- Limits of Insurance; may have against any person or organization to the extent required of you by a written contract (2) The First paragraph of Paragraph f. executed prior to any "occurrence" or "suit" in the definition of "insured contract" arises out of operations contemplated by such is replaced by the following: contract. The waiver applies only to the person or organization designated in such contract. IIC GL 50 04 04 1.0 6of7 oo~s~ IIIIIIII II VIII IIIIIII VIII II (IIIII VIIIII II (IIIII VIIIII VIII (IIIII 'CY802905~D000D5A8N8A - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. That part of any other contract or agreement pertaining to your (1) Equipment, of at least 1,000 pounds business (including an gross vehicle weight, designed indemnification of a municipality in primarily for: connection with work performed for a municipality) under which you 5. Personal and Advertising Injury assume the tort liability of another party to pay for "bodily injury" or Paragraph f. in the definition of "personal property damage" to a third person and advertising injury" is replaced by the or organization, provided the "bodily following; injury" or "property damaged" is caused, in whole or in part, by you or f. Copying, in your "advertisement", a by those acting on your behalf. Tort person's or organization's "advertising liability means a liability that would idea" or style of "advertisement". be imposed by law in the absence of any contract or agreement. B. Added Definitions 4. Mobile Equipment "Advertising idea" means any idea for an "advertisement" Paragraph f. (1) in the definition or "mobile equipment" is replaced by the following: IICGL50040410 7of7 moss 1111111111111111111111 IN IIIIII11111111111111111111IIIIIIIII11111111 CY90tl05WOP5O9g9NPbN• Commercial Lines - (415) 541-7900 Wells Fargo Insurance Services USA, Inc. - CA Lic#: 0 45 Fremont Street, Suite 800 San Francisco, CA 94105-2259 City of Ashland 20 E. Main Street Ashland, OR 97520 lfffffMfRf1f11ffRRRfRRRfRRRRRIRRRRRRRRRRffYRR,lfleffRRRRRflRR1ff11ffR11f11fRff1RRRRRRRRIRRfRRRf11f11f RRRfffRRRRfflfff Would you like to receive this certificate via email or fax? We offer expedited delivery to better serve our mutual clients. To update the delivery method for revisions to this certificate and for next year's copy, please enter this information in your browser: https://www.cybersure.com/cybersure/forms/iyoc/cdmu.aspx When prompted, enter this information for security purposes: Client ID: 158327 Cert ID: 7805934 Passcode: ClBB7552 Follow the instructions and let us know your delivery preference. You'll receive future copies of this certificate via the method you provide. Thank you for helping us provide certificates to you more quickly. 1^\ (E G ~ a IV F. xIRfRIfRRRxxRRR11RRRRRxxxllxRRlfxfRRfxffRfifRR1ff11ffff11fff1flfRRfffffffRRRffxRlRRf1f1RRR1fRRf #f{ U JUN 1 2 2014 IIII III II III II IIIIIIIIIII II II III VIII II IIIIII II II II III IIIIIII II II 'CYB03BOSN000OSNINBMYIQ9'