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HomeMy WebLinkAboutInsurance Certificate: Chown Inc (3) Paxserver 6/24/2014 6:00:23 PM PAGE 2/012 Fax Server Client: 325772 CHOWNINC ACORD,r CERTIFICATE OF LIABILITY INSURANCE ar 06124/2014 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 pollcy(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 NAME' Bambi Brown, CIC, CRM USI Northwest CLt A",g,"H, .503.295.8312 nK, Ne: 610.362.8189 700 NE Multnomah, Suite 1300 ADDRESS: bambi.brown@usi.biz Portland, OR 97232 INSURER(S) AFFORDING 503 224-8390 INSURER A:Massachhuse usetts Bay Insurance s Bay InsuCOVERAGE Nacs Corn 22306 INSURED INSURER 6: Hanover Insurance Company 31534 Chown, Inc. INSURER C Allmerica Financial Benefit 41840 P O Box 2886 Portland, OR 97208 INSURER D: 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 WFTi 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. LT RR TYPEOFINSURANCE PDOL us POLICY NUMBER MMNOM'Y MM,OdY1' P LIMITS IINISIR A GENERAL LIANUTY ZDF2904844003 3/0112014 03/011201 EuCH OCCURRENCE $1100-01000 X COMMERCIAL GENSIAL LIABILITY pI w~0 s100000 CLMMS-MADE Fx1 OCCUR NED E%P aM p.ICOn 15 00D X WA Stop Gap Included PERSONALSADV INNR/ $1000,000 GENERA-AGGREGATE s2000000 GENT AGGREGATE LIMITAPPUESPER: PRODUCTS-CDMPOPAGG 62,000,000 X POLICY PRO LOC s C AUTOMOBILE UABILITY AW2904849803 310112014 03101120 16 COMBINED SINGLE UNIT 1,000,000 (Eii X ANY AUTO BODILY IN.URY (Px p.ea0n) s ALLONNm SCHEDULED eOULYINJURY(P.r..sdmd) S PROPERTY DAMAGE s X HIIREDAUros X NON-0"m AUTOG AUTOS > 5 B X umm""AUAB X OCCUR UH2900898603 310112014 031011201 EAcN occuR ENcE $5000000 EXCESS LIAR CVdMSMAOE AGGREGATE $5,000,000 DED X RETENTION SO $ WORKERS COMPENSATION VIC STATU- OTH- DEMPLOYERS-LIASILITY YIN ANY PROPRI RIPARTNEIVEXECUTVE ELEACHAOoDDIT 5 OFFICEtRAENB EXCLUm N I A (Mandatory in NH) EL.DLSEASE-EAEMPLOYEE $ - N Sdve. und.r DCRIPTON OF OPERATIONS W. ELDIPEA.E-POLICYLIMIT S DESCRIPTION OF OPERATIONS ILOCATIONS IVESICLES(Attach ACOND 101, Additional Remm%. Sehedule, If mort ep..Il requrtd) Re: Parks restroom door and security lock replacement project for select restrooms at various parks throughout the City. The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement (42100800103 and CA2048) that provides Additional Insured status to the Certificate Holder, Oregon and its elected officials, officers and employees, only when there is a written contractthat requires such status, (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ,.6 C) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S12757433/M11795203 ADVZP Faxserver 6/24/2014 6:00:23 PM PAGE 3/012 Fax Server DESCRIRTIONS!(Continued from Pagel) and only with regard to work performed on behalf of the named insured. The General Liability policy contains a special endorsement (42104520607) with Primary and Noncontributory wording. A 30 day notice of cancellation applies ( 10 days for non-payment of premium) to the Named Insured. SAGITTA 25.3 (2010/05) 2 of 2 #5127574331M11795203 Faxserver 6/24/2014 6:00:23 PM PAGE 4/012 Fax Server THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: . COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit Included 2. Additional Insured - Broad Form Vendors Included 3. Aggregate Limit per Location Included 4. Alienated Premises Included 5. Bodily Injury Redefined Included 6. Broad Form Property Damage - Borrowed Equipment, Customers Goods & Included Use of Elevators 7. Extended Property Damage Included 8. Incidental Malpractice (Employed nurses, EMT's & paramedics) Included 9. Knowledge of Occurrence Included 10. Liberalization Clause Included 11. Medical Payments - Increased Limit $ 10,000 12. Mobile Equipment Redefined Included 13. Newly Acquired or Formed Organizations - Covered until end or policy period Included 14. Non-owned Watercraft 51 ft. 15. Personal Injury- Broad Form Included 16. Product Recall Expense - Each Occurrence Limit $ 25,000 -Aggregate Limit $ 50,000 17. Property Damage Legal Liability (Fire, Lighting, Explosion, Smoke or Leakage Damage) $500,000 18. Supplementary Payments Increased Limits - Bail Bonds $ 2,500 - Loss of Earnings $ 300 °79. Unintentional Failure to Disclose Hazards Included 20. Unintentional Failure to Notify Included This endorsement amends coverages provided under the Commercial General Liability Coverage Form through new coverages, higher limits and broader coverage grants. 1. Additional Insured by Contract, Agreement or (2) Premises you own, rent, lease or occupy. Permit This insurance applies on a primary basis if Under Section II - Who Is An Insured, Paragraph 5. that is required by the written contract, written is added as follows: agreement or permit. 5. a. Any person or organization with whom you b. This provision does not apply: agreed, because of a written contract, written (1) Unless the written contract or written agreement or permit to provide insurance, is agreement has been executed or permit an insured, but only with respect to: has been issued prior to the "bodiy injury', (1) 'Your work' for the additional insured(s) property damage°, "personal injury" or at the location designated in the contract, advertising injury'. agreement or permit; or Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Service Office, Inc. 1998 421-0080 (01/03) Page 1 of 6 Faxserver 6/24/2014 6:00:23 PM PAGE 5/012 Fax Server (2) To any person or organization included as (4) Repackaging, unless unpacked solely for an insured by an endorsement issued by the purpose of inspection, demonstration, us and made part of this Coverage Part. testing, or the substitution of parts under (3) To any person or organization included instruction from the manufacturer, and as an insured under item 2 of this then repackaged in the original container; endorsement. (5) Any failure to make such inspection, ad- (4) To any lessor of equipment: justments, tests or servicing as the vendor has agreed to make or normally (a) After the equipment lease expires; or undertakes to make in the usual course (b) If the "bodily injury, 'property dam- of business in connection with the sale of age", "personal injury" or "advertising the product; injury arises out of sole negligence (6) Demonstration, installation, servicing or of the lessor. repair operations, except such operations (5) To any. performed at the vendor's premises in (a) Owners or other interests from whom connection with the sale of the product; land has been leased which takes (7) Products which, after distribution or sale place after the lease for the land ex- by you, have been labeled or relabeled or pires; or used as a container, part or ingredient of (b) Managers or lessors of premises if: any thing or substance by or for the vendor. (I) The occurrence takes place after c. This insurance does not apply to any insured you cease to be a tenant in that premises; or person or organization, from whom you have acquired such products, or any ingredient, (it) The "bodily injury, "property part or container, entering into, accompany- damage", 'personal injury or ing or containing such products. "advertising injury" arises out of structural alterations, new con- 3. Aggregate Limit Per Location struction or demolition operations performed by or on behalf of the (1) Under Section III - Limits of Insurance the manager or lessor. General Aggregate Limit applies separately to each of your "locations" owned by or rented to 2. Additional Insured-Broad Form Vendors You. Under Section II - Who Is An Insured, Paragraph 6. (2) Under Section V - Definitions, definition 23. is is added as follows: added as follows: 6. a. Any person or organization with whom you 22. "Location" means premises involving the ,agreed, because of a written contract or same or connecting lots, or premises whose written agreement to provide insurance, but connection is interrupted only by a street, only with respect to "bodily injury" or "property roadway, waterway or right-of-way of a rail- damage' arising out of 'your products' which road. are distributed or sold in the regular course of the vendor's business, subject to the 4. Alienated Premises following additional exclusions: Under Section I - Coverage A, paragraph 2. Exclu- b. The insurance afforded the vendor does not sions, J. (2) is replaced in its entirety with the apply to: following: (1) 'Bodily injury' or 'property damage" for (2) Premises you sell, give away or abandon, if the which the vendor is obligated to pay dam- "property damage" arises out of any part of those ages by reasons of the assumption of li- premises and occurred from hazards that were ability in a contract or agreement. This known by you, or should have reasonably been exclusion does not apply to liability for known by you, at the time the property was damages that the insured would have in transferred or abandoned. the absence of the contract or agreement; (2) Any express warranty unauthorized by 5. Bodily Injury Redefined you; Under Section V - Definitions, definition 3. "bodily (3) Any physical or chemical change in the injury" is replaced in its entirety with the following: product made intentionally by the vendor, Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Service Office, Inc. 1998 421-0080 (01103) Page 2 of 6 Faxserver 6/24/2014 6:00:23 PM PAGE .6/012 Fax Server 3. "Bodily injury" means bodily injury, sickness or 9. Knowledge of Occurrence disease sustained by a person. This includes Under Section IV - Commercial General Liability mental anguish, mental injury, shock, fright or Conditions, Condition 2 - Duties in the Event of death resulting from "bodily injury", sickness or Occurrence, Offense, Claim or Suit, paragraph e. is disease. added as follows: 6. Broad Form Property Damage Borrowed e. Notice of an 'occurrence", offense, claim or "suit" 9e - will be considered knowledge of the insured if Equipment, Customers Goods, Use of Elevators reported to an individual named insured, partner, (1) Under Section 1 - Coverage A, paragraph 2. executive officer or an 'employee' designated by Exclusion J. Is amended as follows: you to give us such a notice. Paragraph (4) does not apply to 'property dam- age" to borrowed equipment while at a jobsite 10. Liberalization Clause and not being used to perform operations. Under Section IV - Commercial General Liability Paragraphs (3), (4) and (6) do not apply to Conditions, condition 10. is added as follows: .property damager to "customers goods" while on 10. Liberalization Clause your premises nor do they apply to the use of elevators at promises you own, rent, lease or If we adopt any revision that would broaden the occupy coverage under this Coverage Form without (2) Under Section V -Definitions, definition 24. is additional premium, within 45 days prior to or during the policy period, the broadened added as follows: coverage will immediately apply to this 23. "Customers goods" means property of your Coverage Part. customer on your premises for the purpose of being: 11. Medical Payments- Increased Limits a. worked on; or (1) Under Section 1 - Coverage C, paragraph a. b. used in your manufacturing process. (2) is replaced in its entirety by the following: (3) The insurance afforded under this provision is (2) The expenses are incurred and reported to excess over any other valid and collectible prop- us within three years of the date of the erty insurance (including deductible) available to accident; and the insured whether primary, excess, contingent (2) Under Section III - Limits of Insurance, or on any other basis. paragraph T. is replaced in its entirety by the following: 7. Extended Property Damage 7. Subject to 5. above, the higher of: Under Section I - Coverage A, paragraph 2. a. $10,000; or Exclusions, Exclusion a. is replaced in its entirety, with the following: b. The amount shown in the Declarations for Medical Expense Limit is the most a. 'Bodily injury' or 'property damage' expected or we will pay under Coverage C for all intended from the standpoint of the insured. This medical expenses because of 'bodily exclusion does not apply to "bodily injury' or injury' sustained by one person. "property damage" resulting from the use of reasonable force to protect persons or property. (3) This coverage does not apply if Coverage C - Medical Payments is excluded either by the 6. Incidental MalpracUce - Employed Nurses, EMT's provisions of the Coverage Part or by and Paramedic; endorsement. Under Section 11 - Who Is An Insured, paragraph 12. Mobile Equipment Redefined 2.a.(1)(d) does not apply to a nurse, emergency medical technician or paramedic employed by you if Under Section V - Definitions, definition 12, you are not engaged in the business or occupation of Mobile Equipment, paragraph f.(1)(a)(b)(c) does providing medical, paramedical, surgical, dental, x-ray not apply to self-propelled vehicles of less than or nursing services. 1,000 pounds gross vehicle weight. 13. Newly Acquired Or Formed Organizations Under Section li - Who Is An Insured, paragraph 4.a. is replaced in its entirety by the following: Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Service Office, Inc. 1998 421-0080 (01/03) Page 3 of 6 Faxserver 6/24/2014 6:00:23 PM PAGE 7/012 Fax Server a. Coverage under this provision Is afforded only repair, replacement, adjustment, removal until the end of the policy period. or disposal of: (1) 'Your product'; 14. Non-Owned Watercraft Under Section 1 - Coverage A, paragraph 2 (2) 'Your work; or Exclusions, g.(2) is replaced in its entirety by the (3) 'Impaired property; following: if such product, work, or property is (2) A watercraft you do not own that is: withdrawn or recalled from the market or (a) Less than 51 feet long; and from use by any person or organization because of a known or suspected defect, (b) Not being used to carry persons or deficiency, inadequacy or dangerous properly for a charge; condition in it, but this exclusion does not This provision applies to any person, who apply to "product recall expenses" that you with your consent, either uses or is incur for the "covered recall" of 'your responsible for the use of a watercraft. product'. The exception to the exclusion does not apply to 'Product recall expenses" 15. Personal Injury - Broad Form resulting from: (1) Under Section I - Coverage B, paragraph 2.e. (1) Failure of any products to accomplish is deleted in its entirety. their intended purpose; (2) Under Section V - Definitions, definition 14, (2) Breach of warranties of fitness, quality, paragraph b. is replaced in its entirety by the durability or performance; following: (3) Loss of customer approval, or any cost b. Malicious prosecution or abuse of process. incurred to regain customer approval; (3) Under Section V - Definitions, definition 14, (4) Redistribution or replacement of 'your paragraph h. is added as follows: product' which has been recalled by h. Discrimination or humiliation (unless like products or substitutes; insurance thereof is prohibited by law) that (5) Caprice or whim of the insured; results in injury to the feelings or reputation (6) A condition likely to cause loss of which of a natural person, but only if such any insured knew or had reason to discrimination or humiliation is: know at the inception of this insurance; (1) Not done intentionally by or at the (7) Asbestos, including loss, damage or direction of. clean up resulting from asbestos or (a) The insured; asbestos containing materials; (b) Any officer of the corporation, (8) Recall of "your products" that have no director, stockholder, partner or known or suspected defect solely member of the insured; and bemuse a known or suspected defect in another of 'lymrr products' has been (2) Not directly or indirectly related to an found. .employee", not to the employment, prospective employment or termination (2) Under Section II - Who Is An Insured, of any person or persons by an paragraph 4.d. is added as follows: insured. d. Coverage A does not apply to 'product (4) This coverage does not apply if Coverage B - recall expense' arising out of any Personal and Advertising Injury Liability is withdrawal or recall that occurred before excluded either by the provisions of the you acquired or formed the organization. Coverage Part of by endorsement. (3) Under Section III - Limits of Insurance, paragraph 8. is added as follows: 16. Product Recall Expense S. The Limits of Insurance and rules stated (1) Under Section I - Coverage A, paragraph 2 below fix the most we will pay under this Exclusions, n. is replaced in its entirety by the coverage part. following: (1) The Aggregate Limit is the most we will n. Recall of Products, Work or Impaired reimburse you for the sum of all "product Property recall expenses' incurred for all "product Damages claimed for any loss, cost or recall expenses" initiated during the policy expense incurred by you or others for the period. loss of use, withdrawal, recall, inspection, Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Service Office, Inc. 1998 421-0080 (01103) Page 4 of 6 Faxserver 6/24/2014 6:00:23 PM PAGE 8/012 Fax Server (2) The Each Occurrence Limit shown in the such products are free from defects Summary of Coverages Declaration is the that could be a cause of loss under this most we will pay in connection with any one insurance. defect or deficiency. (5) Under Section V - Definitions, the following (a) All "product recall expenses" in definitions are added: connection with substantially the same 25. "Covered recall," means a recall made general harmful condition will be necessary because you or a government deemed to arise out of the same defect body has determined that a known or or deficiency and considered one suspected defect, deficiency, inadequacy, occurrence. or dangerous condition in your product" (b) Any amount reimbursed for "product has resulted or will result in 'bodily injury' recall expenses" in connection with any or 'property damage". one occurrence will reduce the amount 26. 'Product recall expense' means: of the Aggregate Limit available for a. Necessary and reasonable expenses reimbursement of 'product recall for: expenses' in connection with any other (1) Communications, including radio or defect or deficiency. television announcements or (c) If the Aggregate Limit has been printed advertisements including reduced by reimbursement of 'product stationery, envelopes and postage; recall expenses' to an amount that is 2 less than the Each Occurrence Limit, Shipping the recalled products the remaining Aggregate ate Limit is the from any purchaser, distributor or 9 g9re9 user to the place or places most that will be available for designated by you reimbursement of "product recall expenses" in connection with any other (3) Remuneration paid to your regular defect or deficiency. 'employees' for necessary over- time; The Limits of Insurance of Product Recall (4) Hiring additional persons, other Expense apply separately to each than your regular employees'; consecutive annual period and to any remaining period of less than 12 months, (5) Expenses incurred by "employees' starting with the beginning of the policy including transportation and so- period shown in the Declarations, unless commodations; the policy period is extended after issuance (6) Expenses to rent additional ware- for an additional period of less than 12 house or storage space; months. In that case, the additional period .will be deemed part of the last preceding (7) Disposal of 'your product', but only period for the purposes of determining the to the extent that specific methods Limits of Insurance. of destruction other than those employed (3) A Deductible of $500 applies for Each for trash discarding or disposal are required to avoid Occurrence. 'bodily injury" or "property damage" (4) Under Section N - Commercial General as a result of such disposal; Liability Conditions, Condition 2 - Duties in You incur exclusively for the purpose of the Event of Occurrence, Offense, Claim or recalling 'your product"; and Suit, paragraph f. is added as follows: b. Your lost profit resulting from such f. You must see to it that the following are "covered recall". done in the event of an actual or anticipated 'covered recall' that may result in "product recall expense": 17. Property Damage Legal Liability (Fire, Lightning, Explosion, Smoke or Leakage from (1) Give us prompt notice any discovery _ Fire Protective Systems Damage) or notification that 'your r product" must be withdrawn or recalled. Include a (1) The word fire is changed to fire, lightning, description of your product' and the explosion, smoke and leakage from fire pro- reason for the withdrawal or recall; tective systems where it appears in the Limits of Insurance section of the Declarations for the (2) Cease any further release, shipment, Commercial General Liability Coverage Part. consignment or any other method of distribution of like or similar products until it has been determined that all Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Service Office, Inc. 1998 421-0080 (01/03) Page 5 of 6 Faxserver 6/24/2014 6:00:23 PM PAGE 9/012 Fax Server (2) Under Section 1 - Coverage A the last para- 18. Supplementary Payments Increased Limits graph (after the exclusions) is replaced in its Under Section 1 - Supplementary Payments, entirety by the following: Coverages A and B. paragraphs 1.b. and 1.d. are Exclusions c. through n. do not apply to dam- replaced in their entirety as follows: age by fire, lightning, explosion, smoke or leak- 1.b. Up to $2,500 for cost of bail bonds required age from fire protective systems to premises because of accidents or traffic law violations while rented to you or temporarily occupied by arising out of the use of any vehicle to which you with the permission of the owner. A sepa- the Bodily Injury Liability Coverage applies. ' rate limit of insurance applies to this coverage We do not have to furnish these bonds. as described in LIMITS OF INSURANCE (SEC- TION III). This limit will apply to all damage 1.d. All reasonable expenses incurred by the proximately caused by the same event, whether insured at our request to assist us in the such damage results from fire, lightning, ex- Investigation or defense of the claim or "suit, plosion, smoke or leakage from fire protective including actual loss of earnings up to $300 a systems or any combination of the five. day because of time off from work. (3) Under Section III - Limits Of Insurance, para- graph 6. is replaced in its entirety by the follow- 19. Unintentional Failure to Disclose Hazards ing: Under Section IV - Commercial General Liability 6. Subject to 5. above, the higher of: Conditions, Condition 6. - Representations, a. $500,000; or paragraph d. is added as follows: d. We will not disclaim coverage under this b. The Fire, Lightning, Explosion, Smoke Coverage Part if you fail to disclose all hazards or Leakage from Fire Protective Sys- existing as of the inception date of the policy tems Damage Limit shown in the Dec- provided such failure is not intentional. larations is the most we will pay under Coverage A for damages because of "property damage' from fire, lightning, 20. Unintentional Failure to Notify explosion, smoke and leakage from fire Under Section IV - Commercial General Liability protective systems to premises, while Conditions, Condition 2. - Duties in the Event of rented to you or temporarily occupied Occurrence, Offense, Claim or Suit, paragraph g. by you with permission of the owner. is added as follows: (4) Under Section IV - Commercial General f. Your rights afforded under this policy shall not Liability Conditions, Condition 4. Other be prejudiced if you fail to give us notice of an Insurance, paragraph b.(2) is replaced by the "occurrence", offense, claim or'suir, solely due following: to your reasonable and documented belief that b.(2) That is fire, lightning, explosion, smoke the "bodily injury" or "property damage' is not or leakage from fire protective systems covered under this policy. insurance for premises rented to you or temporarily occupied by you with per- mission of the owner; or (5) Under Section V - Definitions, definition 9. "Insured contract", a. is replaced in its entirety by the following: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or leakage from fire pro- tective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract". (6) This coverage does not apply if Fire Damage Legal Liability of Coverage A is excluded either by the provisions of the Coverage Part or by endorsement. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Service Office, Inc. 1996 421-0080 (01/03) Page 6 of 6 'Faxserver 6/24/2014 6:00:23 PM PAGE 10/012 Fax Server POLICYNUMBER: AW2904849803 - COMMERCIALAUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By, Named Insured: Chown. Inc. Authorized Representative) SCHEDULE Name of Person(s) or Organization(s) : City of Ashland, Oregon and its elected officials, officers and employees, (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement. ) Each person or organization shown in the Schedule Is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 © Insurance Services Office, Inc., 1998 Faxserver 6/24/2014 6:00:23 PM PAGE 11/012 Fax Server THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Other Insurance - Primary and Non-Contributory (Additional Insured) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Section IV - Commercial General Liability Conditions 4. Other Insurance a. Additional Insureds (a) That is Fire, Extended If you agree in a written contract, written Coverage, Builder's agreement or permit that the insurance Risk, Installation Risk or provided to any person or organization similar coverage for included as an Additional Insured under your work', Section II - Who Is An Insured, is (b) That Is Fire insurance primary and non-contributory, the for premises rented to following applies: the Additional Insured or temporarily occupied the If other valid and collectible insurance is Insured with permission available to the Additional Insured for a of the owner; loss we cover under Coverages A or B of this Coverage Part, our obligations (c) That is insurance are limited as follows: purchased by the Additional Insured to 1.Prtmary Insurance cover the Additional This insurance is primary to other Insured's liability as a insurance that is available to the tenant for "property Additional Insured which covers the damage' to premises Additional Insured as a Named rented to the Additional Insured. We will not seek Insured or temporarily contribution from any other occupied by the insurance available to the Additional Additional with Insured except: permission of the 1. For the sole negligence of the owner; or Additional Insured; (d) If the loss arises out of II. when the Additional Insured is the maintenance or use an Additional Insured under of aircraft, autos" or another primary liability policy; watercraft to the extent or not subject to Exclusion g. of Section I - Ill. when 2. below applies. Coverage A - Bodily If this Insurance Is primary, our Injury And Property obligations are not affected unless Damage Liability. any of the other Insurance is also When this insurance is excess, we will have primary. Then, we will share with all no duty under Coverages A or B to defend the that other insurance by the method Insured against any "suit' if any other Insurer described In 3. below. has a duty to defend the Insured against that 2. Excess Insurance "suit". If no other Insurer defends, we will This insurance is excess over: undertake to do so, but we will be entitled to the Insured's rights against all those other (1) Any of the other insurance, Insurers. whether primary, excess, When this insurance is excess over other contingent or on any other Insurance, we will pay only our share of the basis: amount of the loss, if any, that exceeds the sum of. Page 1 of 2 421-0452 06 07 Includes copyrighted material of Insurance Sences Otfxss, Inc., with its permission 'Faxserver 6/24/2014 6:00:23 PM PACE 12/012 Fax Server (1) The total amount that all such other 3. Method Of Sharing insurance would pay for the loss in the If all of the other insurance permits absence of this insurance; and contribution by equal shares, we will (2) The total of all deductible and self- follow this method also. Under this insured amounts under all that other approach each insurer contributes equal insurance. amounts until it has paid its applicable We will share the remaining loss, if any, limit of insurance or none of the loss with any other insurance that is not remains, whichever comes first. described in this Excess Insurance If any of the other insurance does not provision and was not bought specifically permit contribution by equal shares, we to apply in excess of the Umits of will contribute by limits. Under this Insurance shown in the Declarations of method, each insurers share is based on this Coverage Part. the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. Page 2 of 2 421-0452 06 07 Includes copyrighted material of Ir=rsnce Services Offices, Inc., with its percussion