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HomeMy WebLinkAboutInsurance Certificate: Pilot Rock Excavation PILORO l ID: KID it DS SRO CERTIFICATE OF LIABILITY INSURANCE 0711812014m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED.BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A-statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER Phone: 541-779232 NA ONTACT ME: Hart Insurance Fax: 541-772-3963 PNONE FAX 1123 Royal Ave. A/c No Ed], A/C. NA: Medford, OR 97504 E-MAIL Hart Insurance I Medford ADDRESS: INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A: Cincinnati Insurance 10677 INSURED Pilot Rock Excavation Inc INSURER a: SAIF Corp 36196 650 E Pine St Ste 102b Central Point, OR 97502 INSURER C: 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 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 DD TYPE OF INSURANCE POLICY NUMBER MM/DCDIYYYY MMIDDY EXP INSR MD LTR IYYYY UNITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X EPP0151857 0712012014 07/2012015 PREMISES Eeoaurrence S 1,000,00 CLAIMS-MADE OCCUR MED EXP(Any are pe.) S 15,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC $ AUTOMOBILE UAMUTY COMBINED SINGLE LIMB 1,000,00 Ea eccidImt B ANY AUTO EBA0151857 07/20/2014 07120/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per ecculenl S X UMBRELLA UAS X OCCUR EACH OCCURRENCE $ 4,000,00 A EXCESS LIAB CLAIMS-MADE EPPOIS1857 0712012014 07/2012015 AGGREGATE $ 4,000,00 DED X RETENTION $ 10,000 S WORKERS COMPENSATION X WC STATU. OTH- AND EMPLOYERS' UABIUTY TORY I IMr-S FR 784439 09113/2013 09101/2014 E.L. EACH ACCIDENT $ 600,00 B ANY PROPRIETOR/PARTNERIF.XECUIVE YIN N/A OFFICERJUEMBER EXCLUDED? 784439 0910112014 09/0112015 E.L. DISEASE - EA EMPLOYEE 1 500,00 (Mandatory In In NH) H) H y desaiEe under DESCRIPTION OF OPERATIONS Dolow E.L. DISEASE -POLICY LIMIT S 500,00 A Lease/Rented Equip EPP0151857 07/2012014 07/2012015 Limit 100,00 Ded. 50 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, It mom space is nqulretl) City of Ashland and its employees, officers and agents are included as additional insured as respects to general liability and auto liability per form GA233 project: Alley Extension - N Main to Lori Lane CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Hart Insurance ance / Medford ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A Endorsement - Table of Contents: Begins on Page: Coverage: 1. Employee Benefit Liability Coverage ..................................................................................................2 8 2. Unintentional Failure to Disclose Hazards 8 3. Damage to Premises Rented to You 9 4. Supplementary Payments 5. Medical Payments .........................................................................................................................10 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control 10 Liability Coverage (Coverage b.) 7, 180 Day Coverage for Newly Formed or Acquired Organizations ...................................................10 8. Waiver of Subrogation .....................................................................................................................10 9. Automatic Additional Insured - Specified Relationships; 11, x Managers or Lessors of Premises; x Lessor of Leased Equipment; x Vendors; x State or Political Subdivisions - Permits Relating to Premises; x State or Political Subdivisions - Permits; and x Contractors' Operations 10. Broadened Contractual Liability - Work Within 50' of Railroad Property ..........................................16 11. Property Damage to Borrowed Equipment ......................................................................................16 12. Employees as Insureds - Specified Health Care Servi.es :.............................................................16 x Nurses; x Emergency Medical Technicians; and x Paramedics 13. Broadened Notice of Occurrence .....................................................................................................16 E. Limits of Insurance: The Commercial General UabilityLimlts of Insurance applyto the insurance provided by this endorsement, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 1 of 16 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a.$250 Coverage b. $250 unless otherwise stated $ COVERAGE FReP.~I - ^UM BASIS ADVANCE PP.EMiUM R ..T~ (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units e Other In. Care, Custody or Can TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: 2) Our right and duty to 1. Employee Benefit Liability Coverage defend ends when we have a. The fol loving is added to SECTION 1 used up the rance cable limit of insurance - COVERAGES: Employee Benefit in the payment of Liability Coverage. judgments or settle- (1) Insuring Agreement ments. (a) We will pav those sums that No other obligation or liabil- the insured becomes legally Ity to pay sums or perform obligated to pay as dam- acts or services is covered ages caused by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pay- sured, or of any other per- ments. son for whose acts the in- (b) This insurance applies to sured is legally liable, to damages only if the ad, er- which this insurance ap- ror or omission, is negii- plies. We will have the right gently committed in the and duty to defend the in- "administration" of your sured against any "suit" "employee benefit program". seeking those damages. and However, we will have no duty to defend against any 1) Occurs during the pol- ,sult" seeking damages to icy period; or which this insurance does not apply. We may, at our 2) Occurred prior to the discretion, investigate any effective date of this report of an act, error or endorsement provided. omission and settle any a) You did not have claim or "suit" that may re- knowledge of a sult. But: claim or "suit" on 1) The amount we will pay or before the ef- for damages is limited fective date of this as described in SEC- endorsement. TION 111 - LIMITS OF You will be INSURANCE; and deemed to have Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 2 of 16 knowledge of a 1) Failure of any invest- claim or "suit" ment to perform; when any "author- 2) Errors in providing in- formation on past per- tive"; formance of investment i) Reports all, or vehicles; or any part, of the 3) Advice given to any ad, error or person with respect to omission to us that person's decision in any other to participate or not to surer; participate in any plan ii) Receives a included in the "em- written or ver- ployee benefit pro- baI demand or gram". claim for dam- (f) Workers' Compensation ages because and Similar Laws of the act, error or omission; Any claim arising out of your and failure to comply with the b) There is no other mandatory provisions of any applicable insur- workers' compensation, un- ance. employment compensation insurance, social security or (2) Exclusions disability benefits law or any similar law. This insurance does not apply to: (g) (a) Bodily Injury, Property ERISA Damage or Personal and Damages for which any.in- Advertising Injury sured is liable because of li- ability imposed on a fidud- 'Bodily injury', "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable to Perform a Con- funds accrued or other col- (c) Failure lectible insurance. tract Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to (j) Employment Related meet any obligations under Practices any plan included in the "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any: ance of Investment / Ad- (1) Refusaltoemploy; vice Given With Respect to Participation (2) Termination of em- ployment; Any claim based upon: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 3 of 16 (3) Coercion, demotion, tors are insureds, but only evaluation, reassign- with respect to their duties ment, discipline, defa- as your officers or directors. mation, harassment, Your stockholders are also humiliation, discrimina- insureds, but only with ra- tion or other. employ- spec: to their liability as ment-related practices, stockholders. ads or omissions; or (e) A trust, you are an insured. (4) Consequential liability Your trustees are also in- as a result of (1); (2) or sureds, but only with respect - (3) above. to their duties as trustees. This exclusion applies (2) Each of the following is also an whether the insured may be. insured: held liable as an employer (a) Eacti Of your "amployea5' or in any other capacity and who is or was authorized to to any obligation to share administer your "employee damages with or repay benetlt program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having proper temporary authoriza- (3) Supplementary Payments tion to administer your yrour "am- SECTION I - COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS - COVERAGES A AND legal representative Is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- sped to duties as such. ity Coverage, SECTION II - WHO IS That representative will AN INSURED is deleted in its entirety have all your rights and du- and replaced bythe following: ties under this Coverage (1) if you are designated in the Dec- Part. larations as: (3) Any organization you newly ac- quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over which only with respect to the con- you maintain ownership o ma- dud of a business of which jority interest, will qualify as a you are the sole owner. Named Insured if no other simi- (b) A partnership or joint ven- lar insurance applies to that or- ture, you are an insured. ganizalion. However, coverage Your members, your pan- under this provision: hers, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, (c) A limited liability company, whichever is earlier; and you are an insured. Your (b) Does not apply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation. eds, but only with respect to their duties as your manag- c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, you tirety and replaced bythe following: are an insured. Your "ex- ecutive officers" and direc- Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 4 of 16 (1) The Limits of Insurance shown in amount stated in the Decla- Section B. Limits of Insurance, rations as applicable to 1. Employee Benefit Liability Each Employee. The limits Coverage and the rules below of insurance shall not be re- fix the most we will pay regard- duced by the amount of this less of the number of: deductible. (a) Insureds; (b) The deductible amount stated in the Declarations (b) Claims made or "suits" applies to all damages sus- brought; . tained by any one "em- ployee", including such (c) Persons or organizations "employee's" dependents making 'daims' or bringing and beneficiaries, because "suits"; of all acts, errors or omis- (d) Acts, errors or omissions; or sions to which this insur- ance applies. (e) Benefits included In. your "employee benefit program". (c) The terms of this insurance, including those with respect (2) The Aggregate Limit shown in to: Section B. Limits of Insurance, 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement is defend the insured the most we will pay for all dam- against any "suits" ages because of ads, errors or seeking those dam- omissions negligently committed ages; and in the "administration" of your 2) Your duties, and the "employee benefit program". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown In Section B. Limits omission, or claim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of plication of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's' dependents effect settlement of any and beneficiaries, as a result of: claim or "suit" and, upon no- tification of the action taken, (a) An act, error or omission; or you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, negligently committed in the As respects Employee Benefit Li- "nistration" of your "em_ ability Coverage, SECTION IV - administration" benefit program COMMERCIAL GENERAL LIABIL- ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of teed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and to the payment of benefits in any replaced by the following: plan included in the "employee benefit program". 2. Duties in the Event of an (4) Deductible Amount A_ct, Error or Omission, or Claim or Suit (a) Our obligation to pay dam- a. You must see to it that ages on behalf of the in- we are notified a soon sured applies only to the as practicable of an act, amount of damages in ex- error or omission which cess of the deductible Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with Its permission. Page 5 of 16 may result in a daim. surance may also To the extent possible, apply. notice should Include: d. No insured will, except (1) What the act, error at that insured's own or omission was cost, voluntarily make a and when it oc- payment, assume any curred, and obligation, or incur any expense without Our (2) The names and consent. addresses of any- - OriE Who may SU;- (2) item 5. Mher Insurance is de- fer damages as a rated in,its entirety and reoiaced result of the act, by the following: error or omission. 5. Other insurance b. If a claim is made or If other valid and colle~-Iible "suit" is brought against insurance is avallable to the any insured, you must: insured for a loss we cover (1) Immediately re- under this Coverage Part, cord the specifics our obligations are limited of the claim or as follows: "suit" and the date a. Primary Insurance received; and (2) Notify us as soon This insurance is pri- mary except when c. below applies. If this in- You must see to It that surance is primary, our we receive written no- obligations are not af- tice of the daim or fected unless any of the "suit" as soon as practi- other insurance is also cable. primary. Then, we will share with all that other c. You and any other in- insurance by the volved insured must~ method described in b. (1) Immediately send below. us copies of any b. Method of Sharing demands, notices, summonses or le- If all of the other insur- gal papers re- ante permits contribu- ceived in connec- lion by equal shares, lion with the claim we will follow this or "suit", method also. Under this approach each insurer (2) Authorize us to ob- contributes equal tain records and amounts until it has other information; paid its applicable limit of insurance or none of (3) Cooperate with us the loss in the investigation remains, whichever comes first. or settlement of the claim or de- If any of the other in- fense against the surance does riot per- "suit"; and mit contribution by (4) Assist us, uoon equal shares, we will our request, in the contribute by limits. Under this method, enforcement Of each insurer's share is any right against based on the ratio of its any person or or- applicable limit of in- ganization which surance to the total ao- may be liable to the insured be- plicable limits insur- s. ance of all insurers. cause of an ad, error or omission c. No Coverage to which this in- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 6 of 16 This insurance shall not providing some or all of the cover any loss for following benefits to "em- which the insured is en- ployees", whether provided titled to recovery under through a "cafeteria plan" or any other insurance in otherwise: force previous to the ef- a. Group life insurance; fective date of this group accident or Coverage Part. health Insurance; den- e. Additional Definitions tal, vision and hearing plans, and flexible As respects Employee Benefit Li- spending accounts; ability Coverage, SECTION V - provided that no one DEFINITIONS is amended as fol- other than an "em- lows: ployee" may subscribe (1) The following definitions are such such benefits and added: such benefits are made generally available to 1. "Administration" means: those "employees" who satisfy the plan's eligi- a. Providing information to bility requirements; "employees", including their dependents and b. Profit sharing plans, beneficiaries, with re- employee savings sped to eligibility for or - plans, employee stock scope of "employee ownership plans, pen- benefit programs"; sion plans and stock subscription plans, pro- b. Interpreting the "em- vided that no one other ployee benefit pro- than an "employee" grams"; may subscribe to such benefits and such c. Handling records in benefits are made gen- connection with the erally available to all "employee benefit pro- "employees" who are grams"; or eligible under the plan d. Effecting, continuing or for such benefits; terminating any "em- c, Unemployment insur- ployee's" participation ance, social security in any benefit included benefits, workers' com- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- a. Handling payroll deduc- grams; leave of ab- tions; or sence programs, in- cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assistance or adequate limits of plans; transportation coverage of insurance, and health club subsi- including but not limited dies. to unemployment in- surance, social security (2) The following definitions are de- benefits, workers' com- leted in their entirety and re- pensation and disability placed by the following: benefits. 21. "Suit" means a civil pm- 2. "Cafeteria plans" means ceeding in which money plan authorized by applica- damages because of an act, ble law to allow "employees' error or omission to which to elect to pay for certain this insurance applies are benefits with pre-tax, dollars. alleged. "Suit" includes: 3. "Employee benefit pro- a. An arbitration proceed- grams" means a program ing in which such dam- Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 7 of 16 ages are claimed and The exclusions under SECTION to which the insured I - COVERAGES, COVERAGE must submit or does A. BODILY INJURY AND submit with our con- PROPERTY DAMAGE LIABIL- sent; ITY, 2. Exclusions, other than I. War and the Nuclear Energy b. Any other alternative Liability Exclusion, are deleted dispute resolution pro- and the following are added: ceeding in which such damages are claimed This insurance does not apply to: in- _ and to which the in- a sured' submits with our (a) "Property damsge consent; or 1) Assumed in any con- c. An appeal of a civil pro- tract; or ceeding. 2) Loss caused by or m- 8,'Employee". means a person suiting from any of the actively employed, formerly following: employed, an leave of ab- a) Wear and tear; sence or disabled, or re- tired. "Employee" includes a b) Rust, corrosion, "leased worker". "Employee" fungus, decay, de- does not include a "tempo- terioration, hidden rary worker". or latent defect or any quality in 2. Unintentional Failure to Disclose Haz- property that aids causes it to dam- SECTION IV - COMMERCIAL GENERAL age or destroy it- LIABILITY CONDITIONS, 7. Represen- self; tations Is hereby amended by the addi- c) smog; tlon of the following: d) Mechanical break- Based on our dependence upon your reo- down including resentatlons as to existing hazards, If un- rupture or bursting intentionally you should fail to disclose all caused by con- such hazards at the inception date of your trifugal force; policy, we will not reject coverage under this Coverage Part based solely on such e) Settling, cracking, failure. shrinking or ex- pansion; or 3. Damage to Premises Rented to You Nesting or infesta- a. The last Subparagraph of Paragraph tion, or discharge 2. SECTION I - COVERAGES, or release of waste COVERAGE A- - BODILY INJURY products or secre- AND PROPERTY DAMAGE, 2. LI- tions, by insects. ABILITY Exclusions is hereby de-' birds, rodents or lated and replaced bythe following: other animals. - Exclusions c. through q, do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- redly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; TIONI - COVERAGES,COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE. LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are 3) Water under the ground both rented to and occupied by you. surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liabllity, as provided in Para- through: graph 3.b. above: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 8 of 16 a) Foundations, one "occurrence" to which walls, floor, or this insurance applies. paved surfaces; (3) Theamount we will pay is limited b) Basements, as described in Section B. Lim- whether paved or its of Insurance, 3. Damage to not; or Premises Rented to You of this endorsement. c) Doors, windows or other openings. 4. Supplementary Payments (c) Loss caused by or resulting Under SECTION 1 - COVERAGE, SUP- from water that leaks or PLEMENTARY PAYMENTS - COVER- flows from plumbing, heat- AGES A AND 8: ing, air conditioning, or fire a. Paragraph 2. is replaced by the fol- protection systems caused lowing: by or resulting from freezing, unless: Up to the limit shown in Section B. 1) You did your best to Limits of Insurance, 4.a. Ball Bonds maintain heat in the of this endorsement for cost of bail building or structure; or bonds required because of accidents or traffic law violations arising out of 2) You drained the equip- the use of any vehicle to which the ment and shut off the Bodily Injury Liability Coverage ap- water supply if the heat plies. We do not have to furnish was not maintained. these bonds. (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- owing: 1) Plumbing, heating, air conditioning, fire pro- All reasonable exaenses incurred by tedion systems, or the insured at our request to assist us other equipment or ap- in the investigation or defense of the plianoes; or claim or °suif', including actual loss of earnings up to the limit shown in Sec- t) The interior of any tion B. Limits of insurance, 4.b. building or structure, or Loss of Earnings of this endorsement to personal property in per day because of time off from the building or structure work. caused by or resulting from rain, snow, sleet 5. Medical Payments or ice, whether driven by wrid or not. The Medical Expense Limit of Any One Person as slated in the Declarations is c. Limit of insurance amended to the limit shown in Section B. Limits of Insurance, 5. Medical Pay- The Damage to Premises Rented to ments of this endorsement. You Limit as shown in the Dedara- tions is amended as follows: 6. -Voluntary Property Damage and Care, Custody or Control Liability Coverage (2) Paragraph 6. of SECTION III - LIMITS OF INSURANCE is a. Voluntary Property Damage Cov- hereby deleted and replaced by erage the following: We will pay for "property damage" to 6. Subject to 5. above, the property of others arising out of op- Damage to Premises erations incidental to the insured's Rented to You Limit is the business when: most we will pay under COVERAGE A. BODILY (1) Damage is caused by the in- INJURY AND PROPERTY sured; or DAMAGE LIABILITY, for (2) Damage occurs while in the in- damages because of "prop- sured's possession. erly damage" to premises while rented to you or tem- With your consent, we will make porarily occupied by you these payments regardless of fault. with permission of the owner, arising out of any Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 9 of 16 b. Care, Custody or Control Liability deductible amount as has been Coverage paid by us. SECTION I - COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or ERAGE A. BODILY INJURY AND Acquired Organizations PROPERTY DAMAGE LIABILITY, 2. SECTION II - WHO IS AN INSURED is Exclusions, j. Damage to Property, amended as follows: Subparagraphs (3), (4) and (5) do not apply to "property damage" to the Subparagraph a. of Paragraph 4. is property of others described therein. hereby deleted and replaced by the fol- w,.h respefto the iisurahce provided by lowing' this 'section of the endorsement, the foi- a. insurance under this provision is at- lowing additional provisions apply: - forded only until the 180th day after you acquire or form the organization a. The Limits of insurance shown in the or the end of the policy period, Declamations are rap aced by the !im- whichever is earlier; its designated in Section B. Limits of Insurance, 6. Voluntary Property 8. Waiver of Subrogation Damage and Care, Custody or Control Liability Coverage of this SECTION IV - COMMERCIAL GENERAL endorsement with respect to cover- LIABILITY CONDITIONS, 9. Transfer of age provided by this endorsement. Rights of Recovery Against Others to These limits are Inclusive of and not Us is hereby amended by the addition of in addition to the limits being re- the following: placed. The Limits of Insurance We waive any right of recovery we may shown in Section B. Limits of Insur- have because of payments we make for ante, 6. Voluntary Property Dam- injury or damage arising out of your ongo- age and Care, Custody or Control ing operations or "your work" done under Liability Coverage of this endorse- a written contract requiring such waiver ment fix the most we will pay in any vsth that person or organization and in- one "occurrence" regardless of the cluded in the "products-completed opera- number of: tions hazard". However, our rights may (1) Insureds; only be waived prior to the "occurrence" giving rise to the injury or damage for (2) Claims made or "suits" brought; which we make payment under this Cov- or erage Part. The insured must do nothing (3) Persons or organizations making after a loss to impair our rights. At our re- bringing "suits". quest, the insured will bring "suit"or trans- claims or far those rights to us and help us enforce b. Deductible Clause those rights. (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- on your behalf applies only to the fied Relationships amount of damages for each a. The following is hereby added to "occurrence" which are in excess SECTION II -WHO IS AN INSURED~ of the deductible amount stated in Section B. Limits of Insur- (1) Any person or organization de- ance, 6. Voluntary Property scribed in Paragraph 9.a.(2) be- Damage and Care. Custody or. low (hereinafter referred to as Control Liability Coverage of additional insured) whom you are this endorsement The limits of required to add as an additional insurance will not be reduced by insured under this Coverage Part the application of such deducti- by reason of: ble amount. (a) A written contract or agree- (2) Condition 2. Duties in the Event ment; or of Occurrence, Offense, Claim or Suit, applies to each claim or (b) An oral agreement or con- "suit" irrespective of the amount. tract where a certificate of insurance showing that per- (3) We may pay any part or all of the son or organization as an deductible amount to effect set- additional insured has been tlement of any claim or "suit" issued, and, upon notification of the ac- tion taken, you shall promptly re- is an insured, provided: imburse us for such part of the Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 10 of 16 (a) The written or oral contract or use of equipment leased or agreement is: to you by such person(s) or organizations(s). However, 1) Currently in effect or this insurance does not ap- becomes effective dur- ply to any "occurrence" ing the policy period; which takes place after the and equipment lease expires. 2) Executed prior to an (c) Any person or organization "occurrence" or offense (referred to below as ven- to which this insurance dor) with whom you have would apply; and agreed per Paragraph (b) They are not specifically 9.a.(1) above to provide in- named as an -addltional in- surance, but only with re- spect to "bodily injury' or svision of, r endorsement "property damage" arising added to, this Coverage out of "your products" which Part.. are distributed or sold in the regular course of the ven- (2) Only the following persons or or- dot's business, subject to ganizations are additional insur- the following additional ex- eds under this endorsement, and clusions: insurance coverage provided to 1) The insurance afforded such additional insureds is lim- the vendor does not ited as provided herein: apply to: (a) The manager or lessor of a a) "Bodily injury" or premises leased to you with Whom you have agreed per "property damage" Paragraph 9.a.(1) above to for which the den- provide insurance, but only dor is obligated to with respect to liability aris- pay damages by ing out of the ownership, reason of the as- maintenance or use of that sumption of liability part of a premises leased to in a contract or you, subject to the following agreement. This additional exclusions: apply to to exclusion l does not a liability for This insurance does not ap- damages that the ply to: vendor would have in the absence of 1) Any "occurrence" which the contract or takes place after you agreement; cease to be a tenant in that premises. b) Any express war- ranty unauthorized 2) Structural alterations, by you; new construction or demolition operations c) Any physical or performed by or on be- chemical change half of such additional in the product insured. made intentionally by the vendor; (b) Any person or organization from which you lease d) Repackaging, ex- equipment with whom you cept when un- have agreed per Paragraph packed solely for 9.a.(1) above to provide in- the purpose of in- surance. Such person(s) or spection, demon- organization(s) are insureds, stration, testing, or but only to the extent that the substitution of the liability far "bodily injury", parts under in- "property damage" or "per- structions from the sonal and advertising injury" manufacturer, and is caused by your negli- then repackaged gence, acts or omissions in in the original con- the maintenance, operation tainer; Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 11 of 16 e) Any failure to Part with respect make such inspec- to such products. tions, adjustments, (d) Any state or political subdi- tests or servicing vision with which you have as the vendor has agreed per Paragraph agreed to make or 9•a,(1) above to provide in- normally under- surance, subject to the fol- takes to make in (owing additional provisiom the usual course of business, in con- This insurance applies only nection with the with respect to the following distribution of sale hazards for which the stale of the products; or political subdivision has Demonstration, in- issued a permit in connec- tion with premises you own, stallation, servicing rent or control and to which or repair opera- this insurance applies: lions, except such operations per- _ 1) The existence, mainte- formed at the ven- nance, repair, construc- dor's premises in "lion, erection, or re- connection with moval of advertising the sale of the signs, awnings, cano- product; pies, cellar entrances, coal holes, driveways, g) Products which, manholes, marquees, after distribution or hoist away openings. sale by you, have sidewalk vaults, street been labeled or re- banners, or decorations labeled or used as and similar exposures; a container, part or or ingredient of any other thing or sub- 2) The construction, erec- stance by or for tlon, or removal of ele- the vendor; or vators; or h) "Bodily injury" or 3) The ownership, main- "property damage" tenance, or use of any arising out of the elevators covered by negligence, acts or this insurance. omissions of the vendor, its em- (e) Any state or political subdr ployees or anyone vision with which you have else acting on its agreed per Paragraph behalf. 9.a.(1) above to provide in- surance, subject to the fol- 2) This insurance does not lowing provisions: apply to any insured person or organization: 1) This insurance applies only with respect to op- a) From whom you erations performed by have acquired you or on your behalf such products, or for which the state or any ingredient, political subdivision has part or container, issued a permit. entering into, ac- companying or 2) This insurance does not containing such apply to "bodily injury", products; or "property damage" or "personal and advertis- b) When liability in- ing injury" arising out of cluded within the operations performed "products- for the state or political completed opera- subdivision. tions hazard" has been excluded un- (f) For "your work" performed der this Coverage in Oregon, any person or Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 12 of 16 organization with which you (a) Subparagraphs (e), (f) and have agreed per Paragraph (g) do not apply to "bodily in- 9.a.(1) above to provide in- jury' or "property damage" surance, but onlyto the ex- included within the "prod- tent that the liability is ucts-completed operations caused by "your work" per- hazard"; formed for that additional in- sured and only to the extent (b) Subparagraphs (a), (d), (e) that such liability is caused and (g) do not apply to "bod- by your negligence or the ily injury", "property dam- negligence of those acting - age" or "personal and ad- on your tiehalf. A person or vertising injury' arising out organization's status as an of the sole negligence or insured under this provision willful misconduct of the.ad- of this endorsement contin- ditional insured or its "em- ues for only the period of ployaes"; or time required by the written (c) Subparagraph (f) and (g) do contract or agreement, but not apply to "bodily injury", in no event beyond the. expi "property damage" or "per- ration date of this Coverage sonal and advertising injury" Part. If there is no written arising out of: contract or agreement, or if no period of time is required 1) The rendering of, or by the written contract or failure to render, any agreement, a person or or- professional services ganizatton's status as an in- by you or on your be- sured under this endorse- half, but only with ce- ment ends when your op- spect to either or both erations for that insured are of the following opera- completed. tions: (g) For "your work" performed a) Providing engi- in the "coverage territory" neering, architec- but not in Oregon, any per- tural or surveying son or organization with services to others; which you have agreed per and Paragraph 9.a.(1) above to provide insurance, but only b) Providing, or hiring with respect to liability aris- independent pro- ing out of "your work" per- fessionals to pro- formed for that additional in- vide, engineering, sured by you or on your be- architectural or half. A person or organiza- surveying services tion's status as an insured in connection with under this provision of this construction work endorsement continues for you perform. only the period of time re- 2) Subject to Paragraph 3) quired by the written con- below, professional tractor agreement, but in no services include: event beyond the expiration date of this Coverage Part. a) Preparing, approv- If there is no written contract ing, of failing to or agreement, or if no period prepare or ap- of time is required by the prove, maps, shop written contract or agree- drawings, opin- ment, a person or organiza- ions, reports, sur- tion's status as an insured veys, field orders, under this endorsement change orders, or ends when your operations drawings and for that insured are com- specifications; and pleted. b) Supervisory or in- (3) Any insurance provided to an spection activities additional insured designated performed as part under Paragraph 9.a.(2): of any related ar- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 13 of 16 chitectural or engi- primary to other insurance neering activities. available to the additional Insured except: 3) Professional services do not include services 1) As otherwise provided within construction in SECTION IV - means, methods, tech- COMMERCIAL GEN- niques, sequences and ERAL LIABILITY procedures employed CONDITIONS, 5. by you in connection Other Insurance, b. with construction work Excess Insurance; or you perform. 2)' For any other valid and (d) Subparagraphs (f) and (g) collectible insurance do not apply to "bodily in- available to the addi- jury" or "property damage" tional insured as an ad- arising put of"yourwork" "tor ditional insured by at- which a consolidated (wrap- tachment of an en- - up) insurance program has dorsement to another been provided by the prime insurance policy that is contractor / project manager written on an excess or owner of the construction basis. In such case, the project in which you are in- - coverage provided un- volved. der this endorsement - shall also be excess. b. Only with regard to insurance pro- vided to an additional insured desig- (2) Condition 11. Conformance to nated under Paragraph 9.a.(2) Sub- Specific Written Contract or paragraphs (f) and (g) above, SEC- Agreement is hereby added: TION III - LIMITS OF INSURANCE is 11. Conformance to Specific amended to include: Written Contract or The limits applicable to the additional Agreement insured are those specified in the a. With respect to addi- wrttten contract or agreement or in tional insureds de- the Declarations of this Coverage scribed in Paragraph Part, whichever are less. If no limits 9,a.(2)(f) above only: are specified in the written contract or agreement, or if there is no written If a written contract or contract or agreement, the limits ap- agreement between plicable to the additional insured are you and the additional those specified in the Declarations of insured specifies that this Coverage Part. The limits of in- coverage for the addi- surance are inclusive of and not in tional insured: addition to the limits of insurance shown in the Declarations. (1) Be provided by the Insurance Ser- c. SECTION IV - COMMERCIAL GEN- vices Office addi- ERAL LIABILITY CONDITIONS is tional insured form hereby amended as follows: number CG 32 61, (1) Condition 5. Other Insurance is CG 32 62 or CG 3263; or amended to include (2) Include coverage (a) Where required by a written for completed op- contract or agreement, this erations; or insurance is primary and / or noncontributory as respects (3) Include coverage any other insurance policy for "your work"; issued to the additional in- sured, and such other in- and where the limits or surance policy shall be ex- coverage provided to cess and / or noncontribut- the additional insured is ing, whichever applies, with more restrictive than this insurance. was - specifically re- quired in that written (b) Any insurance provided by contract or agreement, this endorsement shall be the terms of Para- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 14 of 16 ~ graphs 9.a.(3)(a) or 9.b. agreement specifies above, or any combina- the Insurance Services tion thereof, shall be in- Office additional in- terpreted as providing sured form number CG the limits or coverage 20 10 but does not required bytheten'ns of specify which edition, or the written contract or specifies an edition that agreement, but only to does not exist, Para- the extent that such Jim- graphs 9.2.3.b. and its or coverage is in- 9.b. of this endorse- cluded within the terms ment shall not apply of the Coverage Part to and Paragraph which this endorsement 9.a.(3)(a) of this en- is attached. dorsement shall apply, b. With respect to addi- 10. Broadened Contractual Liability - Work tional insureds de- Within 50' of Railroad Property scribed in Paragraph It is hereby agreed that Paragraph f.(1) of 9.a.(2)(g) above only: Definition 12. "Insured contras" (SEC- If a written contract or TION V - DEFI NITIONS) is deleted. agreement between you and the additional 11. Property Damage to Borrowed Equip- insured specifies that ment coverage for the addi- a. The followi rig is hereby added to Ex- tional insured: elusion j. Damage to Property of a. Be provided by the Paragraph 2., Exclusions of SEC- Insurance Ser- TION I -COVERAGES, COVERAGE vices Office addi- A. BODILY INJURY AND PROP- tional insured form ERTY DAMAGE LIABILITY: number CG 20 10 Paragraphs (3) and (4) of this exclu- or CG 20 37 sion do not apply to tools or equip- (where edition ment loaned to you, provided they are specified); or not being used to perform operations b, Include coverage at the time of loss. .for completed op- b. With respect to the insurance pro- erations; or vided by this section of the endorse- c. Include coverage ment, the following additional provi- for "your work"; sions apply: and where the limits or (1) The Limits of insurance shown in cove age provided to the Declarations are replaced by the additional insured is the limits designated in Section more restrictive than B. Limits of Insurance, 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These limits are in- the terms of Para- elusive of and not in addition to graphs 9.a.(3)(a), the limits being replaced, The 9.a.(3)(b) or 9.1d. above, Limits of Insurance shown in or any combination Section B. Limits of Insurance, thereof, shall be inter- 11. of this endorsement fix the preted as providing the most we will pay in any one "oc- limits or coverage re- currence" regardless of the quired by the terms of number of: the written contract or (a) Insureds; agreement, but only to the extent that such lim- (b) Claims made or "suits" its or coverage is in- brought; or cluded within the terms of the Coverage Part to (c) Persons of organizations which this endorsement making claims or bring is attached. If, however, "suits". the written contract or Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 15 of 16 (2) Deductible Clause a. Nurses; (a) Our obligation to pay dam- b. Emergency Medical Technicians; or ages on your behalf applies C. Paramedics, only to the amount of dam- ages for each "occurrence" in the jurisdiction where an "occurrence" which are in excess of the or offense to which this insurance applies Deductible amount stated in takes place. Section B. Limits of Insur- ance, 11. of this endorse- 13. Broadened Notice of Occurrence ment. The limits of insur- Paragraph a. of Condition 2. Duties in ;3ffanse, ante will not be reduced by the EVc6t L _cur r--_c-, o. c, w the application of such De- Claim or Suit (SECTION IV - COMfvier - ductible amount. CIAL GENERAL LIABILITY CONDI- (b) Condition 2. Duties in the TIONS) is hereby deleted and replaced by. Event of Occurrence, Of- the following: fense, Claim or Suit, ap- a. You must see to it that we are notified plies to each claim or "suit" as soon as practicable of an "occur- Irrespective of the amount, rence" or an offense which may result ,(c) We may pay any part or all in a claim. To the extent possible, no. of.the deductible amount to lice should include: effect settlement of any (1) . How, when and where the "oc- claim or "suit" and, upon no- currence" or offense took place; tification of the action taken, you shall promptly reim- (2) The names and addresses of burse us for such part of the any injured persons and wit- deductible amount as has nesses; and been paid by us. (3) The nature and location of any 12. Employees as Insureds - Specified injury or damage arising out of Health Care Services the "occurrence" or offense. It is hereby agreed that Paragraph This requirement applies only when 2.a.(1)(d) of SECTION 11 - WHO IS AN the "occurrence" or offense is (mown INSURED, does not apply to your "em- to an "authorized representative". ployees" who provide professional health care services on your behalf as duly li- censed: Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 16 of 16