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HomeMy WebLinkAboutInsurance Certificate: S&S Sheetmetal Inc assn Wilson BBNW (2/8) 07/23/2014 11:06:27 AM -070( AC"R" CERTIFICATE OF LIABILITY INSURANCE 7/23/2014 Y) 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 endorsement(s). PRODUCER CONTACT Susan Wilson, AAI, AIC NAME: Brown & Brown Northwest A/c° No Ext : (541) 772-1111 AIC No : (541) 772-3785 3256 Hillcrest Park Drive E-MAIL ADDRESS: swilson@bbnw.com IN AFFORDING COVERAGE NAIC # Medford OR 97504 INSURERA:Allied Group / Nationwide INSURED INSURER B :SAIF Corporation 52412 S & S Shee tmetal Inc. INSURER C : 912 Antelope Road INSURERD: INSURER E White City OR 97503 INSURER F COVERAGES CERTIFICATE NUMBER:CL1442133537 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. YY LIMITS IN SR TYPE OF INSURANCE POLICY NUMBER MM DD/YYYY MMDDYYYEXP LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurtence $ A CLAIMS-MADE NO OCCUR CP3006611718 4/24/2014 4/24/2015 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 21000,000 POLICY X E 0 LOC $ AUTOMOBILE LIABILITY COMBINED S NCL LMI Ea accident) 1 000,000 X ANYAUTO BODILY INJURY (Per person) $ A ALL OVvNED SCHEDULED CP3006611718 4/24/2014 4/24/2015 AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE H IRED AUTOS AUTOS (Per accide Hired Nor.OwnedLiabift $ 1,000,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB CLAHAS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 CP3006611718 4/24/2014 4/24/2015 $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN TORY LltvlT_S ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA 11929 10/1/2013 10/1/2014 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 Hyes; describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) Re: HVAC System Install-No. Mountain Shop effective 7/28j14. General Liability includes Additional Insured Primary/Non-contributory coverage when required by a written contract per attached endorsement CG73231111, including Per Project Aggregate and Waiver of Subrogation. Subject to policy terms, limits, conditions and exclusions. CERTIFICATE HOLDER CANCELLA11ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Ashland, Oregon ACCORDANCE WITH THE POLICY PROVISIONS. Its elected officials, officers & AUTHORIZED REPRESENTATIVE employees 20 East Main Street Ashland, OR 97520h 1 S Wilson, AAI, AIC/SU ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (2otoo5)ol The ACORD name and logo are registered marks of ACORD :son Wilson BBNW (3/8) 07/23/2014 11:07:28 AM -070( COMMERCIAL GENERAL LIABILITY CG 73 23 11 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LOST KEY COVERAGE "Loss" means unintentional damage or SECTION I - COVERAGES, COVERAGE A destruction but does not include disappearance, BODILY INJURY AND PROPERTY DAMAGE theft, or loss of use. LIABILITY, coverage is extended to include the NON-OWNED WATERCRAFT following: SECTION I - COVERAGES, COVERAGE A If a customer's master or grand key, excluding BODILY INJURY AND PROPERTY DAMAGE electronic key card, is lost while in your care, LIABILITY, 2. Exclusions is amended as follows: custody or control we will pay the cost of g. Aircraft, Auto Or Watercraft (2) (a) is replacing the keys, including the master lock and replaced with: all keys used in the same lock, the cost of (a) Less than 51 feet long; and adjusting locks to accept the new keys, or the cost to replace the locks, whichever is less. EXPANDED PROPERTY DAMAGE COW Limit of Insurance - The most we will pay for ERAGE "loss" arising out of any one "occurrence" is For the purposes of this endorsement only: $5,000. SECTION I - COVERAGES, COVERAGE A SECTION V DEFINITIONS is amended as BODILY INJURY AND PROPERTY DAMAGE follows: LIABILITY, 2. Exclusions is amended as follows: The following definition applies to Lost Key a. Exclusions j.(3), j.(5), and j.(6) are Coverage: deleted in their entirety. "Loss" means unintentional physical damage or b. Exclusion j.(4) is deleted in its entirety destruction to tangible property, including theft or and replaced by the following: disappearance. Tangible property does not Personal property in the care custody or include money or securities. control of the insured: VOLUNTARY PROPERTY DAMAGE 1. for storage or sale at premises you SECTION I - COVERAGES, COVERAGE A own, rent or occupy; or BODILY INJURY AND PROPERTY DAMAGE 2. while being transported by any LIABILITY, coverage is extended to include the aircraft, "auto" or watercraft owned following: or operated by or rented to or loaned At your request, we will pay for "property damage" to to any insured. property of others caused by you and while in your c. The following exclusions are added: possession, arising out of your business operations 1. The coverage provided by this and occurring during the policy period. endorsement does not apply to Limit of Insurance - The most we will pay for "property damage" arising out of the "loss" arising out of any one "occurrence" is disappearance or loss of use of $500. personal property. SECTION V - DEFINITIONS is amended as 2. The coverage provided by this follows: endorsement does not apply to The following definition applies to Voluntary .'property damage" included in the Property Damage coverage: "products-completed operations hazard". CG 73 23 11 11 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 6 with its permission. s;:n Wilson BBN\y (4/8) 07/23/2014 11:08:23 AM -070( CG 73 23 11 11 Limit of Insurance - The most we will pay b. Up to $2,500 for cost of bail bonds for "property damage" provided by this required because of accidents or traffic coverage in any one "occurrence" is $5,000. law violations arising out of the use of Deductible - Our obligation to pay for a any vehicle to which the Bodily Injury covered loss applies only to the amount of Liability Coverage applies, We do not loss in excess of $250. have to furnish these bonds. This insurance is excess over any other valid 2. 1. d. replaced with: and collectible insurance. d. All reasonable expenses incurred by the DAMAGE TO PREMISES RENTED TO YOU insured at our request to assist us in the SECTION I -COVERAGES, COVERAGE A investigation or defense of the claim or "suit", including actual loss of earnings BODILY INJURY AND PROPERTY DAMAGE up to $500 LIABILITY, the last of 2. Exclusions a day because of time off paragraph from work. of is replaced by the following: If Damage to Premises Rented to You is NEWLY FORMED AND ACQUIRED ORGANIZATIONS not otherwise excluded, exclusions c. through n. do not apply to damage by fire, SECTION II - WHO IS AN INSURED is lightning, explosion, smoke or sprinkler amended as follows: leakage to premises while rented to you or 1. 3. a. is replaced with: temporarily occupied by you with permission a. Coverage under this provision is of the owner. A separate limit of insurance afforded only until the 180`h day after you applies to this coverage as described in acquire or form the organization or the Section III-Limits of Insurance. end of the policy period, whichever is SECTION III - LIMITS OF INSURANCE, earlier; paragraph 6 is replaced with: ADDITIONAL INSURED - WHEN REQUIRED 6. Subject to 5. above, the Damage To IN AN AGREEMENT OR CONTRACT WITH Premises Rented To You Limit is the most YOU PRIMARY AND NON-CONTRIBUTORY we will pay under Coverage A for damages The following is added to SECTION II -WHO IS because of "properly damage" to any one AN INSURED premises, while rented to you, or in the case 4. Any person(s) or organization(s) with whom of damage by fire, lightning, explosion, you have agreed in a valid written contract or smoke or sprinkler leakage, while rented to written agreement that such person or you or temporarily occupied by you with organization be added as an additional permission of the owner. The limit is insured on your policy during the policy increased to $300,000. period shown in the Declarations. Such SECTION IV - COMMERCIAL GENERAL person or organization is an additional LIABILITY CONDITIONS, 4. Other Insurance, insured only with respect to liability for b. Excess Insurance (1) (a) (ii) is replaced "bodily injury", "property damage" or with: "personal and advertising injury". (11) That is Fire, Lightning, Explosion, The person or organization added as an Smoke or Sprinkler leakage insurance insured by this endorsement is an insured for premises rented to you or temporarily only to the extent you are held liable due to: occupied by you with permission of the a. Lessors of Leased Equipment owner. Maintenance, operation or use of SUPPLEMENTARY PAYMENTS equipment leased to you by such person SECTION I - COVERAGES, SUPPLEMEN- or organization. This insurance does not TARY PAYMENTS - COVERAGES A AND B is apply to any "occurrence" which takes amended as follows: place after the equipment lease expires. 1. 1. b. replaced with: However, their status as additional insured under this policy ends when their lease, contract or agreement with you for such leased equipment expires. Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 11 11 with its permission. .icon Filson BBNW (5/8) 07/23/2014 11;09:21 AM -070( CG 73 23 11 11 b. Managers or Lessors of Premises The insurance does not apply to: The ownership, maintenance or use of (1) "bodily injury", "property damage", or that part of the premises you own, rent, "personal and advertising injury" arising lease or occupy. out of the rendering of or the failure to This insurance does not apply to: render any professional architectural, (1) Any "occurrence" which takes place engineering or survey services, after you cease to be a tenant in that including: premises. (a). The preparing, approving, or failing 2) Structural alterations, new con- to prepare or approve maps, shop ( struction or demolition operations drawings, opinions, reports, survey, performed by or on behalf of the field orders, change orders or drawings and specifications: or person or organization. However, their status as additional (b) Supervisory, inspection, architec- insured under this policy ends when you tural or engineering activities. cease to be a tenant of such premises. (2) "Bodily injury" or "property damage" c. State or Political Subdivision - occurring after: Permits (a) All work, including materials, parts or equipment furnished in Operations performed by you or on your connection with such work, on the behalf for which the state or political project (other than service, subdivision has issued a permit. maintenance or repairs) to be This insurance does not apply to: performed by or on behalf of the (1) "Bodily injury" "property damage" additional insured(s) at the location of the covered operations has been or "personal or advertising injury" completed; or arising out of operations performed for the state or municipality; or (b) That portion of "your work" out of which the injury or damage arises (2) "Bodily injury" or "property damage" has been put to its intended use by included within the "products- any person or organization other completed operations hazard". than another contractor or However, such state or political subcontractor engaged in subdivision's status as additional insured performing operations for a principal under this policy ends when the permit as a part of the same project. ends. However, a person or organization's d, Owners, Lessees, or Contractors status as additional insured under this "Bodily injury", "property damage" or policy ends when your operations for "personal and advertising injury" caused, in that additional insured are completed. whole or in part, by: With respect to paragraph 4 of SECTION II (1) Your acts or omissions; or WHO IS AN INSURED, Condition 4. Other Insurance of Section IV - Commercial (2) The acts or omissions of those acting on General Liability Conditions is replaced by the your behalf; following: in the performance of your ongoing 4. Other Insurance operations performed for that additional If other valid and collectible insurance is insured, whether the work is performed by available to the insured for a loss we cover you or on your behalf. under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: CG 73 23 11 11 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 6 with its permission. zsan )Wilson BBNW (6/8) 07/23/2014 11:10:14 AM -070( CG 73231111 (1) That this insurance be primary. If other insurance is also primary, we (2) When this insurance is excess, we will share with all that other will have no duty under Coverages A insurance as described in c. below; or B to defend the additional insured or against any "suit" if any other insurer (2) The coverage afforded by this has a duty to defend the additional insurance is primary and non- insured against that "suit". If no contributory with the additional other insurer defends, we will insured's own insurance. undertake to do so, but we will be entitled to the additional insured's Paragraphs (1} and (2) do not apply rights against all those other to other insurance to which the insurers. additional insured has been added as an additional insured or to other (3) When this insurance is excess over insurance described in paragraph b. other insurance, we will pay only our below. share of the amount of the loss, if any, that exceeds the sum of: b. Excess Insurance (a) The total amount that all such This insurance is excess over: other insurance would pay for (1) Any of the other insurance, whether the loss in the absence of this primary, excess, contingent or on insurance; and any other basis: (b) The total of all deductible and (a) That is Fire, Extended self-insured amounts under all Coverage, Builder's Risk, that other insurance. Installation Risk or similar (4) We will share the remaining loss, if coverage for "your work"; any, with any other insurance that is (b) That is fire, lightning, or not described in this Excess explosion insurance for Insurance provision and was not premises rented to you or bought specifically to apply in temporarily occupied by you with excess of the Limits of Insurance permission of the owner; shown in the Declarations of this (c) That is insurance purchased by Coverage Part. you to cover your liability as a c. Method Of Sharing tenant for "property damage" to If all of the other insurance available to premises rented to you or the additional insured permits temporarily occupied by you with contribution by equal shares, we will permission of the owner; or follow this method also. Under this (d) If the loss arises out of the approach each insurer contributes equal maintenance or use of aircraft, amounts until it has paid its applicable "autos" or watercraft to the limit of insurance or none of the loss extent not subject to Exclusion remains, whichever comes first. g. of Section I - Coverage A - If any of the other insurance available to Bodily Injury And Property the additional insured does not permit Damage Liability. contribution by equal shares, we will (e) That is any other insurance contribute by limits. Under this method, available to an additional each insurer's share is based on the insured under this endorsement ratio of its applicable limit of insurance to covering liability arising out of the total applicable limits of insurance of the premises or operations, or all insurers. products completed operations, for which the additional insured has been added as an additional insured by that other insurance. Page 4 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 7323 11 11 with its permission. .isan \lilson BBNUT (7/8) 07/23/2014 11:11:06 AM -070( CG 73 23 11 11 EMPLOYEE BODILY INJURY TO ANOTHER MEDICAL PAYMENTS EMPLOYEE SECTION III - LIMITS OF INSURANCE, SECTION II - WHO IS AN INSURED The Paragraph 7. is replaced: following Paragraph is added to 2.a.(1) 7. Subject to 5. above, the higher of: Paragraphs 2.a.(1)(a), (b) and (c) do not a. $10,000; or apply to "bodily injury" to a co-"employee" in b. The amount shown in the Declarations the course of the co-"employee's" for Medical Expense Limit is the most employment by you, or to "bodily injury" to a co-"volunteer worker" while performing we will pay under Coverage C for all duties related to the conduct of your medical expenses because of "bodily injury' sustained by one person, business. BROAD FORM NAMED INSURED This coverage does not apply if Coverage C - SECTION II - WHO IS AN INSURED The Medical Payments is excluded either by the provisions of any coverage forms attached to the following Paragraph is added to 2. policy or by endorsement. e. Any business entity incorporated or KNOWLEDGE OF AN OCCURRENCE organized under the laws of the United State SECTION IV - COMMERCIAL GENERAL of America (including any State thereof), its or Canada LIABILITY CONDITIONS, The following is added territories or possessions (including any Province thereof) in which the to 2. Duties In The Event Of Occurrence, Named Insured shown in the Declarations Offense, Claim Or Suit condition: owns, during the policy period, an interest of e. Knowledge of an occurrence, offense, claim more than fifty percent. If other valid or suit by an agent or employee of any collectible insurance is available to any insured shall not in itself constitute business entity covered by this solely by knowledge of the insured unless you, a reason of ownership by the Named Insured partner, if you are a partnership; or an shown in the Declarations in excess of fifty executive officer or insurance manager, if percent, this insurance is excess over the you are a corporation receives such notice of other insurance, whether primary, excess, an occurrence, offense, claim or suit from contingent, or on any other basis. the agent or employee. AGGREGATE LIMIT PER LOCATION f. The requirements in Section IV - SECTION III - LIMITS OF INSURANCE The Conditions Paragraph 2.b. will not be following paragraph is added to paragraph 2: considered breached unless there is The General Aggregate Limit under Section knowledge of occurrence as outlined in III Limits of Insurance applies separately to paragraph e. above. each of your locations owned by or rented to UNINTENTIONAL FAILURE TO DISCLOSE you or temporarily occupied by you with the HAZARD permission of the owner. For the purposes of SECTION IV - COMMERCIAL GENERAL this provision, location means premises LIABILITY CONDITIONS, 6. Representations is involving the same or connecting lots, or amended to include: premises whose connection is interrupted d. Your failure to disclose all hazards or prior only by a public street, roadway, waterway or "occurrences" or offenses existing as of the railroad right-of-way. inception date of the policy shall not AGGREGATE LIMIT PER PROJECT prejudice the coverage afforded by this SECTION III - LIMITS OF INSURANCE The policy provided such failure to disclose all following paragraph is added to paragraph 2: hazards or prior "occurrences" or offenses is The General Aggregate Limit under Section not intentional. This provision does not III Limits of Insurance applies separately to affect our right to collect additional premium each of your construction projects away from or exercise our right of cancellation or non- premises owned by or rented to you. renewal. CG 73 23 11 11 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 6 with its permission. zsan Wilson BBNW (8/8) 07/23/2014 11:12:05 AM -070( CG 73231111 WAIVER OF SUBROGATION BROADENED BODILY INJURY DEFINITION SECTION IV - COMMERCIAL GENERAL (MENTAL ANGUISH) LIABILITY CONDITIONS, 8. Transfer of Rights SECTION V - DEFINITIONS is amended as of Recovery Against Others to Us is amended follows: to include: 1. 3. "Bodily injury" is deleted and replaced with If required by a written contract executed the following: prior to loss, we waive any right of `Bodily injury' means physical injury, subrogation we may have against the sickness or disease to a person and, if contracting person or organization because arising out of the foregoing, mental anguish, of payments we make for injury or damage mental injury, shock or humiliation, including arising out of your ongoing operations or death at any time resulting therefrom. "your work" done under a contract with that person or organization and included in the "products-completed operations hazards". LIBERALIZATION SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 10. Liberalization is added as follows: If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. All terms and conditions of this policy apply unless modified by this endorsement. Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 11 11 with its permission. -an Wilson BBNW (1/8) 07/23/2014 11:05:53 AM --070( % -Brawn. ;Brawl a N0 TH E T DATE: 07/23/2014 11:05:09 AM -0700 Attention: City of Ashland From: Susan Wilson Organization: I Fax Number: 541-494-2758 Fax Number: 541-488-5311 ;Phone Number: 541-494-2658 Phone Number: Email: swilson@bbnw.com Num Pages Including Cover:8 COMMENTS: Following is certificate requested for S&S Sheetmetal, Inc. Please contact me if you have any question or concern. Thank you. c/ Brown and Brown Northwest Oregon I Washington Toll Free 800-654-5565 Fax 503-274-0323 bbnwmail@bbnw.com www.bbnw.com