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HomeMy WebLinkAboutInsurance Certificate: Day Wireless Systems c~ : _a--.cam. - YY`~w-). t-~ l ~ j ~t~l ~ - ~Ac DAYMANA-01 KELLIL ACORO~ CERTIFICATE OF LIABILITY INSURANCE DATE 1 (0MMIDDMM/DD/YYYY) 4 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 -NAME: Julie Douglas Durham and Bates Agencies, Inc. PHONE FAX 720 SW Washington St. Ste250 ACA Lo EXt : (503) 224-5170 A/c No): (503) 221-0540 Portland, OR 97205 ADDRESS: julied@dbates.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Atlantic Specialty Ins. Co. 27154 INSURED INSURER B : Hartford Day Management Corporation dba: Day Wireless Systems INSURER C : 4700 SE International Way INSURER D : Milwaukie, OR 97222 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 TYPE OF INSURANCE I DL UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 X OCCUR 711014061-0001 10/01/2014 10101/2015 DAMAGE T RENTED REMISES Ea occurrence $ 1,000,00 CLAIMS-MADE _P X $1,000,000 Umbrella MED EXP (Any one person) $ 10,00 X Washington Stop Gap PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY F PRO- JECT a LOC PRODUCTS - COMP/OP AGG $ 2,000,00 OTHER: WA Emplrs Liab $ 500,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO 711014061-0001 10/01/2014 10/0112015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER To EMPLOYERS' LIABILITY STATUTE o B ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N N /A 52WELN9641 10/01/2014 10/01/2015 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See attached forms VCG245 02 05 Additional Insured-Designated Person or Organization; VCG207 07 09 Vantage for General Liability Technology Companies; VCA 201 01 09 Vantage for Automobile; and CA0001 0413 Business Auto Coverage (Other Insurance). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks ofACORD POLICY NUMBER: 711014061-0001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VANTAGE FOR GENERAL LIABILITY TECHNOLOGY COMPANIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provisions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured - Broad Form Vendors 8. Coverage Territory - Worldwide 2. Additional Insured - by Contract, Agreement or 9. Duties in Event of Occurrence, Claim or Suit Permit relating to: 10. Expected or Intended Injury (PD) o Work performed by you 11. Incidental Medical Malpractice o Premises you own, rent, lease or occupy 12. Medical Payments o Equipment you lease 13. Mobile Equipment Redefined 3. Aggregate Limit Per Location 14. Newly Acquired or Formed Organizations 4. Blanket Waiver of Subrogation 15. Non-Owned Aircraft 5. Bodily Injury Redefined - Mental Anguish 16. Non-Owned Watercraft 6. Broadened Named Insured 17. Personal and Advertising Injury 7. Broadened Property Damage 18. Product Recall Expense o Borrowed Equipment 19. Supplementary Payments Increased Limits o Customers' Goods o Use of Elevators 1. ADDITIONAL INSURED - BROAD FORM VENDORS Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to below as vendor) with whom you agreed in a written contract or agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: a. This provision 1. does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty not authorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (8) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (a) The exceptions contained in Subparagraphs 4. or 6.; or VCG 207 07 09 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 7 Copyright 2009, OneBeacon Insurance Group LLC PRODUCER (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (9) Any vendor, person or organization if the "products-completed operations hazard" is excluded either by the provisions of the Coverage Form or by endorsement. b. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 2. ADDITIONAL INSURED -CONTRACT, AGREEMENT OR PERMIT a. Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organi- zation(s) with whom you agreed in a written contract, written agreement or permit to provide insurance such as is afforded under this Coverage Part, but only with respect to Iiabirity for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of "your work" for the additional insured(s) at the location designated in the contract, agreement or permit; or 2. In the maintenance, operation or use of equipment leased to you by such person (s) or organization (s), or 3. In connection with premises you own, rent, lease or occupy. This insurance applies on a primary or primary and non-contributory basis if that is required in writing by the contract, agreement or permit. b. The insurance provided to the additional insured herein is limited. This insurance does not apply: 1. Unless (a) the written contract, agreement or permit is currently in effect or becomes effective during the term of this policy; and (b) the contract or agreement was executed or permit issued prior to the "bodily injury", "property damage", or "personal and advertising injury"; 2. To any person or organization included as an insured under the Additional Insured - Broad Form Vendors provision of this endorsement; 3. To any person or organization included as an insured by an endorsement issued by us and made part of this Coverage Part; 4. To any person or organization if the "bodily injury", "property damage", or "personal and advertising injury" arises out of the rendering of or failure to render any professional architectural, engineering or surveying services by or for you including: (a) The preparing, approving, or fairing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. 5. To any: (a) Lessor of equipment after the equipment lease terminates or expires; or (b) Owners or other interests from whom land has been leased; or (c) Managers or lessors of premises if. (1) The "occurrence" takes place after you cease to be a tenant in that premises; or (2) The "bodily injury", "property damage", "personal and advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. 6. To "bodily injury, or "property damage" occurring after: (a) All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the site of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. Page 2 of 7 Includes copyrighted material of Insurance Services Office, Inc. VCG 207 07 09 Copyright 2009, OneBeacon Insurance Group LLC c. Limits of Insurance applicable to the additional insured are those specified in the contract, agreement or permit or in the Declarations of this policy, whichever is less, and fix the most we will pay regardless of the number of: 1. Insureds; 2. Claims made or "suits" brought; or 3. Persons or organizations making claims or bringing "suits". These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. 3. AGGREGATE LIMIT PER LOCATION a. Under Section III - Limits of Insurance, the General Aggregate Limit applies separately to each of your "locations" owned by or rented or leased to you. b. Under Section V - Definitions, the following definition is added: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 4. BLANKET WAIVER OF SUBROGATION Section IV - Transfer of Rights of Recovery Against Others to Us Condition is amended to add the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations done under a written contract or agreement with that person or organization and included in "your work" or the "products-completed operations hazard". This waiver applies only to persons or organizations with whom you have a written contract, executed prior to the "bodily injury" or "property damage", that requires you to waive your rights of recovery. 5. BODILY INJURY REDEFINED - MENTAL ANGUISH Under Section V, the definition of "bodily injury" is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time. 6. BROADENED NAMED INSURED Section 11- Who Is An Insured is amended to include as an insured the following: Any organization which is a legally incorporated entity in which you own a financial interest of more than 50 percent of the voting stock on the effective date of this endorsement will be a Named Insured until the 180th day or the end of the policy period, whichever comes first, provided there is no other similar insurance available to that organization. The insurance afforded herein does not apply to any entity which is also an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. 7. BROADENED PROPERTY DAMAGE - BORROWED EQUIPMENT, CUSTOMERS' GOODS AND USE OF ELEVATORS The insurance for "property damage" liability is subject to the following: a. The Damage To Property exclusion under Section I Coverage A is amended as follows: 1. The exclusion for personal property in the care, custody or control of the insured does not apply to "property damage" to equipment you borrow while at a job site and provided it is not being used by anyone to perform operations at the time of loss. 2. The exclusions for (a) Property loaned to you; (b) Personal property in the care, custody or control of the insured; and (c) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it do not apply to "property damage" to "customers' goods" while on your premises nor do they apply to "property damage" arising from the use of elevators at premises you own, rent, lease or occupy. Subject to the Each Occurrence Limit, the most we will pay for "property damage" to "Customers' Goods" is $35,000 per "occurrence". VCG 207 07 09 Includes copyrighted material of Insurance Services Office, Inc. Page 3 of 7 Copyright 2009, OneBeacon Insurance Group LLC b. Under Section V - Definitions, the following definition is added: "Customers' Goods" means goods of your customer on your premises for the purpose of being: 1. Repaired; or 2. Used in your manufacturing process. c. The insurance afforded by this provision is excess over any other valid and collectible property insurance (including any deductible) available to the insured whether such insurance is primary, excess, contingent or on any other basis. Any payments by us will follow the Other Insurance - Excess provisions in the COMMERCIAL GENERAL LIABILITY CONDITIONS. 8. COVERAGE TERRITORY- WORLDWIDE The definition of "coverage territory" is replaced by the following: "Coverage territory" means anywhere provided the insured's responsibility to pay damages must be determined in a settlement we agree to or in a "suit" on the merits brought within the United States of America (including its territories and possessions), Puerto Rico or Canada. 9. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Section IV - Duties In The Event Of Occurrence, Claim or Suit is amended by adding the following paragraphs: a. The requirements that you must 1. notify us of an "occurrence" offense, claim or "suit" and 2. send us documents concerning a claim or "suit" apply only when such "accident" claim, "suit" or "loss" is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An executive officer of the corporation or insurance manager, if you are a corporation; or 4. A manager, if you are a limited liability company. b. The requirement that you must notify us as soon as practicable of an "occurrence" or an offense that may result in a claim does not apply if you report an "occurrence" to your workers compensation insurer which later develops into a liability claim for which coverage is provided by this policy. However, as soon as you have definite knowledge that the particular "occurrence" is a liability claim rather than a workers compensation claim, you must comply with the Duties In The Event Of Occurrence, Offense, Claim Or Suit Condition. 10. EXPECTED OR INTENDED INJURY (PROPERTY DAMAGE) The Expected Or Intended Injury exclusion under Coverage A Bodily Injury and Property Damage is replaced by: "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 11. INCIDENTAL MALPRACTICE -EMPLOYED PHYSICIANS, NURSES, EMT'S AND PARAMEDICS a. Under Section II - Who Is An Insured, the paragraph that excludes an employee or volunteer worker as insured for "bodily injury" or "personal and advertising injury" arising out of his or her providing or failing to provide professional health care services does not apply to a physician, dentist, nurse, emergency medical technician or paramedic employed by you if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x-ray or nursing services. b. The insurance afforded by this provision is excess over any other valid and collectible insurance whether such insurance is primary, excess, contingent or on any other basis. Any payments by us will follow the Other Insurance - Excess Insurance provisions in the COMMERCIAL GENERAL LIABILITY CONDITIONS. 12. MEDICAL PAYMENTS -INCREASED LIMITS AND TIME PERIOD In the Insuring Agreement under Coverage C - Medical Payments, the requirement that expenses are incurred and reported to us within one year of the date of the accident is changed to three years. a. The Medical Expense Limit is $15,000 per person or the amount shown in the Declarations as the Medical Expense Limit, whichever is greater. b. This provision 12. does not apply if Coverage C - Medical Payments is otherwise excluded either by the provisions of the Coverage Form or by endorsement. Page 4 of 7 Includes copyrighted material of Insurance Services Office, Inc. VCG 207 07 09 Copyright 2009, OneBeacon Insurance Group LLC I-'ULIUY NUIVIbr-N* /_1IUl4U01-UUUU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. a@VANTAGE FOR AUTOMOBILE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provi- sions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured By Contract 12. Employee Hired Autos 2. Airbag Discharge 13. Fellow Employee Exclusion 3. Auto Theft Reward 14. Glass Repair - Waiver of Deductible 4. Blanket Waiver of Subrogation 15. Hired Auto Physical Damage Coverage 5. Bodily Injury Redefined - Mental Anguish 16. Lease Gap Coverage 6. Broad Form Named Insured 17. Liability Coverage - Supplementary Payments 7. Communications Equipment 18. Newly Formed or Acquired Organizations 8. Diminution in Value 19. Physical Damage - Transportation Expenses 9. Drive Other Car - Executive Officers 20. Rental Reimbursement - Private Passenger 10. Duties In The Event of Accident, Claim, Suit or Loss Vehicles 11. Employees As Insureds 21. Towing - An Covered Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is An Insured provision under SECTION II - LIABILITY COVERAGE is amended to include as an additional "insured" any person or organization with whom you agreed in a written contract, written agreement or permit, to provide insurance such as is afforded under this Coverage Form. Such person or organization is an "insured" only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part by your maintenance, operation or use of your covered "autos". With respect to the insurance afforded to these additional "insureds", this insurance does not apply: a. Unless the written contract or agreement has been executed or the permit has been issued prior to the "bodily injury" or "property damage"; b. To any person or organization included as an "insured" by endorsement or in the Declarations; or c. To any lessor of "autos" when their contract or agreement with you for such leased "auto" ends. 2. AIRBAG DISCHARGE If you purchased physical damage coverage for a covered "auto" under this policy, we will pay to reset or re- place an airbag that accidentally discharges without the vehicle being involved in an accident. No deductible applies to this additional coverage. However, this coverage only applies if the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and con- viction of anyone stealing a covered "auto". A reward will not be paid to you, a family member, employee or any public official while performing their duty. 4. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights of Recovery Against Others To Us condition under SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A. LOSS CONDITIONS is replaced by the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract", provided the contract is in writing and executed prior to the "bodily injury" or "property damage". 5. BODILY INJURY REDEFINED - MENTAL ANGUISH The definition of "bodily injury" under SECTION V - DEFINITIONS is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time. VCA 201 01 09 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 5 Copyright 2004, OneBeacon Insurance Group LLC ppnnl Irro POLICY NUMBER: 711014061-0001 b. Return the stolen property, at our expense. 5. Other Insurance We will pay for any damage that results to a. For any covered "auto" you own, this cov- the "auto from the theft; or erage form provides primary insurance. c. Take all or any part of the damaged or For any covered "auto" you don't own, the stolen property at an agreed or appraised insurance provided by this coverage form value. is excess over any other collectible insur- If we pay for the "loss", our payment will ance. However, while a covered "auto" include the applicable sales tax for the which is a "trailer" is connected to another damaged or stolen property. vehicle, the Liability Coverage this cov- erageform provides for the "trailer" is: 5. Transfer Of Rights Of Recovery Against (1) Excess while it is connected to a Others To Us motor vehicle you do not own. If any person or organization to or for whom we make payment under this coverage form (2) Primary while it is connected to a cov- has rights to recover damages from another, ered "auto" you own. those rights are transferred to us. That person b. For Hired Auto Physical Damage Cover- or organization must do everything necessary age, any covered "auto" you lease, hire, to secure our rights and must do nothing after rent or borrow is deemed to be a covered "accident" or "loss" to impair them. "auto" you own. However, any "auto" that B. General Conditions is leased, hired, rented or borrowed with a driver is not a covered "auto". 1'. Bankruptcy c. Regardless of the provisions of Bankruptcy or insolvency of the "insured" or Paragraph a. above, this coverage form's the "insured's" estate will not relieve us of any Liability Coverage is primary for any liability obligations under this coverage form. assumed under an "insured contract". 2. Concealment, Misrepresentation Or Fraud d. When this coverage form and any other This coverage form is void in any case of fraud coverage form or policy covers on the by you at any time as it relates to this coverage same basis, either excess or primary, we form. It is also void if you or any other will pay only our share. Our share is the "insured", at any time, intentionally conceal or proportion that the Limit of Insurance of misrepresent a material fact concerning: our coverage form bears to the total of a. This coverage form; the limits of all the coverage forms and policies covering on the same basis. b. The covered "auto"; 6. Premium Audit c. Your interest in the covered "auto"; or a. The estimated premium for this coverage d. A claim under this coverage form. form is based on the exposures you told 3. Liberalization us you would have when this policy If we revise this coverage form to provide began. We will compute the final premium more coverage without additional premium due when we determine your actual charge, your policy will automatically provide exposures. The estimated total premium the additional coverage as of the day the will be credited against the final premium revision is effective in your state. due and the first Named Insured will be billed for the balance, if any. The due 4. No Benefit To Bailee - Physical Damage date for the final premium or retrospective Coverages premium is the date shown as the due We will not recognize any assignment or date on the bill. If the estimated total grant any coverage for the benefit of any premium exceeds the final premium due, person or organization holding, storing or the first Named Insured will get a refund. transporting property for a fee regardless of b. If this policy is issued for more than one any other provision of this coverage form. year, the premium for this coverage form will be computed annually based on our rates or premiums in effect at the beginning _ of each year of the policy. rn an ni ns in n i~~. ~o cep, nK a manna o