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HomeMy WebLinkAboutInsurance Certificate: Ashland Flower Shop & Green Houses ■ ■ United Pisk- Fax SysFa, (803) 78^0-6147 To: 54148^05311@ICfax.cen Fax: +15414885311 Page 1 of 120412212015 2:02 PM ASHL05W OP ID: KCF DATE(MM/DDNYYY) F r■~''°'~ CERTIFICATE OF LIABILITY INSURANCE ■ 04122/2015 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 NAMEACT KC Ferguson United Risk Solutions, Inc. PHONE FAx PO Box 936 we No Exc : 541494-7752 A/c, No): 541-245-1112 Medford, OR 97501-0067 E-MAIL ADDRESS: kc-ferguson@unitedrisk.com Cindi L. Jayubo, CIC, CRM INSURER(S) AFFORDING COVERAGE NAIC INSURER A: SAIF Corporation INSURED Ashland Flower Shop INSURER B : and Green Houses, Inc. 87 W Nevada St. INSURER C Ashland, OR 97520-1027 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. EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM/DDlYYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCUP,P.ENCE COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1:1 OCCJR MED EXP (Any one per-on) $ PERSONAL & ADV INJURY $ GENERAL AC GREGATE $ GENTL AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acaden[ $ ANY AUTO BODILY INJURY (Perperson) ALL OWNED SCHEDULED BODILY INJ_RY;Per 3ccden[) $ AUTOS AUTOS F NON-OWNED PROPERTY DUMAGE $ PER ACCIDENT HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X VNC STPSU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER _ A ANY PROPPIETOR/PARTNERIEXECUTIVEY/N 764581 09/01/2014 09/01/2015 EL EACH ACCIDENT $ 500,00 OFFICERPOEMBER EXCLUDE D~ N/A (Mandatory in NH) EL DISEASE -EAEMPLOYEE$ 500,00 IFye~ de3?nbe under DECRIPTIONOFOPERATIOIJSLel,ve EL DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: All Operations of the named insured CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VNLL BE DELIVERED IN City of Ashland ACCORDANCE VATH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520-1814 AUTHORI2ED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD From: United Risk- Fax Sys Far.: (888) 788-6147 To: 5414885311@icfax.con Fax: +15414885311 Page 2 of 120412212015 2:02 PM ASHL05C OP ID: TMR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/22/2015 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). CONTACT PRODUCER NAME: Therese Rayburn United Risk Solutions, Inc. PHONE 541-494-7751 nrc, No): 541-245-1112 PO Box 936 we No Eld ADDRESS: therese.raY`~,,~{",,urn unitedrisk.com Medford, OR 97501-0067 E-MAIL INSURER(S) AFFORDING COVERAGE NAIL # INSURERA : Depositors Insurance 42587 INSURED Ashland Flower Shop & INSURERB : Green Houses, Inc. INSURER C dba: Carol's Colors 87 W. Nevada St. INSURERD: Ashland, OR 97520-1027 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 ADDL SU8 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C A X COMMERCIAL GENERAL LIABILITY X ACP7535236230 0910112014 09/01/2015 PREMISES Ea occurrence $ _ 100,00 CLAIMS-MADE [A] OCCUR MED EXP (Airy one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,00 X POLICY PRO- LOC $ COMINED AUTOMOBILE LIABILITY ((Ea acc dent SINGLE LIMIT $ 1,000,00 B X ANYAUTO X ACP7535236230 09/0112014 09/0112015 BODILY INJURY (Per person) S ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ $ DIED RETENTION $ WORKERS COMPENSATION WC STATU OTI-I AND EMPLOYERS' LIABILITY Y/ N TORY LIMITS ER AfJYPROPP,,IETOR/PARTfJER/E)tECUTIVE ❑ EL EACH ACCIDENT $ _ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) EL _ DISEASE - EA EMPLOYEE $ - If yes, desci ibe under DESCRIPTION OF OPERATIONS below E_L_ DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) General Liability additional insured coverage on a primary & noncontributory basis and auto liability additional insured coverage is included when required by a written contract subject to policy forms, CG7323(11/11) and ACO102(03/10). All coverage is subject to policy terms conditions and exclusions. CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Fiom: United Risk -Fax Sys Fax: (888) 78^0-6147 To: 54148^05311@icfav.con Fax: +15414885311 Page 3 of 120412212015 2:02 PM 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 COV- 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 1 - 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 SE=CTION 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 mill 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 and occurring during the policy period. 1. The coverage provided by this Limit of Insurance - The most we will for endorsement does not apply to pay "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 2311 11 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 6 with its permission. ACP MCT07515236230 L6CR 12236 INSURED COPY 75 002 Fiom: United P.isk- Fax Sys Fax: (888) 788-6147 To: 5414^0^05311@icfax.con Fax: +15414885311 Page 4 of 1204/22/2015 2:02 PM 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 paragraph of 2. Exclusions a day because of time off of is replaced by the following: from work. If Damage to Premises Rented to You is NEWLY FORMED AND ACQUIRED not otherwise excluded, exclusions c. ORGANIZATIONS 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 180th 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 D NON-CONTRIBUTORY we will pay under Coverage A for damages The following is added to SECTION II - WHO IS because of "property damage" to any one AN INSURED premises, while rented to you, or in the case 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 sigh: "personal and advertising injury" (il) 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, SUPPLEMEW 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. ACV MCT07515 L6CR 12236 INSURED COPY 75 0028205 Rom: United Risk- Fax Sys Fax: (828) 738-6147 To: 5414885311@rcfax.con Fax: +15414885311 Page 5 of 120412212015 2:02 PM 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 drawings, opinions, reports, survey, struction or demolition operations field orders, change orders or performed by or on behalf of the 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" occurring after: c. State or Political Subdivision (a) All work, including materials, parts Permits 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" or "property damage" additional insured(s) at the location or "personal or advertising injury" of the covered operations has been arising out of operations performed completed; or 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 It (1) Your acts or omissions; or WHO IS 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 2311 11 Includes copyrighted material of Insurance Services Office, Inc., Image 3 of 6 with its permission. ACP MCT07545236= L6CR 12236 INSURED COPY 75 00 Flom: United Risk- Fax Sys Fax: (886) 788-6147 To: 5414885311@icf3..con Fax: +15414885311 Page 6 of 120412212015 2:02 PM CG 73 23 11 11 (1) That this insurance be primary. It 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 Paragraphs (1) and (2) do not apply entitled to the additional insured's to other insurance to which the rights against all those other additional insured has been added insurers. 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 b. Excess Insurance any, that exceeds the sum of: This insurance is excess over: (a) The total amount that all such 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 Eire, 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. ACP MCT07616236230 L6CR 12235 INSURED CORY 75 7 From: United Risk- Fax SysFax: (888) 78^0-6147 To: 54148^05311@icfax,cor Fax: +15414885311 Page 7 of 12 04/22/201 5 2:02 PM CG 73 2311 11 EMPLOYEE BODILY INJURY TO ANOTHER MEDICAL PAYMENTS EMPLOYEE SECTION fit - 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 business, injury" sustained by one person. BROAD FORM NAMED INSURED This coverage does not apply if Coverage C - SECTION 11 - WHO IS AN INSURED The Medical Payments is excluded either by the fallowing Paragraph is added to 2. provisions of any coverage farms attached to the 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 LIABILITY CONDITIONS, The following is added territories or possessions or Canada (including any Province thereof) in which the to 2. Duties In The Event Of Occurrence, Named Insured shown in the Declarations Offense, Claire Or Snit n ilition: awns, during the policy period, an interest of e. Knowledge of an occurrence, offense, claim more than fifty percent. If ether 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 L The requirements in Section IV - SECTION III - LIMITS OF INSURANCE The Conditions Paragraphs 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 prevision 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 2311 11 Includes copyrighted material of Insurance Services Office, inc., Page 5 of 6 with its permission. ACP i1ACT07616235230 L6CR 12236 INSURED COPY 75 Fiom: United Risk- Fax Sys Fax: (8^08) 7^0^0-6147 To: 5414885311@icfax.con Fax: +15414885311 Page 8 of 1204122/2015 2:02 PM CG 73 23 11 11 WAJVER OF SUBROGATION BROADENED BODILY INJURY DEFINITION SECTION IV - COMMERCIAL GENERAL (MENTAL ANGUISH) LIABILITY CONDITIONS, S. 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 anytime 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. Pave 6 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 11 11 with its permission. ACP MCT07515236230 LSCR 12236 INSURED COPY 75 Fiom: United P,isk- Fa)< Sys Fax: (888) 735-6147 To: 5414385311@rcfax.con Fax: +15414385311 Page 9 of 1204/2212015 2:02 PM COMMERCIAL AUTO AC 01020310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM A. CHANGES FOR TRAILERS AND FARM rental of a vehicle is an "insured" for Liability EQUIPMENT Coverage, but only to the extent that person 1. Under the COVERED AUTOS SECTION, or organization qualifies as an "insured" un- the following are added to Paragraph C. der the Who Is An Insured Provision con- Certain Trailers, Mobile Equipment and tained in the LIABILITY COVERAGE SECTION of the Coverage Form Temporary Substitute Autos: 4. "Trailers" designed to be towed by a pri- D. REPLACED EXCLUSIONS vate passenger type "auto" or a pickup, The Expected or Intended Injury Exclusion panel truck or van if not used for busi- in the LIABILITY COVERAGE SECTION is ness purposes, other than farming or replaced by the following: ranching. Expected or Intended Injury 5. Farm wagons or farm implements while "Bodily injury" or "property damage" which is being towed by a covered "auto". expected or intended by the "insured". This B. CHANGES FOR ADDITIONAL NEWLY exclusion applies even if the resulting "bodi- ACQUIRED VEHICLES ly injury" or "property damage": 2. Paragraph B.2 of the COVERED AUTOS a. is of a different kind, quality or degree SECTION is replaced by the following: than initially expected or intended; or 2. If Symbol(s) 7 or 67 is entered next to b. is sustained by a different person, entity, coverage in Item Two of the Declara- real property, or personal property than tions, an "auto" you acquire will be a that initially expected or intended. covered "auto" for that coverage only if: E. ADDITIONAL EXCLUSIONS a. We already cover at least one "auto" The following exclusions are added to the you own for that coverage or it rep- LIABILITY COVERAGE SECTION: laces an "auto" you previously Damage to Named Insured's Property owned that had that coverage; and b. You tell us within 30 days after you Any claim or "suit" for "property damage" by acquire it that you want us to cover you or on your behalf against any other per- acquire coverage- son or entity that is also a Named Insured it for that under this policy. The most we will pay for Physical Damage Abuse or Molestation Coverage for "loss" under this Coverage Ex- tension is $100,000 per "auto", subject to "Bodily injury" or "property damage" arising the largest deductible applicable to any "au- out of: to" for that Coverage. a. The actual or threatened abuse or C. BLANKET ADDITIONAL INSURED molestation by anyone or any person Any person or organization which you have while in the care, custody or control of agreed to name as an additional insured in a any "insured", or written contract, executed prior to an acci- b. The negligent: dent, other than a contract for the lease or 1) Employment, AC 01 02 0310 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 4 with its permission. From: United P,isk- Fax Sys Fax: (803) 78^0-6147 To: 54148^05311@icfax.cor Fax: +15414885311 Page 10of 1204122/2015 2:D2 PM AC 01 02 03 10 2) Investigation, This insurance does not apply to, 3) Supervision; a. "Loss" to the covered "auto's' contents, 4) Reporting to the proper authorities, except equipment usual to trucks or pri- or failure to so report; or vate passenger "autos". 5) Retention, b. "Loss" to TV antennas, awnings or ca- of a person for whom any "insured" is or banas. ever was legally responsible and whose c. "Loss" to equipment designed to create conduct would be excluded by Para- added living facilities. graph a. above. However, these exclusions do not apply if Abuse means an act which is committed Miscellaneous Personal Property Coverage with the intent to cause harm. is provided by endorsement to this policy. Explosives G. ACCIDENTAL AIRBAG DISCHARGE "Bodily injury" or "property damage" caused COVERAGE by the explosion of explosives you make, Under Paragraph B.3.a. of the PHYSICAL sell or transport. DAMAGE SECTION, the following is added: Rolling Stores Mechanical breakdown does not include the ac- If a covered "auto" is a rolling store, "bodily cidental discharge of an airbag. injury" or "property damage" resulting from H. PHYSICAL DAMAGE LIMIT OF INSURANCE the handling, use or condition of any item Under PHYSICAL DAMAGE COVERAGE the "insured" makes, sells or distributes if SECTION, Paragraph C_, Limit of Insurance is the injury or damage occurs after the "in- replaced by the following: sured" has given up possession of the item. C. Limit Of Insurance Wrong Delivery of Liquid Products 1. The most we will pay for "loss" in any "Bodily injury" or "property damage" result- one "accident" is the lesser of: ing from the delivery of any liquid into the a. The actual cash value of the damaged wrong receptacle or to the wrong address, or stolen property as of the time of the or from the delivery of one liquid for another, "loss", or if the "bodily injury" or "property damage" b. The cost of repairing or replacing the occurs after the delivery has been com- damaged or stolen property. pleted. Delivery is considered completed even if fur- 2. $1,000 is the most we will pay for "loss" in ther service or maintenance work, or correc- any one "accident" to all electronic equip- tion, repair or replacement is required be- ment that reproduces, receives or transmits cause of wrong delivery. audio, visual or data signals which, at the time of "loss", is: Professional Services a. Permanently installed in or upon the "Bodily injury": covered "auto" in a housing, opening or a. Resulting from the providing or the fail- other location that is not normally used ure to provide any medical or other pro- by the "auto" manufacturer for the instal- fessional services. lation of such equipment. b. Resulting from food or drink furnished b. Removable from a permanently installed with these services. housing unit as described in Paragraph "Bodily injury" or "property damage" result- 2.a. above or is an integral part of that ing from the handling of corpses. equipment; or F. MOTOR HOME CONTENTS COVERAGE c. An integral part of such equipment. 1. For a covered "auto" that is a motor home 3. An adjustment for depreciation and physical the following exclusions are added to the condition will be made in determining actual PHYSICAL DAMAGE COVERAGE cash value in the event of a total "loss". SECTION: Motor Home Contents Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc., AC 01 02 03 10 with its permission. Rom: United P,isk- Fax Sys Fax (888) 788-6147 To: 54148^05311@icfax.con Fax: +15414885311 Page 11 of 120412212015 2:02 PM AC 01 02 03 10 4. The cost of repairing or replacing may: 4. A member, if you are a limited liability com- a. Be based on an estimate which includes pany. parts furnished by the original equip- K. UNINTENTIONAL FAILURE TO DISCLOSE ment manufacturer or other sources in- HAZARDS cluding non-original equipment manu- The BUSINESS AUTO CONDITIONS SECTION facturers and and MOTOR CARRIER CONDITIONS b. Include a deduction for betterment for a SECTION- B.2. are amended by the addition of part or parts that are normally subject to the following: repair or replacement during the useful If you unintentionally fail to disclose any hazards life of the "auto", such as, but not limited existing at the inception date of your policy, we to tires and batteries. will not deny coverage under this Coverage Betterment means the difference be- Form because of such failure. However, this tween the actual cash value of a part provision does not affect our right to collect addi- immediately before the "loss" and the tional premium or exercise our right of cancella- cost to replace that part with a new part. tion or nonrenewal. 5. If we offer to pay the actual cash value of L. AUTOS HIRED OR RENTED BY the damaged or stolen property, we will val- EMPLOYEES ue auto advertising wraps, paint customiza- If hired or rented "autos" are covered "autos" on tion, and similar business related advertising this policy, the following provisions apply: modifications, in addition to the actual cash A. Changes In Liability Coverage value of the property. Auto advertising The following is added to the Who Is An In- wraps, paint customization, and similar sured Provision in the LIABILITY business related advertising modifications COVERAGE SECTION: will be valued at the cost to replace them with an adjustment made for depreciation An "employee" of yours is an "insured" while and physical condition. operating an "auto" hired or rented under a 1. GLASS REPAIR-WAIVER OF DEDUCTIBLE contract or agreement in that "employee's" Under Paragraph D. Deductible of the name, with your permission, while performing PHYSICAL DAMAGE COVERAGE SECTION, duties related to the conduct of your busi- the following is added: ness. No deductible applies to glass damage if the B. Changes In General Conditions glass is repaired rather than replaced. Paragraph 5.b. of the Other Insurance J. AMENDED DUTIES IN EVENT OF ACCIDENT, Condition in the Business Auto Coverage CLAIM, SUIT, OR LOSS Form and Paragraph 5.f.of the Other Insur- ance Condition in the Motor Carrier Cover- The requirement in Loss Condition 2.a_ Duties In age Form are replaced by the following: the Event Of Accident, Claim, Suit Or Loss - of For Hired Auto Physical Damage Coverage, the BUSINESS AUTO CONDITIONS SECTION the following are deemed to be covered "au- and the MOTOR CARRIER CONDITIONS tos" you own: SECTION that you must notify us of an "acci- dent", "claim", "suit", or "loss" applies only when 1. Any covered "auto" you lease, hire, rent the "accident", "claim", "suit", or "loss" is known or borrow; and to - 2. Any covered "auto" hired or rented by 1. You, if you are an individual your "employee" under a contract in that 2. A partner, if you are a partnership; individual "employee's" name, with your permission, while performing duties re- 3. An executive officer or the employee desig- lated to the conduct of your business. nated by you to give such notice if you are a However, any "auto" that is leased, hired, corporation-, or rented or borrowed with a driver is not a covered "auto". AC 01 02 0310 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 4 with its permission. From: United Risk- Fax Sys Fax: (888) 788-6147 To: 54143^0531)&cfax.con Fax: +15414385311 Page 12 of 12 0412212015 2:02 PM AC 01 02 03 10 M. EMERGENCY LOCKOUT - PRIVATE 3. Original copies of receipts for services of a PASSENGER VEHICLES locksmith must be provided before reim- We will reimburse you up to $50 for reasonable burse ment is payable. expense incurred for the services of a locksmith N. LIBERALIZATION to gain entry into your covered "auto" of the pri- Paragraph 3, of the General Conditions is re- vate passenger type subject to these provisions: placed by the following: 1. Your door key or key entry pad has been If we adopt any revision that would broaden the lost, stolen or locked in your covered "auto" coverage under this policy without additional and you are unable to enter such "auto" , or premium within 60 days prior to or during the 2. Your key or key entry pad has been lost or policy period, the broadened coverage will im- stolen and you have changed the lock to mediately apply to this policy. prevent an unauthorized entry-, and All terms and conditions of this policy apply unless modified by this endorsement. Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc., AC 01 02 03 10 with its permission.