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HomeMy WebLinkAboutInsurance Certificate: Center for Non-Profit Legal Service ,ibcrt Natural. AMERICAN ECONOMY INSURANCE COMPANY PAGE 1 y - SEATTLE, WASHINGTON I INSURANCE ULTRA OFFICE POLICY NAMED CENTER FOR NON-PROFIT LEGAL RENEWAL DECLARATIONS INSURED SERVICE, INC. AND MAILING PO BOX 1586 POLICY NUMBER 02-BP-574750-8 ADDRESS MEDFORD, OR 97501 RENEWAL OF 02-BP-574750-7 0~-93 AGENT BROWN & BROWN NORTHWEST NAME 3256 HILLCREST PARK DR AND DDRESS MEDFORD, OR 97504 POLICY PERIOD FROM 05-15-14 TO 05-15-15 12:01 AM A STANDARD TIME AT YOUR MAILING ADDRESS SI-IOWN ABOVE. FORM OF 36-28302 (877) 536-1920 BUSINESS: CORPORATION THE TOTAL PREMIUM DUE FOR THE POLICY TERM IS $1,115.00. YOU WILL BE BILLED THROUGH YOUR CUSTOMER ACCOUNT #020-0585-291-01. YOU NEED NOT PAY ANY PREMIUM AT THIS TIME. WE WILL SEND A BILLING STATEMENT IN A SEPARATE MAILING. IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS RENEWAL SERVES THE SAME PURPOSE AS WRITING A NEW POLICY WITH THE SAME PROVISIONS,. CONDITIONS AND INSURING AGREEMENTS, THE POLICY DECLARATIONS EXTENSION WHICH FOLLOWS, LISTS ALL OF THE FORMS THAT APPLY TO YOUR RENEWAL AND THOSE, IF ANY, WHICH NO LONGER APPLY. ONLY NEW OR REVISED FORMS ARE ATTACHED TO THIS RENEWAL. YOU MUST ADD THEM TO YOUR PRIOR POLICY, ADDL INSD-DESIGNATED PERSON ADDL INSD-DESIGNATED PERSON JACKSON COUNTY CITY OF ASHLAND PREMISES 001 HEALTH & HUMAN SERVICES DEPT. PREMISES 001 CITY HALL 1005 E MAIN ASHLAND, OR 97520 MEDFORD, OR 97504 BY (DATE) (AUTHORIZED REPRESENTATIVE) C COMPANY USE ONLY NORTHEAST 25 (STEALT) INSURED COPY PREPARED 03-24-14 C.I N.9d. PP I N7M11 J7107.OMO.Y PAGE 2 POLICY DECLARATIONS EXTENSION q NAMED INSURED: CENTER FOR NON-PROFIT LEGAL POLICY NUMBER: 02-BP-574750-5 THE FOLLOWING FORMS CURRENTLY APPLY TO THIS POLICY (CONTINUED FROM PREVIOUS PAGE): BP812$(0502) EMPLOYMENT PRACTICES LIABILITY a ~ I M s. MEMO, ;I h N N-24-P R I N T001.0102.0011-X PAG E 3 POLICY DECLARATIONS EXTENSION i NAMED INSURED: CENTER FOR NON-PROFIT LEGAL POLICY NUMBER: 02-BP-574750-8 PREMISES 1 225 W MAIN ST CONSTRUCTION: JOISTED MASONRY BUILDING 1 MEDFORD) OR 97501 OCCUPANCY: OFFICE - ATTORNEYS APPLICABLE TO THESE PREMISES LIMITS OF INSURANCE EXCEPT WHERE NOTED BELOW, A DEDUCTIBLE OF $ 250 APPLIES BUILDING - REPLACEMENT COST $ 446,000 BUSINESS PERSONAL PROPERTY $ 176,000 BUSINESS INCOME (NOT EXCEEDING 12 CONSECUTIVE MONTHS) ACTUAL LOSS SUSTAINED DEDUCTIBLE: NONE DAMAGE TO PREMISES RENTED TO YOU $ 11000,000 DEDUCTIBLE: NONE EQUIPMENT BREAKDOWN INCLUDED OUTDOOR SIGNS (DEDUCTIBLE: $ 250) $ 7,500 MONEY AND SECURITIES (DEDUCTIBLE: $ 250): INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 5,000 ACCOUNTS RECEIVABLE $ 25,000 COMMERCIAL FINE ARTS $ 10,000 VALUABLE PAPERS AND RECORDS $ 50,000 SEWER OR DRAIN BACK-UP $ 5,000 ORDINANCE OR LAW SEE ENDORSEMENT ORDINANCE OR LAW - COVERAGES B AND C - COMBINED LIMIT FOR DEMOLITION COST COVERAGE AND INCREASED COST OF $ 150,000 CONSTRUCTION COVERAGE BUSINESS INCOME CAUSED BY DEPENDENT PROPERTIES $ 5,000 ELECTRONIC DATA $ 25,000 .s own" i n.ie_~a.ppiNrnni.nin~,nma.x PAGE A POLICY DECLARATIONS EXTENSION a, r NAMED INSURED: CENTER FOR NON-PRO}! IT LEGAL, POLICY NUMBER: 02-BP-574750-8 ei APPLICABLE TO ALL PREMISES YOU OWN, RENT OR OCCUPY LIMITS Of INSURANCE BUSINESS LIABILITY: LIABILITY (INCLUDING PRODUCTS AND COMPLETED $ 1,000,000 OPERATIONS) AND MEDICAL EXPENSES MEDICAL EXPENSES (ANY ONE PERSON) $ 10,000 AGGREGATE LIMITS $ 2,000,000 MIRED AUTO AND NON-OWNED AUTO LIABILITY SEE BUSINESS LIABILITY EMPLOYEE DISHONESTY (DEDUCTIBLE: NONE) $ 15,000 FORGERY OR ALTERATION (DEDUCTIBLE NONE) $ 25,000 EMPLOYMENT PRACTICES (DEDUCTIBLE: NONE): EACH INCIDENT LIMIT $ 10,000 AGGREGATE LIMIT $ 10,000 RETROACTIVE DATE OF 05/15/03 IDENTITY RECOVERY COVERAGE EXPENSE REIMBURSEMENT $ 25,000 PREMIUM FOR CERTIFIED ACTS OF TERRORISM $ 4.00 TERM PREMIUM $ 1,111.00 TOTAL TERM PREMIUM $ 1,11.5.00 r- GIN -24 • P R I N TO01.0102.0014 •A PACE 5 POLICY DECLARATIONS EXTENSION NAMED INSURED: CENTER FOR NON-PROFIT LEGAL POLICY NUMBER: 02-HP--574750-8 THE FOLLOWING FORMS CURRENTLY APPLY TO THIS POLICY: BP8051(0702) WAIVER OF TRANSFER OF RIGH BP0003(0106) BUSINESSOWNERS SPECIAL COVERAG BP7076(0606) ULTRA PLUS BP7080(0606) ORDINANCE OR LAW COVERAGE BP8094(0606) NON-OWNED AUTO LIAR. AMEND. EN BP1203(0106) LOSS PAYABLE PROVISIONS BP7057(0702) ADDT'L INSD-DESIG.PERSON OR OR BP7059(0105) COMMERCIAL FINE ARTS COV FORM BP0437(0702) EXCLUSION-PERSONAL & ADVERT. I BP8136(0108) EQUIPMENT BREAKDOWN ENDORSEMEN BP0523(0108) CAP ON LOSSES CERTIFIED ACTS BP0565(0107) CONDITIONAL EXCL TERRORISM BP8206(0606) ID RECOVERY COV FOR DEFINE BPO159(0808) WATER EXCLUSION ENDORSEMEN BP0601(0107) EXCL OF LOSS DUE TO VIRUS IL7201(0392) COMPANY COMMON POL CONDITIONS BP8068(0702) EXCLUSION -ASBESTOS BP8029(0702) AMENDMENT-AGGREGATE LIMITS OF BP0455(0106) BUSINESS LIAR COV - TENANT BP0441(0106) BUSINESS INCOME CHANGES - BP0417(0702) EMPLOYMENT RELATED PRACT. EXCL BPO178(0108) OREGON CHANGES BP8128(0502) EMPLOYMENT PRACTICES LIABILITY 0 wrswi r 0-IN-24-PKI NT001.0102.00154 PAG E 6 POLICY DECLARATIONS EXTENSION NAMED INSURED: CENTER FOR NON-PROFIT LEGAL POLICY NUMBER: 02-BP-574750-8 LOSS PAYEE MORTGAGE HOLDER AT&T CREDIT CORPORATION JOHN FERRIS, WILLIAM FERGUSON, PREMISES 001 C/O LEASE INS. AGENCY SERVICES PREMISES 001 AND ROBERT GRANT P.O. BOX 96064 C/O JOHN FERRIS, ATTY AT LAW BELLEVUE, WA 98009 27 NORTH IVY 1607000321800011 - MERLIN II MEDFORD, OR 97501 LOSS PAYEE ADDL INSO-DESIGNATED PERSON COPELCO CREDIT CORP. ROGUE VALLEY COUNCIL OF PREMISES 001 15325 S.E. 30TH PLACE,ST. 100 PREMISES 001 GOVERNMENTS AGING PROGRAM BELLEVUE, WA 98007 P.O. BOX 3275 ACCT# 1232350/SHARP COPIER CENTRAL POINT, OR 97502 LOSS PAYEE LOSS PAYEE LUCENT TECHNOLOGIES PRODUCT AVAYA FINANCIAL SERVICES PREMISES 001 FINANCE C/O ABIC-SPECIALTY PREMISES 001 PO BOX 979220 SERVICES, 5TH FLOOR MIAMI, FL 33197 P.O. BOX 979220 MIAMI, OR 33197 W3032180003A a l II R 0.1 N.24.PR INT001.010UM G-X I W! ert Mutual. BUSINESSOWNERS -y BP 05 65 01 07 INSURANCE POLICY NUMBER: 02-DP-574750--8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONDITIONAL EXCLUSION OF TERRORISM INVOLVING NUCLEAR, BIOLOGICAL OR CHEMICAL TERRORISM (RELATING TO DISPOSITION OF FEDERAL TERRORISM RISK INSURANCE ACT) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE The Exception Covering Certain Fire Losses (Paragraph B.2.) applies to property located in the following state (s): California, Connecticut, Georgia, Illinois, Iowa, Maine, Massachusetts, Missouri, New Jersey, New York, North Carolina, Oregon, Rhode Island, Virginia, Washington, West Virginia, Wisconsin Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. Section I - Property and Section II - Llabll- (2) A renewal, extension or replace- Ity are amended as follows: ment of the Program has become 1. Applicability Of The Provisions Of This effective without a requirement Endorsement to make terrorism coverage available to you and with re- a. The provisions of this endorsement visions that: become applicable commencing on (a) Increase our statutory per- the date when any one or more of centage deductible under the the following first occurs. But If your Program for terrorism losses. policy (meaning the policy period In (That deductible determines b which this endorsement applies) be- gins after such date, then the pro- the amount of all certified pay visions of this endorsement become In a terrorism calendar losses , must before the applicable on the date your policy year, I~ begins, federal government shares in subsequent payment of cer. (1) The federal Terrorism Risk Insur- tified terrorism losses.); or ance Program ("Program'), es- (b) Decrease the federal govern- -r tablished by the Terrorism Risk ment's statutory percentage Insurance Act, has terminated with respect to the type of Insur- share in potential terrorism ance provided under this Cover- losses above such deduct- age Form; or Ible; or ~i u y © ISO Properties, Inc,, 2006 p BP 05 65 01 07 Page 1 of 3 EP o.1N•24.PR1Nrn01.nI Znm M 4 i (c) Redefine terrorism or make (1) The effect is to intimidate or coerce insurance coverage for ter- a government or the civilian rorism subject to provisions population or any segment thereof, or requirements that differ or to disrupt any segment of the from those that apply to economy; or other types of events or oc- (2) It appears that the intent is to intim- currences under this policy. !date or coerce a government, or to b. If the provisions of this endorsement further political, ideological, reli- become applicable, such provisions: gious, social or economic objectives (1) Supersede any terrorism en- or to express (or express opposition dorsement already endorsed to to) a philosophy or ideology. this policy that addresses B. Section I - Property is amended as follows: "certified acts of terrorism" and/or "other acts of terrorism", 1. The following exclusion is added: but only with respect to loss or EXCLUSION OF TERRORISM Injury or damage from an incident(s) of terrorism (however We will not pay for loss or damage caused defined) that occurs on or after directly or indirectly by "terrorism", including the date when the provisions of action in hindering or defending against an this endorsement become appli- actual or expected incident of "terrorism". cable; and Such loss or damage is excluded regardless of any other cause or event that contributes (2) Remain applicable unless we no- concurrently or in any sequence to the loss. tify you of changes in these pro- But this exclusion applies only when one visions, In response to federal or more of the following are attributed to law. an incident of "terrorism": c. If the provisions of this endorsement a. The "terrorism" is carried out by means do NOT become applicable, any ter- of the dispersal or application of radio- rorlsm endorsement already en- active material, or through the use of a dorsed to this policy, that addresses nuclear weapon or device that involves "certified acts of terrorism,, and/or or produces a nuclear reaction, nuclear "other acts of terrorism", will con- radiation or radioactive contamination; tinue in effect unless we notify you or of changes to that endorsement In response to federal law. b. Radioactive material is released, and it appears that one purpose of the 2. The following definition is added and applies "terrorism" was to release such mate- under this endorsement wherever the term rlal; or terrorism is enclosed in quotation marks. c. The "terrorism-" is carried out by means x "Terrorism" means activities against per- of the dispersal or application of patho- sons, organizations or property of any na- genic or poisonous biological or chemi- ture: cal materials; or a. That involve the following or preparation d. Pathogenic or poisonous biological or for the following: chemical materials are released, and it (1) Use or threat of force or violence; appears that one purpose of the or "terrorism" was to release such materi- als. (2) Commission or threat of a danger- ous act; or 2. Exception Covering Certain Fire Losses (3) Commission or threat of an act that The following exception to the Exclusion Of interferes with or disrupts an elec- Terrorism applies only if indicated and as in- tronic, communication, information, dicated In the Schedule of this endorsement. or mechanical system; and if "terrorism" results in fire, we will pay for b. When one or both of the following ap- the loss or damage -caused by that fire, sub- plies: jest to all applicable policy provisions includ- ing the Limit of Insurance on the affected Page 2 of 3 0-I N~24•P R! RT001-0102.001 M property. Such coverage for fire applies only 2. The following exclusion is added: to direct loss or damage by fire to Covered EXCLUSION OF TERRORISM Property, Therefore, for example, the cover- age does not apply to insurance provided We will not pay for "any injury or damage" under Business Income and/or Extra Ex- caused directly or indirectly by "terrorism", pense coverages or endorsements that apply including action in hindering or defending to those coverages. against an actual or expected incident of 3. Application Of Other Exclusions "terrorism". "Any injury or damage" is ex- cluded regardless of any other cause or a. When the Exclusion Of Terrorism ap- event that contributes concurrently or in any plies in accordance with the terms of sequence to such Injury or damage. But this Paragraph 1.a. or 1.b., such exclusion exclusion applies only when one or more applies without regard to the Nuclear of the following are attributed to an Incl- Hazard Exclusion in this Coverage dent of "terrorism": Form, a. The "terrorism" is carried out by means b. The terms and limitations of any terror- of the dispersal or application of radio- ism exclusion, or the inapplicability or active material, or through the use of a omission of a terrorism exclusion, do nuclear weapon or device that involves not serve to create coverage for any or produces a nuclear reaction, nuclear loss or damage which would otherwise radiation or radioactive contamination; be excluded under this Coverage Form, or such as losses excluded by the Nuclear b. Radioactive material is released, and it Hazard Exclusion or the War And Mili- appears that one tary Action Exclusion. purpose of the "terrorism" was to release such mate- C. Sectlon II - Liability is amended as follows: rial; or 1. The following definition is added and applies c. The "terrorism" Is carried out by means under this endorsement wherever the phrase of the dispersal or application of patho- any injury or damage is enclosed in quotation genic or poisonous biological or chomi- marks: cal materials; or "Any injury or damage" means any injury or d. Pathogenic or poisonous biological or damage covered under this Coverage Form chemical materials are released, and it or any applicable endorsement, and includes appears that one purpose of the but is not limited to "bodily injury", "property "terrorism" was to release such materl- damage" or "personal and advertising injury" als. as may be defined under this Coverage In the event of any incident of "terrorism" Form. that is not subject to this Exclusion, cover- age does not apply to "any injury or damage" that is otherwise excluded under this Coverage Form, rre.~ l BP 05 B5 01 07 Page 3 018 EP C•I N-24-PR I NT001-0102p010-X 'Wk X.il?e Mutual. BUSINESSOWNERS BP 80 51 07 02 INSURANCE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under Section III Common Policy Conditions. SCHEDULE* Name of Person or Organization: Rogue Valley Council of Gov.Aging Programs (It no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this ondorsomont.) Paragraph K.2. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage, only with respect to liability arising out of the ownership, maintenance or use of that part of premises you own, rent, lease or occupy. This waiver applies only to tho person or organization shown in the Schedule above. BP 80510702 EP a~ .,o H d rms 3 faNAA.ppINTOf11.fN ~9.Ofl91 .N - C Your Independent Liberty Mutual Insurance Agent: BROWN & BROWN NORTHWEST 3256 HILLCREST PARK DR MEDFORD, OR 97504 (877) 538-1920 CENTER FOR NON-PROFIT LEGAL SERVICE, INC. PO BOX 1586 MEDFORD, OR 97501 Your ULTRA OFFICE POLICY e t Liberty Mutual. INSURANCES ~e AMERICAN ECONOMY INSURANCE COMPANY A Stock Company Safeco Plaza Seattle, WA 98185.0001 ® covert 09 03 EP 1 f..l N.76.P N I NTOM .P/09.M05.X i Liberty Mutual. INSURANCE Thank you for renewing with BROWN & BROWN NORTHWEST and Liberty Mutual Insurance We appreciate your business and thank you for renewing your commercial insurance with us. We look forward to helping you succeed in your business. The Commercial Service Center is available from 8 a.m. to 9 p.m. Eastern for policy changes, billing inquiries or assistance, and issuing Certificates of Insurance. For all of your service needs, please contact the Commercial Service Center at: 1-877-638-1920 We are a premier insurance carrier offering business products In Business Owner Policies (BOP), Property, Automobile, General Liability, Workers Compensation, and Umbrella. For more information on our products and services, please contact us or your independent agent. We recommend that you visit our website at, www.libertymutualgroup.com to take advantage of our resources to help you protect your employees and your business. You'll learn about our loss prevention programs and consultations, and you'll find our Workers Compensation Toolkit to be a valuable resource in providing you with critical state forms and help in getting injured workers back to work. Your enclosed policy was created based on information from the application you completed. Since businesses change over time, please review this policy carefully and call us if you have questions or would like to make changes. The questions below are designed to assist you in reviewing your business compared to your policy. Answering ,,yes,, to any of the following questions may indicate inappropriate or inadequate coverage in the event of a loss. Please contact us or your independent agent to review your coverage. 1. Do parties you do business with require certificates of insurance e.g. mortgagees, landlords, state contractors boards, lion holders? (Please see Reminder below) 2. Have you started an operation in any other state or country? 3. Have you or do you intend to purchase new properties or locations? 4. Have there been any changes to your business e.g. introduction of new services or products? 6. Have you installed a safe or burglar alarm, or replaced the roof, plumbing, heating system or electrical wiring? 6. Have you or has a building owner had any change in tenants, upgrades to your premises or any renovations? 7. Has your business grown in the last year? 8. Have you made any capital expenditures or disposed of any capital assets? 9. Have there been any changes in ownership control or legal structure? 10. Have you acquired any new business? M 11. Have you entered into any new job/contracts that require certificates of insurance involving (e.g. "Moo hold-harmless agreements, clauses and specific insurance requirements)? _ m .r G 48 49 09 10 Page 1 of 2 EP V N•24.P RI NT00I.Ot 02.0007•X J 12. Have you purchased any additional property e.g. tools, fine art or computer equipment? 13. Have you or do you plan to take equipment off premises? , 14. Have you added or deleted any vehicles or drivers? 15. Goo you wish to review your account; do you have any general questions about your coverage? Reminder: While some interested parties such as mortgagees will receive evidence of coverage, Certificates of Insurance are not automatically renewed and issued with your policy. Please contact us with your Authorization if you need a Certificate of Insurance to be issued with this renewal policy. 0 ~I Pago2of2 G1 N-24-PRINT001-0102.00085