HomeMy WebLinkAboutInsurance Certificate: Economy Plumbing
ECON01 C OP ID: HSA
Y)
,4coR~ CERTIFICATE OF LIABILITY INSURANCE 05/ DATE/MM/26122015
015
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: Therese Rayburn
United Risk Solutions, Inc. PHONE 541-245-1111
PO Box 936 (A/C, No Eat): ja/c, No): 541-245-1112
Medford, OR 97507-0067 of DRESS: therese.rayburn@unitedrisk.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Western National Assurance Co ;24465
INSURED Economy Plumbing, Inc. INSURER B_:
309 Kent St.
Ashland, OR 97520-1017 INSURER C:
INSURER D
INSURER E : i
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 SUBR - - POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE N WV POLICY NUMBER MMIDD/YYYY ! MMIDD/YYYY
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C
DAMAGET RENTED
06/01/2015 06/01/2016 PREMISES Ea occurrence $ 100,000
CLAIMS-MADE OCCUR X BOP10007262
MED EXP (Any one person) $ _ 5,00(
1 II
PERSONAL 8 ADV INJURY $ included
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ - 2,000,00
X POLICY E PRO JECT ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,00
I
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
A X ANY AUTO X CPP107477902 06/01/2015 06/01/2016 BODILY INJURY (Per person) ! S
ALL OWNED SCHEDULED BODILY INJURY (Per accident)$
AUTOS AUTOS -
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS I AUTOS (Per accident) I - $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB r CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
_ ER
AND
YIN
ANYY PROPRIETOR/PARTNER/EXECUTIVE LIABILITY NIA E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED E.L. DISEASE - EA EMPLOYEE
(Mandatory in NH) $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S
I i
i
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is Additional Insured for general liability as provided
Endt BP0642 (01/06) and for auto liability as provided by Endt WNCA27
V/12)
CERTIFICATE HOLDER CANCELLATION
CITAS01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland Service ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing
Kariann Olson AUTHORIZED REPRESENTATIVE
90 N. Mountain Ave
Ashland, OR 97520-2014 2014
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
BUSINESSOWNERS
BP 06 42 01 06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OREGON - ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - WITH ADDITIONAL INSURED
REQUIREMENT IN CONSTRUCTION CONTRACT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
The following is added to Paragraph C. Who Is An caused by your ongoing operations for the
Insured in Section 11 - Liability: additional insured and only to the extent
3. Any person(s) or organization(s) for whom that such "bodily injury", "property dam-
you are performing operations is also an age" or "personal and advertising injury" is
additional insured, if you and such per- caused by your negligence or the negli-
son(s) or organization(s) have agreed in gence of those performing operations on
writing in a contract or agreement that your behalf.
such person(s) or organization(s) be in- A person's or organization's status as an
cluded as an additional insured on your insured under this endorsement ends when
policy. Such person(s) or organization(s) is your operations for that insured are com-
an additional insured only with respect to pleted or the contractor's agreement is ter-
liability for "bodily injury", "property dam- minated.
age" or "personal and advertising injury"
BP 06 42 01 06 Copyright, ISO Properties, Inc., 2005 Page 1 of 1
WN CA 27 It 12
BUSINESS AUTO ENHANCEMENT ENDORSEMENT
The Business Auto Enhancement Endorsement is an optional endorsement that provides coverage enhancements.
The following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this
summary, refer to following endorsement for changes in your policy.
SUMMARY OF COVERAGES PAGE
Accidental Airbag Deployment Coverage 4
Auto Loan/Lease Gap Coverage 4
Blanket Additional Insured 2
Blanket Waiver of Subrogation 5
Broadened Definition of Insured includes:
Newly Acquired Organizations for up to 180 Days 2
Employees as Insureds 2
Subsidiaries in Which You Own 50% or More 2
Broadened Definition of Bodily Injury to Include Mental Anguish 5
Deductible Waiver for Glass Repair 3
Employee Hired Auto 2, 5
Fellow Employee Coverage 3
Hired Auto Physical Damage Coverage 3
Knowledge of Accident, Claim, Suit or Loss 4
Loss Of Use Expenses - Amended 3
Personal Effects 3
Rental Reimbursement Coverage 3
Supplementary Payments - Amended:
Bail Bonds up to $5,000 2
Loss of Earnings up to $500/Day 2
Transportation Expense Limits - Amended 3
Unintentional Failure to Disclose Hazards 5
WN CA 27 11 12 Includes copyrighted material of Insurance Services Office, with its permission Page I of 5
WNCA271112
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BUSINESS AUTO ENHANCEMENT ENDORSEMENT
This endorsement modifies the insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement. The SECTIONS of the Business Auto Coverage Form identified in this endorsement
will be amended as shown below.
SECTION II - LIABILITY COVERAGE f. Any "employee" of yours is an "insured" while
AMENDMENTS using a covered "auto" you don't own, hire or
borrow in your business or your personal
A. Who Is An Insured - amended affairs.
SECTION II - LIABILITY COVERAGE, Item A. g, Any "employee" of yours is an "insured" while
Coverage, 1. Who Is An Insured is amended to operating a covered "auto" hired or rented
add: under a contract or agreement in the
d. Any legally incorporated subsidiary of yours in "employee's" name, with your permission,
which you own more than 50% of the voting while performing duties related to the conduct
stock on the effective date of this coverage of your business.
form. B. Blanket Additional Insured
However, "insured" does not include any Section II - LIABILITY COVERAGE, Item A.
subsidiary of yours that is an "insured" under Coverage, 1. Who Is An Insured, paragraph c.
any other automobile liability policy, or would is amended to add the following:
be an "insured" under such policy but for
termination of such policy or the exhaustion Any person or organization who is required under
on such policy's limits of insurance. a written contract or agreement between you and
that person or organization, that is signed and
e. Any organization which is newly acquired or executed by you before the "bodily injury" or
formed by you and over which you maintain "property damage" occurs and that is in effect
majority ownership. However, coverage during the policy period, to be named as an
under this provision: additional insured is an "insured" for Liability
(1) is afforded only for the first 180 days after Coverage, but only for damages to which this
you acquire or form the organization or insurance applies and only to the extent that
until the end of the policy period, persons or organization qualifies as an "insured"
whichever comes first; under the Who Is An Insured provision contained
in Section II.
(2) does not apply to "bodily injury" or
"property damage" that results from an C. Liability Coverage Extensions -
"accident" that occurred before you Supplementary Payments
formed or acquired the organization; SECTION II - LIABILITY COVERAGE, Item A.
(3) does not apply to any newly acquired or Coverage, 2. Coverage Extensions, a.
formed organization that is a joint venture Supplementary Payments is amended by
or partnership; and replacing subparagraphs (2) and (4) with the
following:
(4) does not apply to an "insured" under any
other automobile liability policy, or would (2) Up to $5,000 for cost of bail bonds (including
be an "insured" under such a policy but bonds for related traffic law violations)required
for termination of such policy or the because of an "accident" we cover. We do
exhaustion of such policy's limits of not have to furnish these bonds.
insurance.
(4) All reasonable expenses incurred by the
WN CA 27 11 12 Includes copyrighted material of Insurance Services Office, with its permission Page 2 of 5
WNCA271112
"insured" at our request, including actual loss Causes of Loss, or Collision coverages are
of earnings up to $500 a day because of time provided under this coverage form for any
off from work. "auto" you own, then the Physical Damage
Coverages provided are extended to "autos"
D. Fellow Employee Coverage you hire of like kind and use, subject to the
SECTION II - LIABILITY COVERAGE, B. following:
Exclusions, S. Fellow Employee does not apply. a. The most we will pay for any one "loss" is
$50,000 or the actual cash value or cost
SECTION III - PHYSICAL DAMAGE COVERAGE to repair or replace, whichever is less,
AMENDMENTS minus a deductible;
A. Transportation Expense - Limits Amended b. The deductible will be equal to the largest
SECTION III - PHYSICAL DAMAGE deductible applicable to any owned "auto"
COVERAGE, A. Coverage, 4. Coverage for that coverage. Any Comprehensive
deductible does not apply to "loss" caused
Extensions, a. Transportation Expenses is by fire or lightening;
amended by replacing $20 per day/$600
maximum limit with $50 per day/$1000 maximum. c. Hired Auto Physical Damage coverage is
excess over any other collectible
B. Hired Auto Physical Damage - Loss Of Use insurance; and
Expenses - Limits Amended
d. Subject to the above limit, deductible and
SECTION III - PHYSICAL DAMAGE excess provisions we will provide
COVERAGE, Item A. Coverage, 4. Coverage coverage equal to the broadest coverage
Extensions, b. Loss of Use Expenses is applicable to any covered "auto" you own.
amended by replacing the $20 per day/$600
maximum limit with $50 per day/$750 maximum If a limit for Hired Auto Physical Damage is
limit. indicated in the Declarations, then that limit
replaces, and is not added to, the $50,000 limit
C. Personal Effects Coverage indicated above.
SECTION III - PHYSICAL DAMAGE F. Rental Reimbursement
COVERAGE, Item A., Coverage, 4. Coverage
Extensions is amended by adding the following: SECTION III - PHYSICAL DAMAGE
COVERAGE Item A. Coverage, is amended by
c. Personal Effects adding the following:
We will pay up to $500 for "loss" to personal 6. This coverage applies only to a covered "auto"
effects, which are: of the private passenger or light truck type as
follows:
(1) Owned by an "insured"; and
a. We will pay for rental reimbursement
(2) In or on your covered "auto." expenses incurred by you for the rental of
This coverage applies only in the event of the total a private passenger or light truck type
theft of your covered "auto." No deductible applies "auto" because of "lossi to a covered
to this coverage private passenger or light truck type
"auto". Payment applies in addition to the
D. Glass Repair - Deductible Waiver otherwise applicable amount of each
coverage you have on a covered private
SECTION III - PHYSICAL DAMAGE passenger or light truck type "auto." No
COVERAGE, Item A. Coverage, 3. Glass deductibles apply to this coverage.
Breakage, is amended by adding the following: b. We will pay only for those expenses
No deductible will apply to glass breakage if such incurred during the policy period
glass is repaired, in a manner acceptable to us, beginning 24 hours after the "loss" and
rather than replaced. ending, regardless of the policy's
expiration, with the lesser of the following
E. Hired Auto Physical Damage number of days:
SECTION III - PHYSICAL DAMAGE 1. The number of days reasonably
COVERAGE, Item A. Coverage is amended by required to repair or replace the
adding the following: covered private passenger or light
truck type "auto". If "loss" is caused
5. If hired "autos" are covered "autos" for Liability by theft, this number of days is added
Coverage and if Comprehensive, Specified to the number of days it takes to
WN CA 27 11 12 Includes copyrighted material of Insurance Services Office, with its permission Page 3 of 5
WN CA 27 11 12
locate the covered private passenger In the event of a covered total "loss" to a
or light truck type "auto" and return it covered "auto" described or designated in the
to you; or Schedule or in the Declarations, we will pay
2. 30 days. any unpaid amount due on the lease or loan
for a covered "auto" less:
c. Our payment is limited to the lesser of the
following amounts: a. The amount paid under the Physical
Damage Coverage Section on the policy;
1. Necessary and actual expenses and
incurred, or
b. Any:
2. $50 per day, up to a maximum of
$1,000. (1) Overdue lease/loan payments at the
time of the "loss";
d. This coverage does not apply while there
are spare or reserve private passenger or (2) Financial penalties imposed under a
light truck type "autos" available to you for lease for excessive use, abnormal
your operations. wear and tear or high mileage;
e. If "loss" results from the total theft of a (3) Security deposits not returned by the
covered "auto" of the private passenger or lessor;
light truck type, we will pay under this
coverage only that amount of your rental (4) Costs for extended warranties, Credit
reimbursement expenses which is not Life Insurance, Health, Accident or
already provided for under SECTION III - Disability Insurance purchased with
PHYSICAL DAMAGE COVERAGE, A. the loan or lease; and
Coverage, 4. Coverage Extension.
(5) Carry-over balances from previous
For the purposes of this Rental Reimbursement loans or leases.
coverage, light truck is defined as a truck with a
gross vehicle weight of 10,000 lbs. or less as SECTION IV - BUSINESS AUTO CONDITION
defined by the manufacturer as the maximum AMENDMENTS
loaded weight the auto is designed to carry.
A. Duties In The Event Of Accident, Claim, Suit Or
G. Accidental Airbag Deployment Coverage Loss Amended
SECTION III - PHYSICAL DAMAGE SECTION IV - BUSINESS AUTO CONDITIONS,
COVERAGE Item A. Coverage is amended by A. Loss Conditions, 2. Duties In The Event Of
adding the following: Accident, Claim, Suit Or Loss, a. is amended by
7. We will pay to reset or replace factory adding the following:
installed airbag(s) in any covered "auto' for This condition applies only when the "accident" or
accidental discharge, other than discharge "loss" is known to:
due to a collision loss.
This coverage is applicable only if (1) You, if you are an individual;
comprehensive coverage applies to the (2) A partner, if you are a partnership;
covered "auto".
(3) An executive officer or insurance manager, if
This coverage is excess over any other you are a corporation; or
collectible insurance or reimbursement by
manufacturer's warranty. (4) A member or manager, if you are a limited
liability company.
H. Auto Loan/Lease Gap Coverage
But, this section does not amend the provisions
SECTION III PHYSICAL DAMAGE COVERAGE, relating to notification of police, protection or
Item A., Coverage, is amended by adding the examination of the property which was subject to
following: the "loss".
8. This coverage applies only to a covered "auto"
described or designated in the Schedule or in
the Declarations as including physical
damage coverage.
WN CA 27 11 12 includes copyrighted material of Insurance Services Office, with its permission Page 4 of 5
WN CA 27 11 12
B. Blanket Waiver of Subrogation D. Employee Hired Auto
Section IV - BUSINESS AUTO CONDITIONS, SECTION IV - BUSINESS AUTO CONDITIONS,
A. Loss Conditions, 5. Transfer of Rights of B. General Conditions, 5. Other Insurance, b. is
Recovery Against Others to Us, is amended by deleted and replace by the following:
adding the following exception:
b. For Hired Auto Physical Damage Coverage,
However, we waive any right of recovery we may the following are deemed to be a covered
have against any person or organization to the "autos" you own:
extent required of you by a written contract signed
and executed prior to any "accident" or "loss", (1) Any covered "auto" you lease, hire, rent
provided that the "accident" or "loss" arises out of or borrow.
operations contemplated by such contract. The (2) Any covered "auto" hired or rented by
waiver applies only to the person or organization your "employee" under a contract in that
designated in such contract. individual "employee's" name, with your
C. Unintentional Failure to Disclose Hazards permission, while performing duties
related to the conduct of your business.
SECTION IV - BUSINESS AUTO CONDITIONS,
B. General Conditions, 2. Concealment, However, any "auto" that is leased, hired, rented
Misrepresentation Or Fraud, is amended to add or borrowed with a driver is not a covered "auto".
the following paragraph:
If you unintentionally fail to disclose any hazards SECTION V - DEFINITIONS AMENDMENTS
existing at the inception date of the policy, or A. "Bodily Injury" Redefined To Include Mental
during the policy period in connection with any Anguish
additional hazards, we will not deny coverage
under this Coverage Part because of such failure. SECTION V - DEFINITIONS, C. "Bodily Injury"
is deleted and replaced by the following:
C. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including
death resulting from any of these at any time.
"Bodily injury" includes mental anguish or
other mental injury resulting from such bodily
injury.
WN CA 27 11 12 Includes copyrighted material of Insurance Services Office, with its permission Page 5 of 5