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HomeMy WebLinkAboutInsurance Certificate: Pilot Rock Excavation 9PILORO OP ID: KID ACORO CERTIFICATE OF LIABILITY INSURANCE 07// DATEMM/24/2201015Y) 5 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 Phone: 541-779-4232 NAME CT Hart Insurance Fax: 541-772-3963 PHONE FAX 1123 Royal Ave. A/c No Ext : A/c No : Medford, OR 97504 E-MAIL _ - _ - " - Hart Insurance / Medford ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance 10677 INSURED Pilot Rock Excavation Inc INSURER B : SAIF Corp 5 South Stage Road Medford, OR 97501 INSURER C 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD/YYYY MMI D/VYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X EPP0151857 07/20/2015 07/20/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,00 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 15,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY X ] JECT F 17 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 1 Ea accident $ ,000,000 B ANY AUTO EBA0151857 07/20/2015 07/20/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident) $ $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,00 A EXCESS LIAB CLAIMS-MADE EPP0151857 07/2012015 07/20/2016 AGGREGATE $ 4,000,00 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 784439 09/13/2014 09/01/2015 E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? F-] N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,00 yes, describe under DESCRIFTIOIJ OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00 A Lease/Rented Equip EPP0151857 07/20/2015 07/20/2016 Limit 100,00 Ded. 50 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland and its employees, officers and agents are included as additional insured as respects to general liability and auto liability per form GA233 project: Alley Extension - N Main to Lori Lane CERTIFICATE HOLDER CANCELLATION CITYASH 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 Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Hart Insurance / Medford ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A Endorsement - Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage ..................................................................................................2 2. Unintentional Failure to Disclose Hazards .........................................................................................8 3. Damage to Premises Rented to You .................................................................................................8 4. Supplementary Payments ..................................................................................................................9 5. Medical Payments ............................................................................................................................10 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) ......................................................................................................10 7. 180 Day Coverage for Newly Formed or Acquired Organizations ...................................................10 8. Waiver of Subrogation .....................................................................................................................10 9. Automatic Additional Insured - Specified Relationships: 11 x Managers or Lessors of Premises; x Lessor of Leased Equipment; X Vendors; X State or Political Subdivisions - Permits Relating to Premises; X State or Political Subdivisions - Permits; and x Contractors' Operations 10. Broadened Contractual Liability - Work Within 50' of Railroad Property ..........................................16 11. Property Damage tD Borrowed Equipment ......................................................................................16 12. Employees as Insureds - Specified Health Care Services: 16 x N u ryes; X Emergency Medical Technicians; and x Paramedics 13. Broadened Notice of Occurrence .....................................................................................................16 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit $ 10,000 Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 1 of 16 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM ~a~ Area (For Limits in Excess of (For Limits in Excess of b Payroll $5,000) $5,000) Nd Gross Sales Units e Other b. Are Custody $ or Control TOTAL ANNUAL PREMIUM 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible: $ 250 C. Coverages: 2) Our right and duty to 1. Employee Benefit LiabilityCoverage defend ends when we have used up the appli- a. The following is added to SECTION I cable limit of insurance - COVERAGES: Employee Benefit in the payment of Liability Coverage. judgments or settle- (1) Insuring Agreement ments. (a) We will pay those sums that No other obligation or liabil- the insured becomes legally ity to pay sums or perform obligated to pay as dam- ads or services is covered ages caused by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pay- sured, or of any other per- meets. son for whose acts the in- (b) This insurance applies to sured is legally liable, to damages only if the act, er- which this insurance ap- ror or omission, is negli- plies. We will have the right gently committed in the and duty to defend the in- "administration" of your sured against any "suit" "employee benefit program"; seeking those damages. and However, we will have no duty to defend against any 1) Occurs during the pol- "suit" seeking damages to icy period; or which this insurance does not apply. We may, at our 2) Occurred prior to the discretion, investigate any effective date of this report of an act, error or endorsement provided: omission and settle any a) You did not have claim or "suit" that may re- knowledge of a sult. But: claim or "suit' on 1) The amount we will pay or before the ef- for damages is limited fective date of this as described in SEC- endorsement. TION III - LIMITS OF You will be INSURANCE; and deemed to have Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 2 of 16 knowledge of a 1) Failure of any invest- claim or "suit" ment to perform; when any "author- ized representa- 2) Errors in providing in- tive'; formation on past per- formance of investment i) Reports all, or vehicles; or any part, of the act, error or 3) Advice given to any omission to us person with respect to or any other that person's decision insurer; to participate or not to participate in any plan ii) Receives a included in the "em- written or ver- ployee benefit pro- bal demand or gram". claim for dam- ages because (f) Workers' Compensation of the act, error and Similar Laws or omission; Any daim arising out of your and failure to comply with the b) There is no other mandatory provisions of any applicable insur- workers' compensation, un- ance. employment compensation insurance, social security or (2) Exclusions disability benefits law or any similar law. This insurance does not apply to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- 'Bodily injury', "property ability imposed on a fiduci- ge" or "personal and ary by the Employee Re- dama ama tirement Income Security advertising iBury . Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any intentional, dishonest, (h) Available Benefits fraudulent, criminal or mali- Any daim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations under Q) Employment-Related any plan included in the Practices "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any: ance of Investment 1 Ad- Refusal to employ; vice Given With Respect to Participation (2) Termination of em- Any claim based upon: ployment; Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 3 of 16 (3) Coercion, demotion, tors are insureds, but only evaluation, reassign- with respect to their duties ment, discipline, defa- as your officers or directors. mation, harassment, Your stockholders are also humiliation, discrimina- insureds, but only with re- tion or other employ spect to their liability as ment related practices, stockholders. acts or omissions; or (e) A trust, you are an insured. (4) Consequential liability Your trustees are also in- as a result of (1), (2) or sureds, but only with respect (3) above. to their duties as trustees. This exclusion applies (2) Each of the following is also an whether the insured may be insured: held liable as an employer other capacity and (a) Each of your "employees" or in any who to any obligation to share is or was authorized to damages with or repay administer your "employee someone else who must benefit program". pay damages because of (b) Any persons, organizations the injury. or "employees" having (3) Supplementary Payments proper temporary authoriza- tion to administer your "em- SECTION I - COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS -COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, respects Employee Benefit Liabil- but only with re- As sped to duties as such. h. ity Coverage, SECTION II - WHO IS That representative will AN INSURED is deleted in its entirety have all your rights and du- and replaced bythe following: ties under this Coverage (1) If you are designated in the Dec- Part. larations as: (3) Any organization you newly ac- (a) An individual, you and your quire or form, other than a part- spouse are insureds, but nership, joint venture or limited only with respect to the con- liability company, and over which duct of a business of which you maintain ownership or ma- you are the sole owner. jority interest, will qualify as a Named Insured if no other simi- (b) A partnership or joint ven- lar insurance applies to that or- ture, you are an insured. ganization. However, coverage Your members, your part- under this provision: ners, and their spouses are also insureds but only with (a) Is afforded only until the respect to the conduct of 180th day after you acquire your business. or form the organization or the end of the policy period, (c) A limited liability company, whichever is earlier; and you are an insured. Your members are also insureds, (b) Does not apply to any act, but only with respect to the error or omission that was conduct of your business. committed before you ac- Your managers are insur- quired or formed the organi- eds, but only with respect to zation. their duties as your manag- c. Limits of Insurance e rs. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, you tirety and replaced bythefollowing: are an insured. Your "ex- ecutive officers" and direc- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 4 of 16 (1) The Limits of Insurance shown in amount stated in the Decla- Section B. Limits of Insurance, rations as applicable to 1. Employee Benefit Liability Each Employee. The limits Coverage and the rules below of insurance shall not be re- fix the most we will pay regard- duced by the amount of this less of the number of. deductible. (a) Insureds; (b) The deductible amount stated in the Declarations {b) Claims made or "suits" applies to all damages sus- brought; tained by any one "em- (c) Persons or organizations ployee", including such making claims or bringing "employee's" dependents "suits"; and beneficiaries, because of all acts, errors or omis- (d) Acts, errors or omissions; or sions to which this insur- (e) Benefits included in your ance applies. "employee benefit program". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement is defend the insured the most we will pay for all dam- against any "suits" ages because of acts, errors or seeking those dam- omissions negligently committed ages; and in the "administration" of your "employee benefit program". 2) Your duties, and the duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission, or claim, of Insurance, 1. Employee Benefit Liability Coverage of apply irrespective of the ap- this endorsement is the most we plication of the deductible will pay for all damages sus- amount. tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of: claim or "suit" and, upon no- (a) An act, error or omission; or tification of the action taken, you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such acts, errors or omissions, d. Additional Conditions negligently committed in the As respects Employee Benefit Li- "administration" of your "em- ability Coverage, SECTION N - ployee benefit program". COMMERCIAL GENERAL LIABIL- ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- ceed, and will be subject to the (1) Item 2. Duties in the Event of limits and restrictions that apply Occurrence, Offense, Claim or to the payment of benefits in any Suit is deleted in its entirety and plan included in the "employee replaced by the following: benefit program". 2. Duties in the Event of an (4) Deductible Amount Act, Error or Omission, or Claim or Suit (a) Our obligation to pay dam- ages on behalf of the in- a. You must see to it that sured applies only to the we are noted as soon amount of damages in ex- as practicable of an act, cess of the deductible error or omission which Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 5 of 16 may result in a claim. surance may also To the extent possible, apply. notice should include: d. No insured will, except (1) What the act, error at that insured's own or omission was cost, voluntarily make a and when it oc- payment, assume any curred; and obligation, or incur any expense without our (2) The names and consent. addresses of and one who may suf- (2) Item 5. Other Insurance is de- fer damages as a leted in its entirety and replaced result of the act, by the following: error or omission. 5. Other Insurance b. If a claim is made or "suit" is brought against If other valid and collectible any insured, you must: insurance is available to the insured for a loss we cover (1) Immediately re- under this Coverage Part, cord the specifics our obligations are limited of the claim or as follows: "suit" and the date received; and a. Primary Insurance (2) Notify us as soon This insurance is Ari- as practicable. mary except when c. below applies. If this in- You must see to it that surance is primary, our we receive written no- obligations are not af- tice of the claim or fected unless any of the "suit" as soon as practi- other insurance is also cable. primary. Then, we will share with all that other c. You and any other in- insurance by the volved insured must: method described in b. (1) Immediately send below. us copies of any b. Method of Sharing demands, notices, summonses or le- If all of the other insur- gal papers re- ance permits contribu- ceived in connec- tion by equal shares, tion with the claim we will follow this or "suit'; method also. Under this approach each insurer (2) Authorize us to ob- contributes equal tain records and amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of whichever comes first. the claim or de- If any of the other in- fense against the surance does not per- "suit"; and mit contribution by (4) Assist us, upon equal shares, we will our request, in the contribute by limits. enforcement of Under this method, any right against each insurer's share is any person or or- based on the ratio of its ganization which applicable limit of in- may be liable to surance to the total ap- the insured be- plicable limits of insur- cause of an act, ance of all insurers. error or omission c. No Coverage to which this in- Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 6 of 16 This insurance shall not providing some or all of the cover any loss for following benefits to "em- which the insured is en- ployees", whether provided titled to recovery under through a "cafeteria plan" or any other insurance in otherwise: force previous to the ef- fective date of this a. Group life insurance; Coverage Part. group accident or health insurance; den- e. Additional Definitions tal, vision and hearing plans; and flexible As respects Employee Benefit Li- spending accounts; ability Coverage, SECTION V - provided that no one DEFINITIONS is amended as fol- other than an "em- lows: ployee" may subscribe (1) The following definitions are to such benefits and added: such benefits are made generally available to 1. "Administration" means: those "employees" who satisfy the plan's eligi- a. Providing information to bility requirements; "employees", including their dependents and b. Profit sharing plans, beneficiaries, with re- employee savings spect to eligibility for or plans, employee stock scope of "employee ownership plans, pen- benefit programs"; sion plans and stock subscription plans, pro- b. Interpreting the "em- vided that no one other ployee benefit pro- than an "employee" grams"; may subscribe to such c. Handling records in benefits and such connection with the benefits are made gen- "employee benefit pro- erally available to all grams"; or "employees" who are eligible under the plan d. Effecting, continuing or for such benefits; terminating any "em- c. Unemployment curity ployee's" participation ante in any benefit induced , social security in the "employee bene- benefits, workers' com- fit program". pensation and disability benefits; and However, "administration" does not include: d. Vacation plans, includ- ing buy and sell pro- a. Handling payroll deduc- grams; leave of ab- tions; or sence programs, in- cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assistance or adequate limits of plans; transportation of insurance, a t- nd health club ub su subsi including but not limited dies. to unemployment in- surance, social security (2) The following definitions are de- benefits, workers' com- leted in their entirety and re- pensation and disability placed bythe following: benefits. 21. "Suit" means a civil pro- 2. "Cafeteria plans" means ceeding in which money plan authorized by applica- damages because of an act, ble law to allow "employees" error or omission to which to elect to pay for certain this insurance applies are benefits with pre-tax dollars. alleged. 'Suit" includes: 3. "Employee benefit pro- a. An arbitration proceed- grams" means a program ing in which such dam- Includes copyrighted material of Insurance GA233 OR 0910 Services Office, Inc., with its permission. Page 7 of 16 ages are claimed and The exclusions under SECTION to which the insured I - COVERAGES, COVERAGE must submit or does A. BODILY INJURY AND submit with our con- PROPERTY DAMAGE LIABIL- sent; ITY, 2. Exclusions, other than i. War and the Nuclear Energy b. Any other alternative Liability Exclusion, are deleted dispute resolution pro- and the following are added: ceeding in which such damages are claimed This insurance does not apply to: and to which the in- sured submits with our (a) "Property damage": consent; or 1) Assumed in any con- c. An appeal of a civil pro- tract; or ceeding. 2) Loss caused by or re- 8. "Employee" means a person sulting from any of the actively employed, formerly following: employed, on leave of ab- a) Wear and bear; sence or disabled, or re- tired. "Employee" includes a b) Rust, corrosion, 'leased worker". "Employee" fungus, decay, de- does not include a "tempo- terioration, hidden rary worker". or latent defect or any quality in 2. Unintentional Failure to Disclose Haz- property that ards causes it to dam- SECTION IV - COMMERCIAL GENERAL age or destroy it- LIABILITY CONDITIONS, 7. Represen- self; tations is hereby amended by the addi- c) Smog; tion of the following: d) Mechanical break- Based on our dependence upon your rep- down including resentations as to existing hazards, if un- rupture or bursting intentionally you should fail to disclose all caused by cen- such hazards at the inceptions date of your trifugal force; policy, we will not reject coverage under this Coverage Part based solely on such e) Settling, cracking, failure. shrinking or ex- 3. Damage to Premises Rented to You pansion; or f) Nesting or infesta- a. The last Subparagraph of Paragraph tion, or discharge 2. SECTION I - COVERAGES, or release of waste COVERAGE A. - BODILY INJURY products or secre- AND PROPERTY DAMAGE, 2. LI- tions, by insects, ABILITY Exclusions is hereby de- birds, rodents or Ieted and replaced by the following: other animals. Exclusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow ning, smoke or soot to premises in while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; TION 1 -COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in Para- through: graph 3.b. above: Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 8 of 16 a) Foundations, one "occurrence" to which walls, floors or this insurance applies. paved surfaces; (3) The amount we will pay is limited b) Basements, as described in Section B. Lim- whether paved or its of Insurance, 3. Damage to not; or Premises Rented to You of this endorsement. c) Doors, windows or other openings. 4. Supplementary Payments (c) Loss caused by or resulting Under SECTION I - COVERAGE, SUP- from water that leaks or PLEMENTARY PAYMENTS - COVER- flows from plumbing, heat- AGES AAND B: ing, air conditioning, or fire protection systems caused a. Paragraph 2. is replaced by the fol- by or resulting from freeang, lowing: unless: Up to the limit shown in Section B. 1) You did your best to Limits of Insurance, 4.a. Bail Bonds maintain heat in the of this endorsement for cost of bail building or structure; or bonds required because of accidents or traffic law violations arising out of 2) You drained the equip- the use of any vehicle to which the ment and shut off the Bodily Injury Liability Coverage ap- water supply if the heat plies. We do not have to furnish was not maintained. these bonds. (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- 1) Plumbing, heating, air lowing: conditioning, fire pro- All reasonable expenses incurred by tection systems, or the insured at our request to assist us other equipment or ap- in the investigation or defense of the pliances; or claim or "suit", including actual loss of earnings up to the limit shown in Sec- 2) The interior of any tion B. Limits of Insurance, 4.b. building or structure, or Loss of Earnings of this endorsement to personal property in the building or structure per day because of time off from work caused by or resulting . from rain, snow, sleet 5. Medical Payments or ice, whether driven by wind or not. The Medical Expense Limit of Any One Person as stated in the Dedarations is c. Limit of Insurance amended to the limit shown in Section B. The Damage to Premises Rented to Limits of Insurance, 5. Medical Pay- ments of this endorsement. You Limit as shown in the Declara- tions is amended as follows: 6. Voluntary Property Damage and Care, (2) Paragraph 6. of SECTION III - Custody or Control Liability Coverage LIMITS OF INSURANCE is a. Voluntary Property Damage Cov- hereby deleted and replaced by erage the following: We will pay for "property damage" to 6. Subject to 5. above, the property of others arising out of op- Damage to Premises erations incidental to the insured's Rented to You Limit is the business when: most we will pay under COVERAGE A. BODILY (1) Damage is caused by the in- INJURY AND PROPERTY sured; or DAMAGE LIABILITY, for (2) Damage occurs while in the in- damages because of "prop- erty damage" to premises sured's possession. while rented to you or tem- With your consent, we will make porarily occupied by you these payments regardless of fault. with permission of the owner, arising out of any Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 9 of 16 b. Care, Custody or Control Liability deductible amount as has been Coverage paid by us. SECTION I - COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or ERAGE A. BODILY INJURY AND Acquired Organizations PROPERTY DAMAGE LIABILITY, 2. SECTION II -WHO IS AN INSURED is Exclusions, j. Damage to Property, amended as follows: Subparagraphs (3), (4) and (5) do not apply to "property damage" to the Subparagraph a. of Paragraph 4. is property of others described therein. hereby deleted and replaced by the fol- With respect to the insurance provided by lowing: this section of the endorsement, the fol- a. Insurance under this provision is af- lowing additional provisions apply: forded only until the 180th day after a. The Limits of Insurance shown in the you acquire or form the organization Declarations are replaced by the lim- or the end of the policy period, its designated in Section B. Limits of whichever is earlier; Insurance, 6. Voluntary Property 8, Waiver of Subrogation Damage and Care, Custody or Control Liability Coverage of this SECTION IV - COMMERCIAL GENERAL endorsement with respect to criver- LIABILITY CONDITIONS, 9. Transfer of age provided by this endorsement. Rights of Recovery Against Others to These limits are inclusive of and not Us is hereby amended by the addition of in addition to the limits being re- the following: placed. The Limits of Insurance shown in Section B. Limits of Insur- We waive any right of recovery we may ante, 6. Voluntary Property Dam- have because of payments we make for age and Care, Custody or Control injury or damage arising out of your ongo- Liability Coverage of this endorse- ing operations or "your work" done under ment fix the most we will pay in any a written contract requiring such waiver one "occurrence" regardless of the with that person or organization and in- number of: cluded in the "products-completed opera- tions hazard". However, our rights may (1) Insureds; only be waived prior to the "occurrence" (2) Claims made or "suits" brought; giving rise to the injury or damage for which we make payment under this Cov- or erage Part. The insured must do nothing (3) Persons or organizations making after a loss to impair our rights. At our re- claims or bringing "suits". quest, the insured will bring "suit' ortrans- fer those rights to us and help us enforce b. Deductible Clause those rights. (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- on your behalf applies only to the Pied Relationships amount of damages for each "occurrence" which are in excess a. The following is hereby added to of the deductible amount stated SECTION 11-WHO IS AN INSURED: in Section B. Limits of Insur- (1) Any person or organization de- ance, 6. Voluntary Property scribed in Paragraph 9.a.(2) be- Damage and Care, Custody or low (hereinafter referred to as Control Liability Coverage of additional insured) whom you are this endorsement. The limits of required to add as an additional insurance will not be reduced by insured under this Coverage Part the application of such deducti- by reason of: ble amount. A written (2) Condition 2. Duties in the Event (a) m nt; or contract or agree- of Occurrence, Offense, Claim or Suit, applies to each claim or (b) An oral agreement or con- "suit' irrespective of the amount. tract where a certificate of insurance showing that per- (3) We may pay any part or all of the son or organization as an deductible amount to effect set- additional insured has been tlement of any claim or "suit" issued, and, upon notification of the ac- tion taken, you shall promptly re- is an insured, provided: imburse us for such part of the Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 10 of 16 (a) The written or oral contract or use of equipment leased or agreement is: to you by such person(s) or 1 Currently in effect or organizations(s). However, Y this insurance does not ap- becomes effective dur- ply to any "occurrence" ing the policy period; which takes place after the and equipment lease expires. 2) Executed prior to an (c) Any person or organization "occurrence" or offense (referred to below as ven- to which this insurance dor) with whom you have would apply; and agreed per Paragraph (b) They are not specifically 9.a.(1) above to provide in- named as an additional in- surance, but only with re- sured under any other pro- spect to "bodily injury' or vision of, or endorsement property damage arising added to, this Coverage out of "your products" which Partare distributed or sold in the regular course of the ven- (2) Only the following persons or or- dor's business, subject to ganizations are additional insur- the following additional ex- eds under this endorsement, and clusions: insurance coverage provided to such additional insureds is lim- 1) The insurance afforded ited as provided herein: the vendor does not apply to: (a) The manager or lessor of a premises leased to you with a) "Bodily injury" or whom you have agreed per "property damage" for which the ven- Paragraph 9.a.(1) above to dor is obligated to provide insurance, but only with respect to liability aris- pay damages by ing out of the ownership, reason of the as- maintenance or use of that sumption of liability part of a premises leased to in a contract or you, subject to the following agreement. This additional exclusions: exclusion does not apply to liability for This insurance does not ap- damages that the ply to: vendor would have in the absence of 1) Any "occurrence" which the contract or takes place after you agreement; cease to be a tenant in that premises. b) Any express war- ranty unauthorized 2) Structural alterations, by you; new construction or demolition operations c) Any physical or performed by or on be- chemical change half of such additional in the product insured. made intentionally (b) Any person or organization by the vendor; from which you lease d) Repackaging, ex- equipment with whom you cept when un- have agreed per Paragraph packed solely for 9.a.(1) above to provide in- the purpose of in- surance. Such person(s) or spection, demon- organization(s) are iinsureds, stration, testing, or but only to the extent that the substitution of the liability for'bodily injury", parts under in- "property damage" or "per- structions from the sonal and advertising injury" manufacturer, and is caused by your negli- then repackaged genre, acts or omissions in in the original con- the maintenance, operation tainer; Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 11 of 16 e) Any failure to Part with respect make such inspec- to such products. tions, adjustments, tests or servicing (d) Any state or political subdi- as the vendor has vision with which you have agreed to make or agreed per Paragraph normally under- 9.a(1) above to provide in- takes to make in suranoe, subject to the fol- the usual course of lowing additional provision: business, in con- This insurance applies only nection with the with respect to the following distribution or sale hazards for which the state of the products; or political subdivision has f) Demonstration, in- issued a permit in connec- stallation, servicing tion with premises you own, or repair opera- rent or control and to which tions, except such this insurance applies: operations per- 1) The existence, mainte- formed at the ven- nance, repair, construc- dor's premises in tion, erection, or re- connection with moval of advertising the sale of the signs, awnings, cano- product; pies, cellar entrances, g) Products which, coal holes, driveways, after distribution or manholes, marquees, sale by you, have hoist away openings, been labeled or re- sidewalk vaults, street labeled or used as banners, or decorations a container, part or and similar exposures; ingredient of any or other thing or sub- 2) The construction, erec- stance by or for tion, or removal of ele- the vendor; or vators; or h) 'Bodily injury" or " 3) The ownership, main- property damage" tenance, or use of any arising out of the elevators covered by negligence, acts or this insurance. omissions of the vendor, its em- (e) Any state or political subdi- ployees or anyone vision with which you have else acting on its agreed per Paragraph behalf. 9.a(1) above to provide in- surance, subject to the fol- lowing provisions: apply to any insured person or o.ganization: 1) This insurance applies a) From whom you only with respect to op- have acquired erations performed by such products, d you or on your behalf any ingredient, for which the state or political subdivision has part or container, issued entering into, ac- companying or 2) This insurance does not containing such apply to "bodily injury", products; or "property damage" or "personal and advertis- b) When liability he ing injury" arising out of cluded within the "products- operations performed "products- for the state or political completed opera- tions hazard" has subdivision. been excluded un- (f) For "your work" performed der this Coverage in Oregon, any person or Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 12 of 16 organization with which you (a) Subparagraphs (e), (f) and have agreed per Paragraph (g) do not apply to "bodily in- 9.a(1) above to provide in- jury" or "property damage" surance, but only to the ex- included within the "prod- tent that the liability is ucts-completed operations caused by "your worts" per- hazard"; formed for that additional in- sured and only to the extent (b) Subparagraphs (a), (d), (e) that such liability is caused and (g) do not apply to "bod- by your negligence or the ily injury", "property dam- negligence of those acting age" or "personal and ad- on your behalf. A person or vertising injury' arising out organization's status as an of the sole negligence or insured under this provision willful misconduct of the ad- of this endorsement contin- ditional insured or its "em- ues for only the period of ployees"; or time required by the written (c) Subparagraph (f) and (g) do contract or agreement, but not apply to "bodily injury", in no event beyond the expi- "property damage" or "per- ration date of this Coverage sonal and advertising injury" Part. If there is no written arising out of contract or agreement, or if no period of time is required 1) The rendering of, or by the written contract or failure to render, any agreement, a person or or- professional services ganization's status as an in- by you or on your be- sured under this endorse- half, but only with re- ment ends when your op- spect to either or both erations for that insured are of the following opera- completed. tions: (g) For "your work" performed a) Providing engi- in the "coverage territory" neeri ng, architec- but not in Oregon, any per- tural or surveying son or organization with services to others; which you have agreed per and Paragraph 9.a.(1) above to provide insurance, but only b) Providing, or hiring with respect to liability aris- independent pro- ing out of "your work" per- fessionals to pro- formed for that additional in- vide, engineering, sured by you or on your be- architectural or half. A person or organiza- surveying services tion's status as an insured in connection with under this provision of this construction work endorsement continues for you perform. only the period of time re- 2) Subject to Paragraph 3) quired by the written con- below, professional tract or agreement, but in no services include: event beyond the expiration date of this Coverage Part. a) Preparing, approv- If there is no written contract ing, or failing to or agreement, or if no period prepare or ap- of time is required by the prove, maps, shop written contract or agree- drawings, opin- ment, a person or organiza- ions, reports, sur- tion's status as an insured veys, field orders, under this endorsement change orders, or ends when your operations drawings and for that insured are com- specifications; and pleted. b) Supervisory or in- (3) Any insurance provided to an spection activities additional insured designated performed as part under Paragraph 9.a.(2): of any related ar- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 13 of 16 chitectural or engi- primary to other insurance neering activities. available to the additional insured except: 3) Professional services do not include services 1) As otherwise provided within construction in SECTION IV - means, methods, tech- COMMERCIAL GEN- niques, sequences and ERAL LIABILITY procedures employed CONDITIONS, 5. by you in connection Other Insurance, b. with construction worts Excess Insurance; or you perform. 2) For any other valid and (d) Subparagraphs (f) and (g) collectible insurance do not apply to "bodily in- available to the addi- jury" or "property damage" tional insured as an ad- arising out of "your world' for ditional insured by at- which a consolidated (wrap- tachment of an en- up) insurance program has dorsement to another been provided by the prime insurance policy that is contractor/ project manager written on an excess or owner of the construction basis. In such case, the project in which you are in- coverage provided un- volved. der this endorsement shall also be excess. b. Only with regard to insurance pro- vided to an additional insured desig- (2) Condition 11. Conformance to nated under Paragraph 9.a.(2) Sub- Specific Written Contract or paragraphs (f) and (g) above, SEC- Agreement is hereby added: TION III - LIMITS OF INSURANCE is amended to include: 11. Conformance to Specific Written Contract or The limits applicable to the additional Agreement insured are those specified in the written contract or agreement or in a. With respect to addi- the Declarations of this Coverage tional insureds de- Part, whichever are less. If no limits scribed in Paragraph are specified in the written contract or 9.a.(2)(f) above only: agreement, or if there is no written If a written contract or contract or agreement, the limits ap- agreement between plicable to the additional insured are you and the additional those specified in the Declarations of insured specifies that this Coverage Part. The limits of in- coverage for the addi- surance are inclusive of and not in tional insured: addition to the limits of insurance shown in the Declarations. (1) Be provided by the Insurance Ser- c. SECTION IV - COMMERCIAL GEN- vices Office addi- ERAL LIABILITY CONDITIONS is ticnal insured form hereby amended as follows: number CG 32 61, (1) Condition 5. Other Insurance is CG 32 62 or CG amended to include: 32 63; or (a) Where required by a written (2) Include coverage contract or agreement, this for completed op- insurance is primary and / or erations; or noncontributory as respects (3) Include coverage any other insurance policy for "your worts'; issued to the additional in- sured, and such other in- and where the limits or surance policy shall be ex- coverage provided to cess and / or noncontribut- the additional insured is ing, whichever applies, with more restrictive than this insurance. was specifically re- quired in that written (b) Any insurance provided by contract or agreement, this endorsement shall be the terms of Para- Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 14 of 16 graphs 9.a.(3)(a) or 9.b, agreement specifies above, or any combina- the Insurance Services tion thereof, shall be in- Office additional in- terpreted as providing sured form number CG the limits or coverage 20 10 but does not required bythe terms of specify which edition, or the written contract or specifies an edition that agreement, but only to does not exist, Para- the extent that such lim- graphs 9.a.3.b. and its or coverage is in- 9.b. of this endorse- cluded within the terms ment shall not apply of the Coverage Part to and Paragraph which this endorsement 9.a.(3)(a) of this en- is attached. dorsement shall apply. b. With respect to addi- 10. Broadened Contractual Liability - Work tional insureds de- Within 50' c f Railroad Property scribed in Paragraph It is hereby agreed that Paragraph f(j) of 9.a.(2)(9) above only: Definition 12. "Insured contract" (SEC- If a written contract or TION V - DEFINITIONS) is deleted. agreement between you and the additional 11. Property Damage to Borrowed Equip- insured specifies that ment coverage for the addi- a. The following is hereby added to Ex- tional insured: clusion j. Damage to Property of a. Be provided by the Paragraph 2., Exclusions of SEC- Insurance Ser- TION I -COVERAGES, COVERAGE vices Office addi- A. BODILY INJURY AND PROP- tional insured form ERTY DAMAGE LIABILITY: number CG 20 10 Paragraphs (3) and (4) of this exclu- or CG 20 37 sion do not apply to tools or equip- (where edition ment loaned to you, provided they are specified); or not being used to perform operations b. Include coverage at the time of loss. for completed op- b. With respect to the insurance pro- erations; or vided by this section of the endorse- c. Include coverage ment, the following additional provi- for "your work"; sions apply. and where the limits or (1) The Limits of insurance shown in coverage provided to the Declarations are replaced by the additional insured is the limits designated in Section more restrictive than B. Limits of Insurance, 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These limits are in- the terms of Para- clusive of and not in addition to graphs 9.a.(3)(a), the limits being replaced. The 9.a.(3)(b) or 9.b. above, Limits of Insurance shown in or any combination Section B. Limits of Insurance, thereof, shall be inter- 11. of this endorsement fix the preted as providing the most we will pay in any one "oc- limits or coverage re- currence" regardless of the quired by the terms of number of: the written contract or agreement, but only to (a) Insureds; the extent that such lim- (b) Claims made or "suits" its or coverage is in- brought; or cluded within the terms of the Coverage Part to (c) Persons or organizations which this endorsement making claims or bring is attached. If, however, "suits". the written contract or Includes copyrighted material of Insurance GA233 OR 09 10 Services Office, Inc., with its permission. Page 15 of 16 (2) Deductible Clause a. Nurses; (a) Our obligation to pay dam- b. Emergency Medical Technicians; or ages on your behalf applies only to the amount of dam- c. Paramedics, ages for each "occurrence" in the jurisdiction where an "occurrence" which are in excess of the or offense to which this insurance applies Deductible amount stated in takes place. Section B. Limits of Insur- ance, 11. of this endorse- 13. Broadened Notice of Occurrence ment. The limits of insur- ance will not be reduced by Paragraph a. of Condition 2. Duties in the application of such De- the Event of Occurrence, Offense, ductible amount. Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- (b) Condition 2. Duties in the TIONS) is hereby deleted and replaced by Event of Occurrence, Of- the following: fense, Claim or Suit, ap- plies to each claim or "suit" a. You must see to it that we are notified irrespective of the amount. as soon as practicable c. j i "occur- rence" or an offense which may result (c) We may pay any part or all in a claim. To the extent possible, no- of the deductible amount to tice should include: effect settlement of any „ claim or "suit" and, upon no- (1) How, when and where the oc- tification of the action taken, currence" or offense took place; you shall promptly reim- (2) The names and addresses of burse us for such part of the any injured persons and wit- deductible amount as has nesses; and been paid by us. (3) The nature and location of any 12. Employees as Insureds - Specified injury or damage arising out of Health Care Services the "occurrence" or offense. It is hereby agreed that Paragraph This requirement applies only when 2.a.(1)(d) of SECTION II - WHO IS AN the "occurrence" or offense is known INSURED, does not apply to your "em- to an "authorized representative". ploWes" who provide professional health care services on your behalf as duly li- censed: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 16 of 16