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HomeMy WebLinkAboutInsurance Certificate: Spring Air 9SPRIAI OP ID: PB CERTIFICATE OF LIABILITY INSURANCE F DATE (MM/DD/YYYY) 09/01/2015 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 Phone: 541-779-4232 N AME: 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 Spring Air, Inc. INSURER B : SAIF Corp 810 N 5th Street - - r- Jacksonville, OR 97530 IN NSURER 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 EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X ECP0160324 09/22/2015 09122/2016 DAMAGE TO RENTED PREMISES (Ea occurrence $ 100,00 CLAIMS-MADE FX7 OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 I GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident $ A X ANY AUTO EBA0160324 09/22/2015 09122/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS (Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE ECP0160324 09/22/2015 09122/2016 AGGREGATE $ 1,000,00 DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 939696 07/01/2015 07/01/2016 E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under - - DESCRIPTION OF OPERATIONS below E1 DISEASE POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland is included as additional insured per form GCP204 05/11 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 / Medf r © 1988-2010 ACORD CORPORATION. II rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD tlement of any claim or "suit" additional insured has been and, upon notification of the ac- issued, tion taken, you shall promptly re- imburse us for such part of the is an insured, provided: deductible amount as has been paid by us. (a) The written or oral contract or agreement is: 5. 180 Day Coverage for Newly Formed or 1) Currently in effect or Acquired Organizations becomes effective dur- SECTION 11 - WHO IS AN INSURED is ing the policy period; amended as follows: and Subparagraph a. of Paragraph 4. is here- 2) Executed prior to an by deleted and replaced by the following: "occurrence" or offense to which this insurance a. Insurance under this provision is af- would apply; and forded only until the 180th day after you acquire or form the organization (b) They are not specifically or the end of the policy period, named as an additional in- whichever is earlier; sured under any other pro- vision of, or endorsement 6. Waiver of Subrogation added to, this Coverage SECTION IV - COMMERCIAL GENERAL Part. LIABILITY CONDITIONS, 9. Transfer of (2) Only the following persons or or- Rights of Recovery Against Others to ganizations are additional insur- Us is hereby amended by the addition of eds under this endorsement, and the following: insurance coverage provided to We waive any right of recovery we may ited such as additional provided herein: insureds is lim- have because of payments we make for injury or damage arising out of your ongo- (a) The manager or lessor of a ing operations or your work" done under premises leased to you with a written contract requiring such waiver whom you have agreed per with that person or organization and in- Paragraph 7.a.(1) above to cluded in the "products-completed opera- provide insurance, but only tions hazard". However, our rights may with respect to liability aris- only be waived prior to the "occurrence" ing out of the ownership, giving rise to the injury or damage for maintenance or use of that which we make payment under this Cov- part of a premises leased to erage Part. The insured must do nothing you, subject to the following after a loss to impair our rights. At our re- additional exclusions: quest, the insured will bring "suit" or trans- This insurance does not ap- fer those rights to us and help us enforce those rights. ply to. 7. Automatic Additional Insured - Speci- 1) Any "occurrence" which fied Relationships takes place after you cease to be a tenant in a. The following is hereby added to that premises. SECTION 11- WHO IS AN INSURED: 2) Structural alterations, (1) Any person or organization de- new construction or scribed in Paragraph 7.a.(2) be- demolition operations low (hereinafter referred to as performed by or on be- additional insured) whom you are half of such additional required to add as an additional insured. insured under this Coverage Part by reason of (b) Any person or organization from which you lease (a) A written contract or agree- equipment with whom you ment; or have agreed per Paragraph (b) An oral agreement or con- 7.a.(1) above to provide in- tract where a certificate of surance. Such person(s) or insurance showing that per- organization(s) are insureds, son or organization as an but only to the extent that the liability or bodily injury, includes copyrighted material of insurance GCP 204 OR 05 11 Services Office, Inc., with its permission, Page 9 of 15 "property damage" or "per- parts under in- sonal and advertising injury" structions from the is caused by your negli- manufacturer, and gence, acts, or omissions in then repackaged the maintenance, operation in the original con- or use of equipment leased tainer; to you by such person(s) or organization(s). However, e) Any failure to this insurance does not ap- make such inspec- ply to any "occurrence" tions, adjustments, which takes place after the tests or servicing equipment lease expires. as the vendor has agreed to make or (c) Any person or organization normally under- (referred to below as ven- takes to make in dor) with whom you have the usual course of agreed per Paragraph business, in con- 7.a.(1) above to provide in- nection with the surance. but only with re- distribution or sale sped to "bodily injury" or of the products; "property damage" arising out of 'your products" which f) Demonstration, in- are distributed or sold in the stallation, servicing regular course of the ven- or repair opera- dor's business, subject to tions. except such the following additional ex- operations per- clusions: formed at the ven- dor's premises in 1) The insurance afforded connection with the vendor does not the sale of the apply to: product; a) "Bodily injury" or g) Products which, "property damage" after distribution or for which the ven- sale by you, have dor is obligated to been labeled or re- pay damages by labeled or used as reason of the as- a container, part or sumption of liability ingredient of any in a contract or other thing or sub- agreement. This stance by or for exclusion does not the vendor; or apply to liability for damages that the h) "Bodily Injury" or vendor would have "property damage" in the absence of arising out of the the contract or negligence, ads or agreement; omissions of the vendor, its em- b) Any express war- ployees or anyone ranty unauthorized else acting on its by you; behalf. c) Any physical or 2) This insurance does not chemical change apply to any insured in the product person or organization: made intentionally by the vendor: a) From whom you have acquired d) Repackaging, ex- such products. or cept when un- any ingredient, packed solely for part or container. the purpose of in- entering into, ac- spection, demon- companying or stration, testing, or containing such the substitution of products; or Includes copyrighted material of Insurance GCP 204 OR 05 11 Services Office, Inc., with its permission. Page 10 of 15 b) When liability in- "personal and advertis- cluded within the ing injury" arising out of "products- operations performed completed opera- for the state or political tions hazard" has subdivision. been excluded un- r this Coverage (fl For "your work" performed der with respect in Oregon, any person or to such products. organization with which you have agreed per Paragraph (d) Any state or political subdi- 7.a.(1) above to provide in- vision with which you have surance, but only to the ex- agreed per Paragraph tent that the liability is 7.a.(1) above to provide in- caused by your work" per- surance, subject to the fol- formed for that additional in- swing additional provision: sured and only to the extent that such liability is caused This insurance applies only by your negligence or the with respect to the following negligence of those acting hazards for which the state on your behalf. A person or or political subdivision has organization's status as an issued a permit in connec- insured under this provision tion with premises you own, of this endorsement contin- rent or control and to which ues for only the period of this insurance applies: time required by the written 1) The existence, mainte- contract or agreement, but nance, repair, construc- in no event beyond the expi- tion, erection, or re- ration date of this Coverage moval of advertising Part If there is no written signs, awnings, cano- contract or agreement, or if pies, cellar entrances, no period of time is required coal holes, driveways, by the written contract or manholes, marquees, agreement, a person or or- hoist away openings, ganization's status as an in- sidewalk vaults, street sured under this endorse- banners, or decorations ment ends when your op- and similar exposures, erations for that insured are or completed. 2) The construction, erec- (g) For 'gout work" performed tion, or removal of ele- in the "coverage territory" vators; or but not in Oregon, any per- son or organization with 3) The ownership, main- which you have agreed per tenance. or use of any Paragraph 7.a.(1) above to elevators covered by provide insurance, but only this insurance. with respect to liability aris- ing out of your work" per- (e) Any state or political subdi- formed for that additional in- vision with which you have sured by you or on your be- agreed per Paragraph half. A person or organiza- 7.a.(1) above to provide in- tion's status as an insured surance, subject to the fol- under this provision of this lowing provisions: endorsement continues for 1) This insurance applies only the period of time re- only with respect to op- quired by the written con- erations performed by tract or agreement, but in no you or on your behalf event beyond the expiration for which the state or date of this Coverage Part. political subdivision has if there is no written contract issued a permit. or agreement, or if no period of time is required by the 2) This insurance does not written contract or agree- apply to "bodily injury", ment, a person or organiza- "property damage" or tion's status as an insured includes copyrighted material of insurance GCP 204 OR 05 11 Services Office, Inc., with its permission. Page 11 of 15 under this endorsement field orders, ends when your operations change orders, or for that insured are com- drawings and pleted. specifications: and (3) Any insurance provided to an b) Supervisory, or in- additional insured designated spection activities under Paragraph 7.a.(2): performed as part (a) Subparagraphs (e), (f) and of any related - chitectural or enargi- (g) do not apply to "bodily in- neering activities. jury" or "property damage" included within the "prod- 3) Professional services ucts-completed operations do not include services hazard": within construction means, methods (b) Subparagraphs (a). (b), (d), , tech- (e), (f) and (g) do not apply pique sequences and to "bodily injury", "ProPe proced procedures employed ly J rty by you in connection damage" or "personal and with construction work advertising injury" arising you perform. out of the sole negligence or willful misconduct of the ad- (d) Subparagraphs (f) and (g) ditional insured or its "em- do not apply to "bodily in- ployees"; or jury" or "property damage" (c) Subparagraphs (f) and (g) arising out of 'your work" for not grapy to "bodily in- wup) hich insurance a consolidated (wrap- do jury", "property damage" or been provided by the prime "personal and advertising in- contractor / project manager jury" arising out of. or owner of the construction 1) The rendering of, or project in which you are in- failure to render, any volved. professional services b. Only with regard to insurance pro- by you or on your be- vided to an additional insured desig- half, but only with re- nated under Paragraph 7.a.(2) Sub- spect to either or both paragraphs (f) and (g) above, SEC- of the following opera- TION Ili - LIMITS OF INSURANCE is tions: amended to include: a) Providing engi- The limits applicable to the additional neering, architec- insured are those specified in the tural, or surveying written contract or agreement or in services, to others: the Declarations of this Coverage and Part, whichever are less. If no limits b) Providing, or hiring are specified in the written contract or independent pro- agreement, or if there is no written fessionals to pro- contract or agreement, the limits ap- vide, engineering, plicable to the additional insured are architectural or those specified in the Declarations of surveying services this Coverage Part. The limits of in- in connection with surance are inclusive of and not in construction work addition to the limits of insurance you perform, shown in the Declarations. 2) Subject to Paragraph 3) c. SECTION IV - COMMERCIAL GEN- below, professional ser- ERAL LIABILITY CONDITIONS is vices include: hereby amended as follows: a) Preparing, approv- (1) Condition S. Other Insurance is ing or failing to amended to include: prepare or ap- (a) Where required by a written prove maps, shop contract or agreement, this drawing, opinions, insurance is primary and / or reports, surveys, noncontributory as respects Includes copyrighted material of Insurance GCP 204 OR 05 11 Services Office, Inc., with its permission. Page 12 of 1S any other insurance policy (3) Include coverage issued to the additional in- for "your work"; sured. and such other in- and where the lim- surance policy shall be ex- cess and / or noncontribut- its or coverage ing. whichever applies, with provided to the this insurance. additional insured is more restrictive (b) Any insurance provided by than was specially this endorsement shall be required in that primary to other insurance written contract or available to the additional agreement, the insured except: terms of Para- 1) As otherwise provided graphs 7.a. or 7.b. above, or , or in SECTION IV - COM- any combination MERCIAL GENERAL thereof, shall be LIABILITY CONDI- interpreted as TIONS, S. Other In- providing the limits surance, b. Excess or coverage re- insurance: or quired by the 2) For any other valid and terms of the writ- collectible insurance ten contract or available to the addi- agreement, but tional insured as an ad- only to the extent ditional insured by at- that such limits or tachment of an en- coverage is in- dorsement to another cluded within the insurance policy that is terms of the Cov- written on an excess erage Part to basis. In such case, the which this en- coverage provided un- dorsement is at- der this endorsement tached. shall also be excess. b. With respect to addi- (2) Condition 11. Conformance to tional insureds de- Specific Written Contract or scribed in Paragraph Agreement is hereby added: 7.a.(2)(f) above only: 11. Conformance to Specific If a written contract or Written Contract or agreement between Agreement you and the additional insured specifies that a. With respect to addi- coverage for the addi- tional insureds de- tional insured: scribed in Paragraph (1) Be provided by the 7.a.(2)(f) above only insurance Ser- If a written contract or vices Office addi- agreement between tional insured form you and the additional number CG 20 10 insured specifies that or CG 20 37 coverage for the addi- (where edition tional insured: specified); or (1) Be provided by the (2) Include coverage Insurance Ser- for completed op- vices office addi- erations: or tional insured form number CG 32 61, (3) Include coverage CG 32 62 or CG for'your work 32 63: or and where the limits or (2) Include coverage coverage provided to for completed op- the additional insured is erations, or more restrictive than includes copyrighted material of insurance GCP 204 OR 05 11 Services Office, Inc., with its permission. Page 13 of 15 was specifically re- B. Limits of Insurance. 9. of quired in that written this endorsement with respect to contract or agreement, coverage provided by this en- the terms of Para- dorsement. These limits are in- graphs 7.a.(3)(a), clusive of and not in addition to 7.a.(3)(b) or 7.b. above, the limits being replaced. The or any combination Limits of Insurance shown in thereof, shall be inter- Section B. Limits of Insurance, preted as providing the 9. of this endorsement fix the limits or coverage re- most we will pay in any one "oc- quired by the terms of currence" regardless of the the written contract or number of agreement, but only to the extent that such iim- (a) Insureds; its or coverage is in- (b) Claims made or "suits" cluded within the terms brought, or of the Coverage Part to which this endorsement (c) Persons or organizations is attached. If, however, making claims or bringing the written contract or "suits". agreement species the Insurance Services (2) Deductible Clause Office additional in- d form number CG (a) Our obligation to pay dam- sure su d but does not ages on your behalf applies 20 10 only to the amount of dam- specify which edition, or ages for each "occurrence" specifies an edition that which are in excess of the does not exist, Para- Deductible amount stated in graphs 7.a.(3)(a) and Section B. Limits of Insur- 7.a.(3)(b) of this en- ance, 9. of this endorse- dorsement shall not ment. The limits of insur- apply and Paragraph ance will not be reduced by 9.b. of this endorse- the application of such De- ment shall apply. ductible amount. 8. Broadened Contractual Liability - Work (b) Condition 2. Duties in the Within 50' of Railroad Property Event of Occurrence, Of- It is hereby agreed that Paragraph f.(1) of fense, Claim or Suit, ap- Definition 12. "Insured contract" (SEC- plies to each claim or "suit" TION V - DEFINITIONS) is deleted. irrespective of the amount. 9. Property Damage to Borrowed Equip- (c) We may pay any part or all ment of the deductible amount to effect settlement of any a. The following is hereby added to Ex- claim or "suit" and. upon no- clusion j. Damage to Property of tification of the action taken. Paragraph 2., Exclusions of SEC- you shall promptly reim- TION I - COVERAGES, COVERAGE burse us for such part of the A. BODILY INJURY AND PROP- deductible amount as has ERTY DAMAGE LIABILITY: been paid by us. Paragraphs (3) and (4) of this exclu- 10. Employees as Insureds - Specified sion do not apply to tools or equip- Health Care Services ment loaned to you, provided they are It is hereby agreed that Paragraph not being used to perform operations 2.a.(1)(d) of SECTION II - WHO IS AN at the time of loss. INSURED. does not apply to your "em- b. With respect to the insurance pro- ployees" who provide professional health vided by this section of the endorse- care services on your behalf as duly li- ment, the following additional provi- censed: sions apply. a. Nurses; (1) The Limits of insurance shown in the Declarations are replaced by b. Emergency Medical Technicians: or the limits designated in Section c. Paramedics, Includes copyrighted material of Insurance GCP 204 OR 05 11 Services Office, Inc., with its permission. Page 14 of 15 in the jurisdiction where an "occurrence" in a claim. To the extent possible, po- or offense to which this insurance applies tice should include: takes place. (1) Now, when and where the "oc- 11. Broadened Notice of Occurrence currence" or offense took place: Paragraph a. of Condition 2. Duties in (2) The names and addresses of the Event of Occurrence, Offense, any injured persons and wit- Claim or Suit (SECTION IV - COMMER- nesses: and CIAL GENERAL LIABILITY CONDI- TIONS) {3) The nature and location of any is hereby deleted and replaced by injury or damage arising out of the e following: the "occurrence" or offense. a. You must see to it that we are notified This requirement applies only when as soon as practicable of an "occur- the "occurrence" or offense is known rence" or an offense which may result to an "authorized representative". Includes copyrighted material of insurance GCP 204 OR 05 11 Services Office. Inc., with its permission. Page 15 of 15