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HomeMy WebLinkAboutInsurance Certificate: Day Wireless Systems DAYMANA-01 MELODYK ~ R~ CERTIFICATE OF LIABILITY INSURANCE 1DATE0 (MM/DD/YYYY) F /1/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: -aura Owens No 503 221-0540 Durham and Bates Agencies, Inc. PHONE 224-5170 AX ( 720 SW Washington St. Ste250 (A/C, No Ext): (503) } E-MAIL Portland, OR 97205 ADDRESS: laurao@dbates.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Atlantic Specialty Ins. Co. 27154 INSURED INSURER B: Hartford XXXXX Day Management Corporation dba: Day Wireless Systems INSURER C 4700 SE International Way INSURER D Milwaukie, OR 97222 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. ADOL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR X 711014061 10/01/2015 10/01/2016 PREMISES (Ea occurrence) $ 1,000,000 X $1,000,000 Umbrella MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER~ GENERAL AGGREGATE $ 2,000,000 PRO- X LOC PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY JECT - - OTHER: COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY (Ea accident) A X ANY AUTO 711014061 10/01/2015 10/0112016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ _ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE - 52WELN9641 10/01/2015 10/01/2016 E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E1 . DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) $1,000,000 Umbrella is included in the Package Policy as shown under the General Liability Section above. See attached forms VCG245 02 05 Additional Insured-Designated Person or Organization; VCG207 11 13 Vantage for General Liability Technology Companies; VCA 201 01 09 Vantage for Automobile; and CA0001 0413 Business Auto Coverage (Other Insurance). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland, Oregon, and ACCORDANCE WITH THE POLICY PROVISIONS. its elected officials, officers and employees 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: DAYMANA-01 MELODYK LOC 0 A~COR"r ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Durham and Bates Agencies, Inc. Day Management Corporation dba: Day Wireless Systems - 4700 SE International Way POLICY NUMBER ~Milwaukie, OR 97222 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Remarks: Workers Compensation Companies Workers Compensation Companies Hartford Casualty Insurance Company - Applies to State of Nevada (NAIC 37478) Hartford Accident and Indemnity Insurance Company - Applies to State OR (NAIC# 22357 ) Hartford Fire Insurance Company - Applies to CA (NAIC#19682) Twin City Fire Insurance Company - Applies to Sates of ID and MT (NAIC# 29459) Washington Employers' Liability Stop Gap Coverage is included under the Workers' Compensation Policy ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 71 1014061 -ITIIS ENDORSEMENT CI IANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WI-10 IS AN INSURED, 2. is arrrended to include as an additional insured: a. The certificate bolder, but only as respects its liability arising out of your activities. b. The person or organization shown in the Schedule as an additional insured but only with respect to liability arising out of your operations or• premises owned by or rented to you. SCHEDULE* The City of Ashland, Oregon And its elected officials, officers and employees 20 East Main Street Ashland, OR 97520 Insured: Day Management Corporation DBA: Day Wireless Systems * Information n2quinxl to complete this S yxlu ifrxi shown on this eridotsone rt; will be slxnvn in the Declaratic-xrs. VCG 245 02 05 Includes col3yrighted material of Insurance Services Office, Inc. Pave I of) Copyright 2004 Policy No: 711014061 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. cOVANTAGE FOR GENERAL LIABILITY TECHNOLOGY COMPANIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provisions to determine the extent of your coverage, SCHEDULE OF COVERAGE EXTENSIONS € 1, Additional Insured - Broad Form Vendors 8. Coverage Territory - Worldwide 2, Additional Insured - by Contract, Agreement or 9. Duties in Event of Occurrence, Claim or Suit Permit relating to: 10. Expected or Intended Injury (PD) o Work performed by you 11. Incidental Medical Malpractice o Premises you own; rent, lease or occupy 12. Medical Payments c Equipment you lease 13. Mobile Equipment Redefined 3. Aggregate Limit Per Location 14, Newly Acquired or Formed Organizations I 1 4. Blanket Waiver of Subrogation 15_ Non-Owned Aircraft i 5. Bodily Injury Redefined- Mental Anguish 16. Non-Owned Watercraft 6. Broadened Named Insured 17. Personal and Advertising Injury ! 7. Broadened Property Damage 18. Product Recall Expense o Borrowed Equipment 19. Supplementary Payments Increased Limits o Customers' Goods o Use of Elevators 4 1. ADDITIONAL INSURED - BROAD FORM VENDORS Section iI -Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to below as vendor) with whom you agreed in a written contract or agreement to provide insurance, but only with respect to "bodily injury" , or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: a. This provision 1 . does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty not authorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container: (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product: (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or VCG 207 11 13 includes copyrsgnted material of Insurance Services Office, inc. Page ? of s Copyright, OneSeacon Insurance Group LLC PRODUCER (8) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its ci;.,n acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (a) The exceptions contained in Subparagraphs 4. or 6,; or (b) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (9) Any vendor, person or organization if the products-completed operations hazard" is excluded either by the provisions of the Coverage Fora or by endorsement. b. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 2. ADDITIONAL INSURED -CONTRACT, AGREEMENT OR PERMIT a. Section it -Who Is An Insured is amended to include as an additional insured any person (s) or organization(s) with whom you agreed in a written contract, written agreement or permit to provide insurance such as is afforded under this Coverage Part: 1. with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of "your work" for the additional insured(s) at the location designated in the contract, agreement or permit: or (b) In the maintenance, operation or use of equipment leased to you by such person(s) or organization(s), or (c) In connection with premises you own. rent, lease or occupy. 2, with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf and occurring after: (a) All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the site of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. This insurance applies on a primary or primary and non-contributory basis if that is required in writing by the contract, agreement or pen-nit, b. The insurance provided to the additional insured herein is limited. This insurance does not apply: t. Unless (a) the written contract, agreement or permit is currently in effector becomes effective during the term of this policy; and (b) the contract or agreement was executed or permit issued prior to the "bodily injury", "property damage", or "personal and advertising injury2. To any person or organization included as an insured under the Additional Insured - Broad Form Vendors provision of this endorsement; 3. To any person or organization included as an insured by an endorsement issued by us and made part of this Coverage Part, 4. To any person or organization if the "bodily injury""property damage", or "personal and advertising injury' arises out of the rendering of or failure to render any professional architectural, engineering or surveying services by or for you including: (a) The preparing, approving. or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications: or (b) Supervisory, inspection; architectural or engineering activities. VCG 207 11 13 lnciudes copyrighted material of insurance Senices Office me Page 2 of 8 Co.py.right. OneBeacon Insurance Group L_C 5. To any: (a) Lessor of equipment after the equipment lease terminates or expires; or (b) Owners or other interests from whom land has been leased; or (c) Managers or lessors of premises if: (1) The "occurrence' takes place after you cease to be a tenant in that premises; or (2) The "bodily injury", "property damage", "personal and advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. c. Limits of insurance applicable to the additional insured are those specified in the contract, agreement or permit or in the Declarations of this policy, whichever is less, and fix the most we will pay regardless of the number of 1. Insureds; 2. Claims made or "suits" brought; or 3. Persons or organizations making claims or bringing "suits". These Limits of insurance are inclusive of and not in addition to the Limits of insurance shown in the Declarations. 3. AGGREGATE LIMIT PER LOCATION a. Under Section III - Limits of Insurance, the General Aggregate Limit applies separately to each of your 'locations' owned by or rented or leased to you. b. Under Section V - Definitions, the following definition is added: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 4. BLANKET WAIVER OF SUBROGATION Section IV - Transfer of Rights of Recovery Against Others to Us Condition is amended to add the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations done under a written contract or agreement with that person or organization and included in "your work" or the "products-completed operations hazard". This waiver applies only to persons or organizations with whom you have a written contract, executed prior to the bodily injury" or "property damage", that requires you to waive your rights of recovery. 5. BODILY INJURY REDEFINED - MENTAL ANGUISH Under Section V, the definition of "bodily injury.. is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time. 6. BROADENED NAMED INSURED Section 11 - Who Is An Insured is amended to include as an insured the following: Any organization which is a legally incorporated entity in which you own a financial interest of more than 80 percent of the voting stock on the effective date of this endorsement will be a Named Insured until the 180 day or the end of the policy period, whichever comes first, provided there is no other similar insurance available to that organization. The insurance afforded herein does not apply to any entity which is also an insured under another policy or would be an insured under such policy but for its termnation or the exhaustion of its limits of insurance. VCG 207 11 13 Inchudes copyrighted mater al of':nsurance Services Office, Inc. Page 3 of 8 Copyright, OneBeacrn Insurance Group LLC Policy No- 711014061 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. @VANTA E FOR AUTOMOBILE This endorsement modifies insurance provided underthe following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement, Refer to the individual provi- sions to determine the extent of your coverage. _ SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured By Contract 12. Employee Hired Autos 2. Airbag Discharge 13. Fellow Employee Exclusion 3. Auto Theft Reward 14. Glass Repair- Waiver of Deductible 4. Blanket Waiver of Subrogation 15. Hired Auto Physical Damage Coverage 5. Bodily Injury Redefined - Mental Anguish 16. Lease Gap Coverage 6. Broad Form Named Insured 17, Liability Coverage - Supplementary Payments 7. Communications Equipment 18, Newly Formed or Acquired Organizations 8. Diminution in Value 19, Physical Damage -Transportation Expenses 9. Drive Other Car - Executive Officers 20. Rental Reimbursement - Private Passenger 10. Duties In The Event of Accident, Claim, Suit or Loss Vehicles 11. Employees As Insureds---- - - 21. Towing - Any Covered Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is An Insured provision under SECTION 11 - LIABILITY COVERAGE is amended to include as an additional "insured" any pet-son or organization with whom you agreed in a written contract, written agreement or permit, to provide insurance such as is afforded under this Coverage Form. Such person or organization is an "insured" only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part by your maintenance, operation or use of your covered "autos". With respect to the insurance afforded to these additional "insureds", this insurance does not apply: a. Unless the written contract or agreement has been executed or the permit has been issued prior to the "bodily injury" or "properly damage"-. b. To any person or organization included as an "insured" by endorsement or in the Declarations: or c. To any lessor of "autos" when their contract or agreement with you for such leased "auto" ends, 2. AIRBAG DISCHARGE If you purchased physical damage coverage for a covered "auto" under this policy, we will pay to reset or re- place an airbag that accidentally discharges without the vehicle being involved in an accident, No deductible applies to this additional coverage. However, this coverage only applies if the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and conviction of anyone stealing a covered "auto". A reward will not be paid to you, a family member, employee or any public official while performing their duty. 4. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights of Recovery Against Others To Us condition under SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A. LOSS CONDITIONS is replaced by the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising Out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract", provided the contract is in writing and executed prior to the "bodily injury" or "property damage". 5. BODILY INJURY REDEFINED - MENTAL ANGUISH The definition of "bodily injury" under SECTION V - DEFINITIONS is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resultinq from any of these at any time. VCA 201 0109 lnc;udes oo, yrignted material of Insurance Services Office. inc. Page 1 o15 ccprght 2004, OneBeacon insurance Group LLC PRODUCER Policy No: 711014061 4. Loss Payment - Physical Damage S. Other Insurance Coverages a. For any covered "auto" you own, this At our option, we may: Coverage Form provides primary a. Pay for, repair or replace damaged or insurance. For any covered "auto" you don't stolen property; own, the insurance provided by this Coverage Form is excess over any other b_ Return the stolen property, at our expense. collectible insurance. However, while a We will pay for any damage that results to covered "auto" which is a "trailer' is the "auto" from the theft; or connected to another vehicle, the Covered c. Take all or any part of the damaged or Autos Liability Coverage this Coverage stolen property at an agreed or appraised Form provides for the "trailer" is: value. (1) Excess while it is connected to a motor If we pay for the "loss", our payment will vehicle you do not own; or include the applicable sales tax for the (2) Primary while it is connected to a damaged or stolen property. covered "auto" you own. 5. Transfer Of Rights Of Recovery Against b. For Hired Auto Physical Damage Coverage, Others To Us any covered "auto" you lease, hire, rent or If any person or organization to or for whom we borrow is deemed to be a covered "auto" make payment under this Coverage Form has you own. However, any "auto" that is rights to recover damages from another, those leased, hired, rented or borrowed with a rights are transferred to us. That person or driver is not a covered "auto". organization must do everything necessary to c. Regardless of the provisions of Paragraph secure our rights and must do nothing after a. above, this Coverage Form's Covered "accident" or "loss" to impair them. Autos Liability Coverage is primary for any B. General Conditions liability assumed under an "insured 1. Bankruptcy contract". 8ankroptcy or insolvency of the "insured" or the d. When this Coverage Form and any other "insured's" estate will not relieve us of any Coverage Form or policy covers on the obligations under this Coverage Form. same basis, either excess or primary, we will pay only our share. Our share is the 2. Concealment, Misrepresentation Or Fraud proportion that the Limit of Insurance of our This Coverage Form is void in any case of Coverage Form bears to the total of the fraud by you at any time as it relates to this limits of all the Coverage Forms and Coverage Form. It is also void if you or any policies covering on the same basis, other "insured", at any time, intentionally 6. Premium Audit conceals or misrepresents a material fact a. The estimated premium for this Coverage concerning: Form is based on the exposures you told us a. This Coverage Form: you would have when this policy began. We b. The covered "auto"; will compute the final premium due when c. Your interest in the covered "auto"; or we determine your actual exposures, The estimated total premium will be credited d. A claim under this Coverage Form. against the final premium due and the first 3. Liberalization Named Insured will be billed for the balance, if any. The due date for the final If we revise this Coverage Form to provide premium or retrospective premium is the more coverage without additional premium date shown as the due date on the bill. if charge, your policy will automatically provide the estimated total premiurrr exceeds the the additional coverage as of the day the final premium due, the first Named Insured revision is effective in your state. will get a refund. 4. No Benefit To Bailee - Physical Damage b. If this policy is issued for more than one Coverages year, the premium for this Coverage Form We will not recognize any assignment or grant will be computed annually based on our any coverage for the benefit of any person or rates or premiums in effect at the beginning organization holding, storing or transporting of each year of the policy, property for a fee regardless of any other provision of this Coverage Form. CA 00 01 10 13 insurance Seriices Office, rrc., 2011 Page 9 or 32