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HomeMy WebLinkAboutInsurance Certificate: Day Wireless Systems (3) DAYMANA-01 MELODYK CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/1/2015 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 Laura Owens Durham and Bates Agencies, Inc. PNAME: HONE FAX 720 SW Washington St. Ste250 _(,_N_c, No, exq_~503) 224-5170 (A,cNo) 503 221-0540 Portland, OR 97205 E-MAIL laurao@dbates.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Atlantic Specialty Ins. Co. 127154 INSURED INSURER B : Hartford IXXXXX 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. INSR ~ADDL SUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY I LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X~ OCCUR X 1711014061 10/01/2015 10/01/2016 PREMISES Ea occurrence $ 1,000,000 X $1,000,000 Umbrella ~ MED EXP (Any one person) I $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,000 EN 'L AGGREGATE LIMIT APPLIES PER I ~-GENERAL AGGREGATE $ 2,000,000 l POLICY 171 PRO- X LOC 2,000,000 PRODUCTS -COMP/OP AGG $ - - OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ~ &aaccident_ 1,000,000 A X ANY AUTO 711014061 10/01/2015 10/01/2016 BODILY INJURY (Per person) 1 $ X ALL OWNED SCHEDULED BODILY INJURY (Per accident) 1 $ 'AUTOS AUTOS i NON-OWNED 70PER-Z-I) DAMAGE $ HIRED AUTOS X AUTOS accd $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _L- G CLAIMS-WADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER B ANY OFFICER/MEMBER EXCLUDED?ETOR/PARTNER/EXECUTIVE N ' N / A 52WELN9641 10/01/2015 10/01/2016 E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) EL. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 I I I 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 City of Ashland, Oregon, and THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: DAYMANA-01 MELODYK LOC 0 ACURL7 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Durham and Bates Agencies, Inc. Day Management Corporation dba: Day Wireless Systems POLICY NUMBER 4700 SE International Way 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 No: 711014061 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OVANTAOE 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 o Equipment you lease 13. Mobile Equipment Redefined 3. Aggregate Limit Per Location 14. Newly Acquired or Formed Organizations 4. Blanket Waiver of Subrogation 15. Non-Owned Aircraft 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 1. ADDITIONAL INSURED - BROAD FORM VENDORS Section 11- 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 injunj" 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 vendorwould 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 forthe 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 copyrighted material of Insurance Semites Office, inc. Page 1 of 8 Copyright, One Beacon Insurance Group LLC PRODUCER POLICY NUMBER: 71 1014061 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION 11 - WI-10 IS AN INSURED, 2. is amended to include as an additional insured: a. The certificate holder, 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'S The City of Ashland, Oregon And its elected officials, officers and employees 20 East Main Street Ashland, OR 9720 Insured: Day Management Corporation DBA: Day Wireless Systems InfaTmtion required to cornplete this Scixxhile, ifnot shown on this endorsement, will be shown in the Declarations VCG 245 02 05 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 Copyright 2004 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 111- 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 "yourwork" 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 require, 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 50 percent of the voting stock on the effective date of this endorsement will be a Named Insured until the 1801'' 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 termination or the exhaustion of its limits of insurance. VCG 207 11 13 Includes copyrighted material of Insurance Services Office, Inc. Page 3 of 8 Copyright, OneBeacon Insurance Group LLC (8) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own 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 Form 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 underthis 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 permit. b. The insurance provided to the additional insured herein is limited. This insurance does not apply: i. Unless (a) the written contract, agreement or permit is currently in effect or becomes effective during the term of this policy; and (b) the contractor agreement was executed or permit issued prior to the "bodily injury", "property damage", or "personal and advertising injury"; 2. 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 Includes copyrighted material of Insurance Services Office. Inc Page 2 of 8 Copyright. One Beacon Insurance Group LLC Policy No: 711014061 4. Loss Payment - Physical Damage 5. 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 VV6 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 namage 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 LIS. That person or driver is not a cohered "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". BankrL)ptcy 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 underthis 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 concerning: a. The estimated premium for this Coverage 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 If we revise this Coverage Form to provide balance, if any. The due date for the final more coverage without additional premium premium or retrospective premium is the date shown as the due date on the bill. If charge, your policy will automatically provide the estimated total premium 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 ser iices Office, Inc., 2011 Page 9 of 12 Policy No: 711 014061 THIS ENDORSEMENT CHANGES THE POLICY. 'PLEASE READ IT CAREFULLY. @VANTAGE 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 18. 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 210. 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 Il - LIABILITY COVERAGE is amended to include as an additional "insured" any person 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 "property 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 tinder 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 oecausse of pyrnentS 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 resulting from any of these at any time. VCA 201 01 09 includes copyrighted material of Insurance Services Office, Inc. Page 1 of 5 Copyright 2004, OneBeacon Insurance Group LLC PRODUCER DATE (MM/DD1YYYY) AC "R CERTIFICATE OF LIABILITY INSURANCE 09911!1512015 5 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION CARNEY INSURANCE ONLY AND, CONFERS NO RIGHTS UPON THE CERTIFICATE 16938 W LINEBAUGH AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SUITE 102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TAMPA, FL 33625 INSURERS AFFORDING COVERAGE NAIC # _ INSURED INSURER A: ALLIED PROPERTY & CASUALTY INS CO ETZEL ANSWERING INC _ _ IfJSLIRf_P, B. - DBA ANSWER PAGE INSURER C 3709 CITATION WAY INSURER D MEDFORD OR 97504 . INSURER E. COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS _ _............................................._............................................._.._........_..................__..._...._..._......_......_........M.........................__..... ............_..._.._............._....._.._...._..___--- IN SR AUD'L TYPE OF INSURANCE l POLICY NUBER DATE I MMJDDIYYYY) DATE ( MIDONYIYY) LIMITS L.TR INSR GENERAL LIABILITY ACP BPOC3016581645 03110/2015 03/10/2016 EACH OCCURRENCE 5 1,000,000 ISES x CUfvlfdFP,('IAL- i.;FNERAI. LIABILITY PREMfv71vES (Ea Ea orcurre ccUrcencc) S 300,000 C.LAIFAS fv ADC X OCGIJr: L.._....... I _-MEC_EXP LAny one person) S 5.000 PERSONAL&ADVINJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 _ GEN'L AG(_REGATE I.MAIT APPLIES PER PRODUCTS • CO IAPIOP AGG S 2.000.000 X POLIO; PKO- 11F.i^T LOC S AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT 5 ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per per•;an) HIRED AUTOS BODILY INJURY S NON OWNEDAUTCIS (Per accident) i PROPERTY DAMAGE S rper a^.Ladent} GARAGE LIABILITY AUTO ONLY- EA,,CCIDE.f1T S Atli AUTO I 07HER'THiJ•1 cA ACG 5 AUTO ONLY AGG S EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUP CLAIMS MADE AGGREGATE S S DFuui:'TIBI_(:: RETErTTIOtJ S 5 EwNIOPLORKERS YTION AND YIN _ TO~NICSI[AIU- 1 10 1H* RY L: MITS -..1(EP, ?.NY PROPRIETORIPARTNEI.IE7ECIJTIVE❑ E.L. EACH ACCIDENT S OFFICE r EXr;LUDEDO OFFICEr in NH) E.L. DISEASE - EA EMPLOYEE S If yrs. (Mandatory I e H) umier C - I, '-A PS .r• C E.L. DISEASE POLICY LIMIT 5 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS THE CITY OF MEDFORD AND ITS OFFICERS, EMPLOYEES AND AGENTS WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES AS SUCH ARE INCLUDED AS ADDITIONAL INSURED WHEN REQUIRED BY WRITTEN CONTRACT AS PER ATTACHED FORM #PB Al 07(01-01) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF MEDFORD DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 411 `~"VESI' 8I'H STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BU 'T FAILURE 1'0 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR RE-PRESENTA71VES. MEDFORD OR 97501 AUTHORIZED FirPRESENY TIVE ACORD 25 (2009101) L A)'1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate. holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. i I ACORD 25 (2009101) EFFECTIVE DATE: 12:01 AM Standard Time, BUSINESSOWNERS (at your principal place of business) PB All 07 (01-01) ACKNOWLEDGEMENT OF ADDITIONAL INSURED STATUS STATE OR POLITICAL SUBDIVISIONS - PERMITS RELATING TO PREMISES Person or Organization Designated as an Additional Insured: THE CITY OF MEDFORD, OR AND ITS OFFICERS, EMPLOYEE SEE BLANK ENDORSEMENT PB2500 411 W 8TH ST MEDFORD OR 975013105 Designated Premises: 3709 CITATION WAY MEDFORD OR 975049022 This form has been sent to you to acknowledge your status as an additional insured under our, meaning the issuing Company stated below, insurance policy issued to the Named..lnsured shown below. Under our Premier Businessowners Liability Coverage Form, Section II. WHO IS AN INSURED provides as follows: Any of the following persons or organizations are automatically insureds when you i.e. the Named Insured stated below and such person or organization have agreed in a written contract or agreement that such person or organization be added as an additional insured on your policy providing general liability coverage. State or Political Subdivisions - Permits Relating to Premises Any state or political subdivision which has issued a permit in connection with premises insured by this Policy which you own, rent, or control is an additional insured, but only with respect to the following hazards: (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decoration and similar exposures, (2) The construction, erection, or removal of elevators; or (3) The ownership, maintenance, or use of any elevators covered by this insurance. HOWEVER, such state or political subdivision's status as additional insured under this policy ends when the permit ends. The policy language set forth above is subject to all of the terms and conditions of the policy issued to the Named Insured shown below. For your information, our Named Insured, the Policy Number, Policy Term and Limits of Insurance are stated below. Named Insured ETZEL ANSWERING INC - DBA Issuing Company: ALLIED P/C INS COMPANY Policy Number: ACP BPOC3016581645 Policy Term: 03-10-15 To 03.10-16 Limits of Insurance: Per Occurrence $1,000,000 All Occurrences $2,000,000 PB Al 07 (01-01) Page 1 of 1 ACP BPOC3016581645 AGENT COPY 59 16322 EFFECTIVE DATE: 12:01 AM Standard Time, BUSINESSOWNERS (at your principal place of business) PB 25 00 (01-01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPLETE NAMES & ADDRESSES OF THE ADDITIONAL INSURED RE: PBA107 THE CITY OF MEDFORD, OR AND ITS OFFICERS, EMPLOYEES AND AGENTS WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES AS SUCH. 411 W 8TH ST MEDFORD, OR 975013105 I. All terms and conditions of this policy apply unless modified by this endorsement. PB 25 00 (01-01) ACP BPOC3016581645 AGENT COPY 59 16323