HomeMy WebLinkAboutInsurance Certificate: Quality Fence Co Reliable Electric
QUALFEN-01 ATHOMPSON
ACORO DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 4/26/2016
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:
McMinnville Office PHONE FAX
Pa neWest Insurance, Inc. -JA/C,No Ext : (503) 472-2121 A/I C, No): (503) 434-5872
yy E-MAIL
P.O. Box 269 ADDRESS:
McMinnville, OR 97128
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Hallmark Insurance Group - 43494
INSURED INSURER B :
Quality Fence Co Reliable Electric Western Vinyl - - -
Products INSURER C :
Steve Rietmann INSURER D :
PO Box 3985 INSURER E :
Central Point, OR 97502 -
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
rv-1 To
CLAIMS-MADE - "OCCUR X X 44CL466835 11/19/2015 11/19/2016 PREMISES DAMAGES ( E. RENTED occurrence) $ 100,000
MED EXP (Any one person) $ 5,000
0
PERSONAL & ADV INJURY $ 1,000,00
GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
POLICY JE LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER'. $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $ 1,000,000
A XANY AUTO X 44CL466835 11/19/2015 11/19/2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS -
NON-OWNED PROPERTY DAMAGE $
X HIRED AUTOS X~ AUTOS Per accident _
$
X UMBRELLA LIAB X ,OCCUR EACH OCCURRENCE $ 3,000,000
A EXCESS LIAB IL CLAIMS-MADE 44CU466836 11119/2015 11/19/2016 AGGREGATE $ -
DED X RETENTION $ 10,000 3,000,000 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER_
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Commercial Property 44CL466835 11/19/2015 11/1912016 leased eq 25,000
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
City of Ashland is additional insured as respects liability arising out of the activities by and on behalf of the named insured per attached endorsements.
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 ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain St
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
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POLICY NUMBER; q 4 CL 4 6 6 8 3 5 COMMERCIAL GENERAL ,LIABILITY
GC 90:25 07 09
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THIS ENDDRSEMENT:CHANGlaS THE-POLICY.: PLEASE READ, iT•-CAREFULL.Y: ° .
OREGON. BLAi KFT-'AD.DITIONAL"INSURED `
COMPLETED ':OPERATIONS
This endorsement modifies insurance provided under.the following;
COMMERCIAL GENirRAL LIABILITY .COVERAGE PART'- '
A. • Section Ii--Who Is'An'insufed'is-amended to iaclude-as•an•addltional Insured.any person gr.organization
for whom you are performing-'operations when you and •scch person. or.organizatlon• have -agree4• in writing In
a contract or agreement-that such'person or organization- be. added as an additional Insured•for:completed
operations.- Such person. or organization is•an -additional insured oniyto.the extent that.the Ilabiilty for "bodily..
Injury" or "property damage" Is caused, in whole or In -part, by "your work" performed for that additional .Jn-
• ' sured and Included In the "products-completed operations -hazard.".
S. With respect to the Insurance afforded-to these. additional Insureds, the following limitations apply:
4. This additional insured status•is granted only at the locations listed In the written contract;
2. Coverage is.limited to !'your work" that is described -in the classifications or schedule of hazards shown -in -
the General Liability Declarations of this policy.
C. With respect to the insurance afforded lo these additional- insureds, the following exclusion applies:
This Insurance does not apply to:
"Bodily Injury" or "property damage" which occurs'prior to the execution of the written contract or the effec- . .
tive date of this endorsement.
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GC 10 25 07 09 Includes copyrighted material of page 9 of T .0
Insurance Services Office, Inc., wlthi Its permission
ART'ISM AAVANTAAQ ENHANCED 0aVERAaI5 5f4DORE5M5N'T
THIS END9I9SEMENT CHANGES THE POUOY, PLEASE READ IT CAREFULLY,
This endorsement madlfles lnsVrarias pr.Qvided under the tollgy~ing:
SU16*-J'NR'AND FE'nsbNAL 1700PERVY DOVBRAQE FC?RM
CAUSES OF-Lg39--Bp1r04 io.R'm - •
COMMERCIAL PROPERTY GO, orI'.IONs, % .
GOVIV15RC1AL q"nNdRAL:LIAbkl7~' ()dV1~RACE FORM
When thls.endbrse►nent Is atiaohed to•the.pblicy, Insurance under the Building and Personal'Property:Cdverage' Form,. the. Oauses of Loss - Special Form, the 0ommer6ial Proporly
conditions and the Commarolal Qeneral•L1ablllty Gouerage Form Is,
enhanced to pYoAde the covergges desorlbed.ln this endorsement. All other oonditlons of the policy.contlnue to apply.
•Th)e.ooverage is aub)ectto.tha proulslans.appl)oablQ.to,the Bu)iding,and I?ers❑nal Property.,Covergge.F❑rm, Gauses.of Less . ,
'Speow Form, the Commercial Property Conditions and the bqf sral Liabliity Coverage Form,...
5'GHEDULE
Coverage Enhancements Limas of'Insupanae Mooh Loceflon
o art r CoVera[te Extensions
Newly Acquired or Donstruoted Properly
sulldings $250,000, at Each Building...
Buslaoss psrsonal Properly ' $100,000. at Each Building
Personal Effects and Property of Others $ 10,000, at Replacement Cost r .
Valuable Papers and Records (Other than Eleotronlo Data) $ 25,000.
Property. Off-Premises (11-i6ding Laptop's and Other Electronic Equipment) 10,000.
Dutdoor Property (Named Perils) $ 1,000. per tree/shrub,' ma:. IIm1t V5,00o.
Non-Owned Detached Trailers $ 10,000. •
Accounts Receivable $ 25,000,
Property In Transit (Inoluding Laptops end Other Electronic Equipment) 10,000,
~roaerty Additional Ooverages
Eleotronic Data $ 16,000,
Arson Reward $ 5+000, I i
Water Back-Up and Sump Overflow $ 25,000.
Business Income Including Extra Expense $ 25,000, I
Inventory or Appraisal Cost $ 5,000. )
Money and Becuriiies I ! j
Inside $ 10,000. ,
outside $ 5,000, !
Ordinanne or Law Coverage !
Oovarage A Included within Bulldtng Limit,
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Coverages B and C Combined 25% of Bldg, Limit, $150,000. maximum
Outdoor Signs $ 5,000, I 1
Reoharging or Fire Exting0ohars $ 6,000,
Inland Marine coverages'tallation Coverage $ 10,000,
Contractors Equipment Coverages
I Small Tools $ 2,500, (Maximum bmlt Pei- Item $5oo) .
i Employee Small Tools $ 1,000, (Maximum )ImItperltem T950) ,
Leased and.Rented Equipment $ 5,000, . ,
Rents! Reimbursement 1,000.
General UEbl(Ity Addttional Coverapas
ElankstAddltlonal Insured (Inoluding Primary Non-Contribuling Coverage) Included in Each Opaurrenoa,LirNt • ,
10oblie Equipment broadened Coverage Included In Eaph 09purrenoe Limit.
Aggregate Umit Per ProJeot Inoluded In Each 0courrenaa Limit
Blanket Waiver Included In ~aoh 0opgrrence Limit
MP 87 67 04 OB Inoludes oapyrighted material of 160 Praperues, Ina, and Page I of 1$
AmedasnMsooWon of Ineufnnee Services, Ina., used with ihelrpermisslon
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j c, The following Js added to ,0.,2, Property Not Covered of the BUILDING AND PERSONAL PROPERTY
CoV.5AAGE FORM;
r. Property while stored or operated underground In ponneotlon with any mining operations,
d, The following Is added to Paragrpph 2. of B. Exclusions of the CAUSES OF LO~3, S , SPECIAL i Ql3M:
n. We will not pay for Joss ordsmage caused by puncture, blowout and road dampgprto tlrsaand tubes mounted on
vehloles, However, we do p'ay for puncture, blov6ut or road damage caused by n specified peril.
o, We will not pay for loss caused by humidity, dampness, dryness or ohangss,'In or extremes of temperature, •
p, We will not payforJoss caused by the weight cif a I* which, under the operating condltJons atthe time of-a loss, ,
exceeds the registered Illtlny,.capaclly, of any squipmerlt or machine.
0.. W..a'wJII not pay for lose due•to theft or mysterious disappearance from any vehicle or attaohed,gontalnsr. We. • ;
will pay for. loss due to burglary when there are signs of forolble entry to a looked vehicle or oontalner.,
e, E,%Valuatlon ofthe BVILVINQ AND. PERSORAL PROPERTY COVERAGE FORM is del stedand rpplaced,by.°fhe
i following:
7, Valuation
We will determine the value of covered properly In the event of loss or damage as follows: ;
a, At actual dash Galue at the tlme df the loss (with a d'eduotion for depreciation) except as provided' In • '
paragraphs b. and c. following,
b, Pair ar set, The value of a lost or. damaged artlole which Is part of a-palr or set Is•baead on a reasonable
proportlon ofthe value of the entire pair or set, The loss Is not considered a total Joss of the pair Or set,'
'o; Loss to Parts,' The value of a lost or darriaged part of an ham that oonslsts of several parts when 1118
complete Is based an the value of only the lost or damaged part or the cost to repair or replace It,
2, Rental Reimburspment "
In the event of loss by a covered peril to covered contractors' equipment that you own, we will reimburse.ypu.for your
expense to rent similar equipment while your equipment Is inoperable.. The most we will reimburse you for-rental -
raimbursement expenses is tnl,a0ti, We will continue to reimburse you forthe rental of equipmentafterfhe expiration
date otthls coverage provided the loss occurred before the expiration date,
We will not reimburse you:
a, If you can oonffinus or resume your operations with similar equipment that Is avallable to you at no additional
expense to you; or
b, Fortha rental expense.of any equipment unless you make every reasonable effortto repair, rep)aoe or rebulld the
inoperable equipment aft-sr the covered loss occurs,
S. With respeotto this Additional Coverage, Contractors Equipment Coverage, Section D, l EXIL'a ibis ofthe 131JII_E]1Na
APIA PERSONAL PROPFRTY COVERAGE FORM is deleted and replaced byths following:
' l II. Deductible
We will notpayfor ibw or damage In any one occurrence untlithe amount of loss or damage exceeds 8500. We will
than pay the amount of loss or. damage In excess pf $500 up to the applicable limit of insurance,
We will not reimburse you for the rental df equipment until after 72 hours have passed since the covered property .
was rendorpd Inoperable, After 72 hours have passed, we will only reimburse you forthe rental expense that you
aotually inour. °
The deduclible of $500 does not apply to rental rslmbursement expenses,
l laeneraIUabilityArldttional Coverages
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I The tollowhi Additional Coverages are added to 6e COMM0CIAL GENERAL LIA13ILfTY GOVEFiAaE FQJ~M.
A. Blanket Additional Insured Coverage -
1. SECTION II- WHO IS ANINSURED off-the COMMERCIAL GENERAL LIABILITY COVERAGE FORM Is amended to •
Jnolude as on Insurad any person or organization (referred to as Addltlonal Insured) Whom you are requlradto add as an
Addltlonal Insured on thls polJcy under:
a, A written contract or agreement; and
b,' WhareaoerttfJoatgofinsuranoeshowingthatpersonororganizatlonasanadditlonalInsured has been Issued; and J
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Page 14 of 18 Insiudes copyrighted malarial of ISO Properties, Inc, and MP 87 67 04 01
American Ana001WIN of Insurance Bervloes, Inc,; used with !heir parmiselon '
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c. When the written contract of agreement and certificate of insurance are currently in effect or becoming In effpct
during the term of the polloy and exeouted%p4or to the "bodily In)ury," "property damage," or "personal; and
advertlsInH Injury,"
i 2. The Insuranoe provided to the Additional insured Is ilmlted a¢ followg;
a. The Additional Insured Is only an additional Insured for:
(1) "godlly Injury," "property damage," or "personal and advertising lo) wry" caused in whole of In part by negligent
Acts or omissions of the Named Insured oranyons. directly or indireetlyQmploysd by the Named Insured or for
whose acts a Named insured may be liable.
(2) Llablilty arising out of your o6golr)g pperatlons for the Additional Insured by of for ,you. A. person's pr
organization's status as an Insured under this ooverage Ands when your operations for that Irisura~ are
I completed: . , .
li. The Llmlt's of Insurance appilcebie to'the Addltionar InsuroEl are those specified In the wrhtpn contraot oragreement •
-Elul not more than tha. Limits-of-Insurance.'spectned-IriTi o,,D'ealaratlons forOls•polloy, The Limits.•of.Insul:arice
applicable to the Additlonei Insured -are inclusive of and not In adtllilon to the Limb of Insuranoe shown In the
Declarations forthe Named insured,
In addition to the otherexcluslons applicable to 3edflatiJ,. Coverages A., B. and C. of1he > 6MMERC1AL GENERAL
LIABILITT GOVBRAGIE FORM, the Insurance provided to the Addltlonal Insured does not apply •to; .
a, "Praperly damage"tot
('f) Property owned, used, occupied by, loaned or rented to the Additional Insured;
(2) Property In this oars, custody or control of the Addltlonal Insured orcverwhlohthe Addltlonal.lnsured are for any
purpose exercising ph~sloal control; or
(3) "Your work", performed for the Additional Insured.,
b. "8odlly Injury," "property damage," or "persoml and advertising Injury" arising out of an•arehltect's, engineer's or
surveyor's rendering arfallure•to render any proissslonal servioes for°you, for the Addltlonal Insured or for-others,
Including, but not limlied to:
(1) The preparing, approving or failure to prepare or approve maps, drawings, oplhions, reports, surveys, change
orders, designs of specifications; or
(2) Supervisory, Inspection or engineering services,
c, "Bodily Injury" or "property damage" occurring after;
(1) All work, lnoluding materials, parts or equlpmenttumishad in connection with such work, on the project (other
than servJoe, maintenance or repairs) to he performed by or on behalf ofthe additional Insured atthe alto of the
covered operations has been completed; or i
{2) That portion of "your work" out of which the injury or damage arlses has been put to Its Intended use by any
person or organization other than another oentractor or subcontractor engaged In performing operations for a
principal as a padofthe same project.
S. SFECTIONIV-COMMERCIAL[!Eid5RALLIABILIMOC1NDIT10NS,paragraph 4.DlherInsurancayisamsndedtoadd
the following subparagraph;
d, Additional Insured's Other Insraranae As Bxoess insurance
To the extent rsqulredby an "Insured contract,"this Insurance Is prlmaT)r on behalf of the Additional Insured; and any
other Insurance malntalned by the Additional Insured Is excess and not contributory with this Insurance, if the.
"Insured contract" does not require this provision, then paragraph ]A, above will apply,
8, Mobile Equipment Broadened Ocverage
V.121(i) of the COMMERCIAL GEN~ZRAL LIABILITY MfERAGE FORM Is replaced by the following:
(1) Equipment des.lgnpdprimarlly tor:
(a) Snow Removal;
(b) Road maintenance, but not construction or resurfacing; or ,
' (a) Street cleaning, c '
Bxoeptths abavs provlolons'do notapplyto self-propelled vehMee of less than I100Dpounds gloss vehlole weightwhioh .
are not Intended for use on a highway,
'C. Aggregate Limit Per Project
TheGeneral Aggragate.Limit under SECTIDITIII-'LiM1TS'OF.INSURA14 DE oftheOOMMERq)ALGIENERALLIASILITY,:„
DOVERACE FORM applies separately to each of your projects awayfrom premises owned by or rented to.you. ,
MP 97 67 04 DB Includes copydghled materlel of 160 Pioperiles, Inc, and Page 1 s of Ia.
AnterloanAs60cl$Iion oFJneuranas Servloes, Inc„ usedvOth Ihelrpermieslon
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D, Blanket Walvar of Transfer Of Rlghts Of Recovery Against Others To IJs
The Transfer of Rights of -recovery -Against Others To Us Candftlon (SECTION! IV - COMMERCIAL GENERAL
LIABILITY QONPIT1ON4 )'ls amended by the addition of the following;
We.walve any right:af recovery we'my have against any: person or organizaton to whom you by written poniraot or,
agreement have vyaiyed yourown right pr* recovery for loes paused by.1hpt person or prganlzation because pf pdym@nts we .
make for Injury or damage arlslnd out of your angoing operatlohe dt: "your work" done under a gontraRt with that person ot<
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organization and Included In tha "products-completed operations hazard,"
Additional Condltlons
- A. Insurance Under.TWo or More Coverages , • y
The'f6liawing Is added to•paf'agraph•C.Insuranoe under'Two•or'flllore Coverages of the•CoftgjWERCIAL PF?C)P9Fi7Y
CONItITIOA'S:
If a Coverage Form-is attachedtp this policy thatprovldes a limirforany coverage provided: bythis endorsement; the limit-
shown in the SCHEDULE and the ooverage provided by this endorsement are deleted and replaced by the'limii and
coverage provided by Ilia Coverage Form.
i 13, Limits at.] risuran ca
Flagardless of thi nurrrber Aulldings at a location covered'by this endorsement, the mostwe will pay undarthis Oov$eage
Enhancement endorsement in any one eoourrenae Is the applicable Limits at Insurance shown In the- SCHEDULE an page 1
of this andorsentent
G Deduotlbkss
The Deductible described In aeof r 11. ofthe BUILDING AND PERSONAL PROPERTY COVERAGE FORD applies to • .
each of the Coverage.Enhancements except as shown helovv: , ,
We will not pay for loss or damage In any one occurrence until the amount of loss or damage exceeds $5[)p. W$'wlli then
paytheamount of loss or damage in excess of $500 uptothe applicable Limit of Insuranoeforthe following enhancements: .
1, Personal Effeats and Property of Others
2 Valuable Papers and Records (Other than Electronic Data)
S, Accounts Receivable
4. Property Off-Premises (Including Laptops and Other Electronic) Equipment)
B. Outdoor Property (Named Perils)
Money and Securities
7. Water Bank-Up and Sump overflow
8. Electronic Data ,
9, Property in Transit (inoluding Laptops and Other Electronic Equipmeno
No deductible provielons applyto the Iollowing enhanaements:. • V.
1. Arson Reward
2. Recharging of Fire Extinguishers
3. inventory or Appraisal Cost
4. Rental Reimbursement i
D, Additional Dahnitfons
The following Additional Definitions applyto this endorsement onl':
T, "BanlQng Premises" means the Interierofthatportlon of anY'bulldirig:obeupfed by a banking Institution or s)milar.eate
dsposltory.
2, "Business Income" means the
• a. Nat,ineome (Net Prop or,Los~ before Jnoome?taxas) that.wotild ttgve been earned had no lass occurred; and . ;
b. Continuing ngrmal operating expanses Incurred; lnoluding•payroll. j
For manufacturing risks, Net Income Includes the net sales value of production,
Page 16 of 18 Inaludes copyrighted material of ISO Properties, Ina, and MP 97 67 04 08
Amuriaan Aeacb1don of Insurmas 5ervlaas, Inc., used with ihelr.pamtisslon
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