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HomeMy WebLinkAboutInsurance Certificate: Western Financial Group WESTFIN-01 CGREGUS DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/30/2016 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: LaPorte & Associates, Inc. a/c°Nno EXt : (503) 239-4116 A/c No : 231-9021 5515 SE Milwaukie Ave (503) Portland, OR 97202 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : TRANSPORTATION INSURANCE CO 29484 INSURED INSURER B : Admiral Insurance Company 24856 Western Financial Group, LLC INSURER C : 3300 NW 185th Ave #270 INSURER D : Portland, OR 97229 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 INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR X X 65085025930 04126/2016 04/26/2017 PDAMAGE TO RENTED REMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 i - PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY ❑ PRO- ❑ JECT LOC PRODUCTS -COMP/OP AGG $ 4,000,000 OTHER: NOH AUTO LIABIL $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liab E000000154919 03113/2016 03/13/2017 Per Occurrence 2,000,000 B Professional Liab E000000154919 03113/2016 03/13/2017 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, its officers, agents, and employees are included as additional primary insured(s) per attached. 30 Days Notice of Cancellation for reasons other than non-payment; 10 Days prior notice for non-payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE r s ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CNA SB-146932-E (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifies insurance provided under the following: .BUSINESSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED - BLANKET VENDORS h. "Bodily injury" or "property damage" arising WHO IS AN INSURED is amended to include as an out of the sole negligence of the vendor for additional insured any person or organization its own acts or omission or those of its employees or anyone else acting on its (referred to below as vendor) with whom you behalf. However, this exclusion does not agreed, because of a written contract or agreement eh to provide insurance, but only with respect to "bodily apply to: injury" or "property damage" arising out of "your (1) The exceptions contained in products" which are distributed or sold in the regular Subparagraphs d. or f.; or course of the vendor's business, subject to the (2) Such inspections, adjustments, tests or following additional exclusions: servicing as the vendor has agreed to 1. The insurance afforded the vendor does not make or normally undertakes to make apply to: in the usual course of business, in a. "Bodily injury" or "property damage" for connection with the distribution or sale which the vendor is obligated to pay of the products. damages by reason of the assumption of 2. This insurance does not apply to any insured liability in a contract or agreement. This person or organization, from whom you have exclusion does not apply to liability for acquired such products, or any ingredient, part damages that the vendor would have in the or container, entering into, accompanying or absence of the contract or agreement; containing such products, b. Any express warranty unauthorized by you; 3. This provision 2. does not apply to any vendor c. Any physical or chemical change in the included as an insured by an endorsement product made intentionally by the vendor; issued by us and made a part of this Policy. d. Repackaging, except when unpacked solely 4. This provision 2. does not apply if "bodily injury" for the purpose of inspection, or "property damage" included within the demonstration, testing, or the substitution of 11 products-completed operations hazard is parts under instructions from the excluded either by the provisions of the Policy or manufacturer, and then repackaged in the by endorsement. original container; 2. MISCELLANEOUS ADDITIONAL INSUREDS e. Any failure to make such inspections, WHO IS AN INSURED is amended to include as an adjustments, tests or servicing as the insured any person or organization (called additional vendor has agreed to make or normally insured) described in paragraphs 2.a. through 2.h. undertakes to make in the usual course of below whom you are required to add as an business, in connection with the distribution additional insured on this policy under a written or sale of the products; contract or agreement but the written contract or f. Demonstration, installation, servicing or agreement must be: repair operations, except such operations 1. Currently in effect or becoming effective during performed at the vendor's premises in the term of this policy; and connection with the sale of the product; 2. Executed prior to the "bodily injury," "property g. Products which, after distribution or sale by damage" or "personal and advertising injury," you, have been labeled or relabeled or used but as a container, part or ingredient of any other thing or substance by or for the Only the following persons or organizations are vendor; or additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: SB-146932-E Page 1 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) a. Additional Insured - Your Work (b) The construction, erection, or That person or organization for whom you removal of elevators; or do work is an additional insured solely for (2) This insurance applies only with respect liability due to your negligence specifically to operations performed by you or on resulting from your work for the additional your behalf for which the state or insured which is the subject of the written political subdivision has issued a permit. contract or written agreement. No coverage This insurance does not apply to "bodily applies to liability resulting from the sole injury," "property damage" or "personal and negligence of the additional insured. advertising injury" arising out of operations The insurance provided to the additional performed for the state or municipality. insured is limited as follows: c. Controlling Interest (1) The Limits of Insurance applicable to Any persons or organizations with a the additional insured are those controlling interest in you but only with specified in the written contract or respect to their liability arising out of: written agreement or in the Declarations of this policy, whichever is less. These (1) Their financial control of you; or Limits of Insurance are inclusive of, and not in addition to, the Limits of (2) Premises they own, maintain or control Insurance shown in the Declarations. while you lease or occupy these premises. (2) The coverage provided to the additional insured by this endorsement and This insurance does not apply to structural paragraph F.9. of the definition of alterations, new construction and demolition "insured contract" under Liability and operations performed by or for such Medical Expenses Definitions do not additional insured. apply to "bodily injury" or "property d. Managers or Lessors of Premises damage" arising out of the "products- completed operations hazard" unless A manager or lessor of premises but only required by the written contract or with respect to liability arising out of the written agreement. ownership, maintenance or use of that specific part of the premises leased to you (3) The insurance provided to the additional and subject to the following additional insured does not apply to "bodily injury," exclusions: property damage, or personal and advertising injury" arising out of the This insurance does not apply to: rendering or failure to render any (1) Any "occurrence" which takes place professional services. after you cease to be a tenant in that b. State or Political Subdivisions premises; or A state or political subdivision subject to the (2) Structural alterations, new construction following provisions: or demolition operations performed by or on behalf of such additional insured. (1) This insurance applies only with respect to the following hazards for which the e. Mortgagee, Assignee or Receiver state or political subdivision has issued A mortgagee, assignee or receiver but only a permit in connection with premises with respect to their liability as mortgagee, you own, rent, or control and to which assignee, or receiver and arising out of the this insurance applies: ownership, maintenance, or use of a (a) The existence, maintenance, repair, premises by you. construction, erection, or removal of This insurance does not apply to structural advertising signs, awnings, alterations, new construction or demolition canopies, cellar entrances, coal operations performed by or for such holes, driveways, manholes, additional insured. marquees, hoistaway openings, sidewalk vaults, street banners, or f. Owners/Other Interests - Land is Leased decorations and similar exposures; An owner or other interest from whom land or has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that SB-146932-E Page 2 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) specific part of the land leased to you and a written contract or written agreement subject to the following additional specifically requires that this insurance exclusions: be either primary or primary and This insurance does not apply to: noncontributing. (1) Any "occurrence" which takes place 4. LEGAL LIABILITY- DAMAGE TO PREMISES after you cease to lease that land; A. Under B. Exclusions, 1. Applicable to or Business Liability Coverage, Exclusion k. (2) Structural alterations, new Damage To Property, is replaced by the construction or demolition following: operations performed by or on k. Damage To Property behalf of such additional insured. g. Co-owner of Insured Premises "Property damage" to: 1. Property you own, rent or occupy, A co-owner of a premises co-owned by you including any costs or expenses and covered under this insurance but only incurred by you, or any other with respect to the co-owners liability as co- person, organization or entity, for owner of such premises. repair, replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such property for any reason, including Any person or organization from whom you prevention of injury to a person or lease equipment. Such person or damage to another's property; organization are insureds only with respect 2. Premises you sell ive awa or to their liability arising out of the abandon if the " g y " maintenance, operation or use by you of property damage equipment leased to you by such person or arises out of any part of those organization. A person's or organization's premises; status as an insured under this 3. Property loaned to you; endorsement ends when their written contract or agreement with you for such 4. Personal property in the care, leased equipment ends. custody or control of the insured; With respect to the insurance afforded 5. That particular part of any real these additional insureds, the following property on which you or any additional exclusions apply: contractors or subcontractors working directly or indirectly in your This insurance does not apply: behalf are performing operations, if (1) To any "occurrence" which takes place the "property damage" arises out of after the equipment lease expires; or those operations; or (2) To "bodily injury," "property damage" or 6. That particular part of any property "personal and advertising injury" arising that must be restored, repaired or out of the sole negligence of such replaced because "your work" was additional insured. incorrectly performed on it. Any insurance provided to an additional insured Paragraph 2 of this exclusion does not designated under paragraphs b. through h. apply if the premises are "your work" above does not apply to "bodily injury" or and were never occupied, rented or "property damage" included within the held for rental by you. "products-completed operations hazard." Paragraphs 1, 3, and 4, of this 3. The following is added to Paragraph H. of the exclusion do not apply to "property BUSINESSOWNERS COMMON POLICY damage" (other than damage by fire or CONDITIONS: explosion) to premises: H. Other Insurance (1) rented to you: 4. This insurance is excess over any other (2) temporarily occupied by you with insurance naming the additional insured the permission of the owner, or as an insured whether primary, excess, (3) to the contents of premises rented contingent or on any other basis unless to you for a period of 7 or fewer consecutive days. SB-146932-E Page 3 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) A separate limit of insurance applies to "occurrence," offense, claim or "suit" is Damage To Premises Rented To You known to: as described in Section D - Liability and (1) You or any additional insured that is an Medical Expenses Limits of Insurance. individual; Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability (2) Any partner, if you or an additional assumed under a sidetrack agreement. insured is a partnership; Paragraph 6 of this exclusion does not (3) Any manager, if you or an additional apply to "property damage" included in insured is a limited liability company; the "products-completed operations (4) Any "executive officer" or insurance hazard." manager, if you or an additional insured B. Under B. Exclusions, 1. Applicable to is a corporation; Business Liability Coverage, the last (5) Any trustee, if you or an additional paragraph of 2. Exclusions is deleted and insured is a trust; or replaced by the following: (6) Any elected or appointed official, if you Exclusions c, d, e, f, g, h, i, k, I, m, n, and or an additional insured is a political o, do not apply to damage by fire to subdivision or public entity. premises while rented to you or temporarily occupied by you with permission of the This paragraph e. applies separately to you owner or to the contents of premises rented and any additional insured. to you for a period of 7 or fewer consecutive 7. Bodily Injury days. A separate limit of insurance applies to this coverage as described in Section D. Section F. Liability and Medical Expenses Liability And Medical Expenses Limits Of Definitions, item 3. "Bodily Injury" is deleted Insurance. and replaced with the following: C. The first Paragraph under item 5. Damage "Bodily injury" means bodily injury, sickness or To Premises Rented To You Limit of disease sustained by a person, including death, Section D. Liability And Medical humiliation, shock, mental anguish or mental Expenses Limits Of Insurance is replaced injury by that person at any time which results by the following: as a consequence of the bodily injury, sickness or disease. The most we will pay under Business Liability for damages because of "property 8• Expanded Personal and Advertising Injury damage" to any one premises, while Definition rented to you, or temporarily occupied by a. The following is added to Section F. you, with the permission of the owner, Liability and Medical Expenses including contents of such premises rented Definitions, item 14. Personal and to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to Advertising Injury, in the Businessowners General Liability You limit shown in the Declaration. Coverage Form: 5. Blanket Waiver of Subrogation h Discrimination or humiliation that results in We waive any right of recovery we may have injury to the feelings or reputation of a against: natural person, but only if such discrimination or humiliation is: a. Any person or organization with whom you have a written contract that requires such a 1 • Not done intentionally by or at the direction of: waiver. 6. Broad Knowledge of Occurrence a. The insured; or The following items are added to E. b. Any "executive officer," director, Businessowners General Liability stockholder, partner, member or Conditions in the Businessowners Liability manager (if you are a limited liability Coverage Form: company) of the insured; and e. Paragraphs a. and b. apply to you or to any 2. Not directly or indirectly related to the additional insured only when such employment, prospective employment, past employment or termination of SB-146932-E Page 4 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) employment of any person or person by c. This provision (Expanded Personal and any insured. Advertising Injury) does not apply if b. The following is added to Exclusions, Personal and Advertising Injury Liability Section B.: is excluded either by the provisions of the Policy or by endorsement. (15)Discrimination Relating to Room, 9. Personal and Advertising Injury Re-defined Dwelling or Premises Caused by discrimination directly or Section F. Liability and Medical Expenses indirectly related to the sale, rental, Definitions, item 14, Personal Advertising Injury, Paragraph c. is replaced by the following: lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, c. The wrongful eviction from, wrongful entry dwelling or premises by or at the into, or invasion of the right of private direction of any insured. occupancy of a room dwelling or premises (16)Fines or Penalties that a person or organization occupies committed by or on behalf of it's owner, Fines or penalties levied or imposed by landlord or lessor. a governmental entity because of discrimination. SB-146932-E Page 5 of 5 (Ed. 06/11)