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HomeMy WebLinkAboutInsurance Certificate: Mountain View Paving (2) ,4CC)R " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/26/2016 THIS CER- "rFICATE 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 NAMEACT Kim Schnetzky FAX Ward Insurance Agency A/CONNo Ext): (541) 687-1117 /C,No): (541)342-8280 PO Box 10167 aDMRIESS: kim@wardinsurance .net INSURER(S) AFFORDING COVERAGE NAIL # Eugene OR 97440 INSURERA:Cincinnati Insurance Company 1110677 INSURED INSURER B : - - - - - Mountain View Paving Inc. INSURER C: PO Box 508 INSURER D : INSURER E : Talent OR 97540 INSURER F : COVERAGES CERTIFICATE NUMBER:16/17 GL/AL/UMB 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 POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY l ~ EACH OCCURRENCE $ 1,000,000 X DAMAG E TO RENTED A CLAIMS-MADE 500,000 - OCCUR PREMISES Ea occurrence).. $ X Y EPP/EBA0404007 9/25/2016 9/25/2017- _-~I - ! I I 1 MED EXP (Any one person) _s 10,000 J PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - I GENERAL AGGREGATE I $ 2,000,000 POLICY ~X JECOT LOC PRODUCTS -COMP/OP A 2,000,000 OTHER: r-- I$ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT _ -acciden~_ $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED I`- SCHEDULED I - AUTOS AUTOS EPP/EBA0404007 9/25/2016 9/25/2017 BODILY INJURY (Per accident) $ NON-OWNED PROPETY HIRED AUTOS L X_J AUTOS AP err a cRdentDAMAGE $ i I I ' I $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB_ CLAIMS-MADE A AGGREGATE _ $ 1,000,000 DED) -RETENTION$ EPP/EBA0404007 9/25/2016 9/25/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/N i STATUTE_ER , ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ - OFFICER/MEMBER EXCLUDED? ~I N /A j (Mandatory in NH) E.L. DISEASE - E4 EMPLOYEE if yes, describe under i - DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT ! $ I i II i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Patches City of Ashland is named as additional insured on a primary and non-contributory basis including waiver of subrogation and completed operations per the attached GA2330R. All when required by written contract. All is subject to policy limits, terms, conditions and exclusions. 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 90 N. Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 1 Darrin Godfrey/TRACES © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 6. Voluntary Property Damage (Coverage a ) and Care, Custody or Control Liability Coverage (Coverage b.) OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY Limits of Insurance (Each Occurrence) BROADENED ENDORSEMENT Coveragea.$000 Coverage b. 555,,000 unless otherwise stated $ Deductibles (Each Occurrence) This endorsement modifies insurance provided under the following: Coverage a. $250 COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage b. $250 unless otherwise stated $ A Endorsement - Table of Contents: COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of Coverage: Begins on Page: (b) Payroll (c) Gross Sales $5,000) $5,000) 1. Employee Benefit Liability Coverage..... . .2 (d) Units 2. Unintentional Failure to Disclose Hazards 3. Damage to Premises Rented to You 8 _ e Other _ - I - 4. Supplementary Payrnents.... 9 b. Care, Custody $ or Control _ 5. Medical Payments . .10 TOTAL ANNUAL PREMIG-fi 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) - _ 10 11. Property Damage to Borrowed Equipment 7. 180 Day Coverage for Newly Formed or Acquired Organizations .................................................10 8. Waiver of Subrogation .10 Each Occurrence Limit: $ 10,000 9. Automatic Additional Insured - Specified Relationships: ........................................11 Deductible: 5 250 x Managers or Lessors of Premises: x Lessor of Leased Equipment; X Vendors; C. Coverages: Sta+e or Political Subdivisions - Permits Relating to Premises; 2) Our right and duty to x State or Political Subdivisions - Permits, and 1. Employee Benefit Liability Coverage defend ends when we x Contractors' Operations have used up the appli- 10. Broadened Contractual Liability- Work Within 50' of Railroad Property ..........................................16 a. The following is added to SECTION I cable limit of insurance 11. Property Damage to Borrowed Equipment 16 - COVERAGES: Employee Benefit in the payment of 12. Employees as Insureds - Specified Health Care Services: ..............................._............................16 Liability Coverage. judgments or settle- x Nurses; x Emergency Medical Technicians: and (1) Insuring Agreement ments. x Paramedics (a) We will pay those sums that No other obligation or liabil- 13. Broadened Notice of Occurrence ..........................................................................................16 the insured becomes legally ity to pay sums or perfcrni obligated to pay as dam- ads or services is covered ages caused by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pay- B. Limits of Insurance: sured, or of any other per- ments- The Commercial General Liability Limits of Insurance applyto the insurance provided by this endorsement, son for whose acts the in- (b) This insurance applies to except as provided below: sured is legally liable, to damages only if the act, er- ,iii, i"Surar ror or omission, is ne li- t. Employee Benefit Liability Coverage plies. We will have the right gently committed in the Each Employee Limit: $ 1,000,000 and duty to defend the in- "administration" of your Aggregate Limit: $ 3,000,000 sured against any "suit' "employee benefit program Deductible: $ 1,000 seeking those damages. and However, we wit have no 3. Damage to Premises Rented to You duty to defend against any 1) Occurs during the pol- "suit" seeking damages to icy period, or The lesser of: which this insurance does 2) Occurred prior to the a. The Each Occurrence Limit shown in the Declarations; or not apply. We may, at our discretion, investigate any effective date of this b. $500,000 unless otherwise stated $ report of an act, error or endorsement provided: omisson 4. Supplementary Payments claim or "su t" that tttmay any a) You did not have suit. But knowledge of a a. Bail bonds: $ 1,000 claim or "suit" on 1) The amount we will pay or before the ef- b. Loss of earnings: $ 350 for damages is limited fective date of this as described in SEC- endorsement. 5. Medical Payments TION III - LIMITS OF Medical Expense Limit: $ 10,000 INSURANCE: and You will be deemed to have Includes copyrighted material of Insurance Includes copyrigl fed material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 1 of 16 GA 233 OR 09 10 Services Office. Inc., with its permission. Page 2 of 16 knowledge of a 1) Failure of any invest- (3) Coercion, demotion. tors are insureds, but only claim or "suit" ment to perform: evaluation. reassign- with respect to their duties when any "author- went, discipline, defa- as your officers or directors. ized re resenta- 2) Errors in providing in- p formation on past matron, harassment. Your stockholders are also five'; Pa per- humi'iation, discrimina- insureds, but only with re- formance of investment tion or other em to s i) Reports all, or vehicles, or menu-related P , peel to stockholderstheir liability as any part, of the practices, . act, error or 3) Advice given to any acts or omissions; or person with respect to (e) A trust, you are insured. omission to us p Pe (4) Consequential liability Your trustees are re also in- or any other that person's decision as a result of (1), (2) or sureds, but only with respect insurer; to participate or not to (3) above, to their duties as trustees. participate in any plan ii) Receives a included in the "em- This exclusion applies (2) Each of the following is also an written or ver- ployee benefit pro- whether the insured may be insured: bal demand or gram". held liable as an employer claim for dam- or in any other capacity and (a) Each of your "employees" ages because (f) Workers' Compensation to any obligation to share who is or was authorized to of the act, error and Similar Laws damages with or repay administer your "employee or omission; Any claim arising out of your someone else who must benefit program". and failure to cc,r, w'it'h the pay dainages because of p - (h) Any persons, organizations b) There is no other mandatory provisions of any the injury. or "employees" having applicable insur- workers' compensation, un- (3) Supplementary Payments proper temporary authcrizs- ante. employment compensation lion to administer your "em- insurance, social security or SECTION I - COVERAGES, ployee benefit program" f (2) Exclusions disability benefits law or any SUPPLEMENTARY PAY- you die, but only until your similar law. MENTS - COVERAGES A AND legal representative is ap- This insurance does not apply to: (g) ERISA B also apply to this Coverage- pointed. (a) Bodily Injury, Property b. Who is an Insured (c) Your legal representative if Damage or Personal and Damages for which any in- you die, but only with re- Advertising Injury sured is liable because of li- As respects Employee Bereft Liabil- spect to duties as such. ability imposed on a fiduct- ity Coverage. SECTION 11 - WHO IS That representative "Bodily injury', and "property and du- damage" ary by the Employee Re- AN INSURED is deleted in its entirety have all your rights is our right ri h mage" or "p tirement Income Security and replaced bythe following: advertising advertising injury'. of 1974, as now or ties under this Coverage Act Pa (b) Dishonest, Fraudulent, hereafter amended, or by (1) If you are designated in the Dec- Part. Criminal or Malicious Act any similar federal, state or larations as (3) Any organization you newly ac- local laws. (a) An individual, you and your cirre or form, other than a part- Damages arising out of any nership, joint venture or limit =j h Available Benefits spouse are insureds, but intentional, dishonest, ( ) only with respect to the con,- liability company, and over which fraudulent, criminal or mali- you maintain ownership or ma- Any claim for benefits to the dud of e business of which cious act, error or omission, extent that such benefits are you are the sole owner. jority interest, will qualify as a committed by any insured, available, with reasonable Named Insured if no other simi- including the willful or reck- effort and coope,ation of the (b) A partnership or joint ver- lar insurance applies to that or- less violation of any statute. insured. from the applicable tire, you are an insured. garrzation. However, coverage (c) Failure to Perform a Con- funds accrued or other col- Your members. your part- under this provision: lectible insurance. ners, and their spouses are tract also insureds but only will (a) Is afforded only until tt, Damages arising out of fail- (i) Taxes, Fines or Penalties respect to the conduct of 181 day after you acquire are of performance of con- your business- or form the organization or Taxes, fines or penaities. the end of the policy perijd, tract by any insurer. including these imposed (e) A limited liability company. whichever is eadler, and (d) Insufficiency of Funds under the Internal Revenue you are an insured. Your Code or any similar state or members are also insureds, (b) Does not apply to any act. Damages arising out of an local law. but only wkh res,pect to tn< error or omission that v, , insufficiency of funds to conduct of your business. committed before you .rj meet any obligations under (j) Employment-Related Your rnanaaers are insur- coined or formed the organ, any plan included in the Practices (AS. but only with respect tc zatio n. "employee benefit program". Any liability arising out of their duties as your manag- c. Limits of Insurance ers (e) Inadequacy of Perform- any: As respects Employee Benefit Lia`.,il- ance of Investment I Ad- (1) Refusal to employ: (d) An organization other than o ity Coverage. SECTION III - LIMITS vice Given With Respect partnership, joint venture or OF INSURANCE is deleted in its en- to Participation (2) Termination of em- limited liability company, you triety and replaced by the following. ployment: arc an insured. Your 'ex- Any claim based upon. ecitive oificer-," and direc- Incudes copyrighted material of Insurance Includes copyri,, t,-l material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 3 of 16 GA 233 OR 09 10 Sac,,.,-;es Offs, . Inc-, with its permission. Page 4 of 15 I (1) The Limits of Insurance shown in amount stated in the Decla-may result in a claim. apply may also SUrance Section B. Limits of Insurance, rations as applicable to To the extent possible a . apply. 1. Employee Benefit Liability Each Employee The limits notice should include: Coverage and the rules below of insurance shall not he re- d. No insured -will, except fix the most we will pay regard- duced by the amount of this (1) What the act, error r: at that ins ,'r s own less of the number of deductible. or omission was cost. voluntarily make a and when it oc- payment, assume any (a) In~ureds: (b) The deductible amount curred, and obligation, or incur any (b) Claims made or "suits" stated in the Declarations expense without our brought: applies to all damages sus- (2) The names and consent. tained by any one "em- addresses of any- (c) Persons or organizations ployee". including such one who may suf- (2) Item 5. Other Insurance is de- making claims or bringing "employee's" dependents fer damages as a leted in its entirety and replaced "suits", and beneficiaries, because result of the act, by the following: of all acts, errors or omis- error or omission. (d) Acts, errors or omissions, or sions to which this insur- 5. Other Insurance ante applies. b. If a claim is made or (e) Benefits included in your "suit" is brought against If other valid and collectible "employee benefit program". (c) The terms of this insurance, any insured, you must: insurance is available to the including those with respect insured for a loss we cover (2) The Aggregate Limit shown in to (1) Immediately re- under this Coverage Part, Section B. Limits of Insurance, cord the specifics our obligations are limited 1. Employee Benefit Liability 1) Our right and duty to of the claim or as follows: Coverage of this endorsement is defend the insured "suit" and the date the most we will pay for all dam- against any "suits" received, and a. Primary Insurance ages because of ads, errors or seeking those dam- soon omissions negligently committed ages; and (2) Notify us as This insurance is pri- in the "administration" of your as practicable. mary except when c. "employee benefit program". 2) Your duties, and the below applies. If this in- duties of any other in- You must see to it that surance is orimary, our (3) Subject to the limit described in volved insured, in the we receive written no- obligations are not af- 2 above, the Each Employee event of an act, error or tice of the claim or fected unless any of the Limit shown in Section B. Limits omission, or claim, "suit" as soon as practi- other insurance is also of Insurance, 1. Employee cable. primary. Then, we will Benefit Liability Coverage of apply irrespective of the ap- share with all that other t lication of the deductible c. You and any other in- his endorsement is the most we P method described in b. will pay for all damages sus- amount. volved insured must: insurance by the tailed by any one "employee", (1) Immediately send below. including damages sustained by (d) We may pay any part or all us copies of any such "employee's" dependents of the deductible amount to demands, notices, b. Method of Sharing and beneficiaries, as a result of. effect settlement of any claim or "suit" and, upon no- summonses ti le- If all of the other insur- (a) An act, error or omission: or tfication of the action taken, gal papers re- ance permits contribu- you shall promptly reim- ceived in connec- lion by equal shares, (b) A series of related acts, er- burse us for such part of the tion with the claim we will follow this rors or omissions, regard- deductible amount as we or "suit', method also. Under this less of the amount of time nave paid. (2) Authorize us to ob- nPPrcach each insurer that lapses between such fain records and contributes equal acts, errors or omissions d. Additional Conditions other information; amounts until it has negligently committed in the As respects Employee Benefit Li- paid its applicable limit "administration" of your "em_ ability Coverage, SECTION N - (3) Cooperate with us of insurance or none of ployee benefit program". COMMERCIAL GENERAL LIABIL- in the investigation the loss remains. ITY CONDITIONS is amended as fol- or settlement of whichever comes first. However, the amount paid under lows the claim or de- this endorsement shall not ex- : fense against the If any of the other in- teed, and will be subject to the (1) Item 2. Duties in the Event of "suit"; and surance does not per- limits and restrictions that apply Occurrence. Offense. Claim or mit contribution by to the payment of benefits in any Suit is deleted in its entirety and (4) Assist us, upon equal shares, we will plan included in the "employee replaced by the following: our request, in the contribute by limits. enforcement of Under this method, benefit program". 2. Duties in the Event of an any right against each insurer's share is (4) Deductible Amount Act, Error or Omission, or any person or or- based on the ratio of its Claim or Suit ganization which applicable limit of in- (a) Our obligation to pay dam- may be liable to p- surance to the total a ages on behalf of the in- a. You must see to it that the insured be- plicable limits of insur- sured applies only to the we are notified as soon cause of an act, ance of all insurers. amount of damages in ex- as practicable of an act, error or omission cess of the deductible error or omission which to which this in- c. No Coverage Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 5 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 6 of 16 This insurance shall not providing some or all of the ages are claimed and The exclusions under SECTION cover any loss for following benefits to "em- to which the insured I - COVERAGES, COVERAGE which the insured is en- ployses", whether provided must submit or does titled to recovery under through a "cafeteria plan" or submit with our con- P BODILY INJURY AND any other insurance in otherwise: PROPERTY DAMAGE LIABIL- force previous to the ef- sent, ITY. 2. Exclusions. other than I. fective date of this a. Group life insurance, b. Any other alternative War and the Nuclear Energy Coverage Part. group accident or dispute resolution pro- Liability Exclusion, are deleted health insurance; den- ceeding in which such and the following are added: e. Additional Definitions tal, vision and hearing damages are claimed Plans; and flexible This insurance does not apply to: As respects Employee Benefit Li- and to which the in- ability Coverage, SECTION V - spending accounts, sured submits with our (a) "Property damage": DEFINITIONS is amended as fol- provided that no one consent: or lows: other than an "em- 1) Assumed in any con- ployee" may subscribe c. An appeal of a civil pro- tract; or (1) The following definitions are to such benefits and ceeding. r re- added: such benefits are made 2 8. "Employee" means a person ) sLoss ulting cafromused any or the generally available to 1. "Administration" means: those "employees" who actively employed, formerly following, satisfy the plan's eligi- employed, on leave of ab- a. Providing information to bility ret~;irements, serve or disabled. o- re- a) Wear and tear, "employees". including tired. "Employee" includes a b) Rust. corrosion, their dependents and b. Profit sharing plans, "leased worker". "Employee" fungus, decay, de- beneficiaries, w& re- employee savings does not include a "tempo- terioration, hidden spect to eligibility for or plans, employee stock rary worker". or latent defect or scope of "employee ownership plans, pen- 2. Unintentional Failure to Disclose Haz- any quality in benefit programs"; sion plans and stock Ards property that subscription plans, pro- b. Interpreting the "em vided that no one other causes it to dam- ployee benefit pro- than an "employee" SECTION IV -COMMERCIAL GENERAL age or destroy it- grams" h LIABILITY CONDITIONS, 7. Represen- self, may subscribe to such tations is hereby amended by the addi- c. Handling records in benefits and such tion of the following: e) Smog: connection with the benefits are made gen- d) Mechanical break- "employee benefit pro- erally available to all Based on our dependence upon your rep- grams"; or "employees" who are resentations as to existing hazards, if un- down including eligible under the plan intentionally you should fail to disclose all rupture or bursting d. Effecting, continuing or for such benefits, such hazards at the inception date of your caused by cen- terminating any "em- policy, we will not reject coverage under trifugal force:. ployee's" participation c. Unemployment insur- this Coverage Part based solely on such e Setting, cracking, ante, social security failure- shrinking or ex- in the "employee bone- benefits, workers' com- fit prol pensation and disability 3. Damage to Premises Rented to You pansion; or However "administration" benefits, and a. The last Subparagraph of Paragraph f) Nesting orinfesta- . does not include: d. Vacation plans, includ- 2. SECTION 1 - COVERAGES, tion, or discharge in g and sell or release of waste g y pro- COVERAGE A. - BODILY INJURY a. Handling payroll deduc- grams: leave of ah- AND PROPERTY DAMAGE. 2. LI- pliorodns. ucts by or secre- tions: or sense programs, in- ABILITY Exclusions is hereby de- cludin military, mater- clod and repla ed by the following: b. The failure to effect or lily, family, and civil other animals. maintain any insurance leave: tuition assistance Exclusions c. through q. do riot apply or adequate limits of (b) Loss caused directly or indi- plans. transportation to damage by fire, explosion, light- recd coverage of insurance, and health club subsi- ning. smoke or soot to premises y by any of tfe follow- including but not limited dies. while rented to you or temporarily oc- ing: ro unemployment in- cupied by you with permission of the 1) Earthquake.. volcanic surance. social security (2) The following definitions are de- owner. eruption, lancslide or benefits, workers' com- leted in their entirety and re- any other earth move- benefits. and disability placed by the fel'~owing- b. The insurance provided under SEC- ben.efits. TION I - COVERAGES, COVERAGE rnent; 21. "Suit" means a civil pro- A. BODILY INJURY AND PROP- 2) Water that backs up or 2. "Ca`e!,e a plans" means ceeding in which money ERTY DAMAGE LIABILITY applies overflows from a sewer, p n,thor-ed by apploa- damages because of an act, to property damage" arising out of drain or sump, b le laN to allow "employees" error or anission to which water damage to premises that are to elect to Pay for certain this insurance applies are both rented to and occupied by you. 3) Water under the ground uenefits with pre-tax dollars. alleged. "Suit" includes: surface pressing on, or (1) As respects Water Damage Le- flowing or seeping 3. "Emp inyee benefit pro- a. An arbitration proceed- gal Liability, as provided in Para- through: qra nrs" means a program ing in which such dam- graph 3.b. above. Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission Page 7 of 16 GA 233 OR 09 10 Services Office. Inc, with is permission- Page 8 of 16 a) Foundations, one "occurrence" to which b. Care, Custody or Control Liability deductible amount as has been walls, floors or this insurance applies. Coverage paid by us. paved surfaces, (3) The amount we will pay is limited SECTION I - COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or b) Basements, as described in Section B. Lim- ERAGE A. BODILY INJURY AND Acquired Organizations whether paved or its of insurance, 3. Damage to PROPERTY DAMAGE LIABILITY, 2. SECTION II - WHO IS AN INSURED is not, or Premises Rented to You of this Exclusions, j. Damage to Property, amended as follow: endorsement. Subparagraphs (3), (4) and (5) do not c) Doors, windows or apply to "property damage" to the Subparagraph a. of Paragraph 4. is other openings. 4. Supplementary Payments property of others described therein. hereby deleted and replaced by the fol- (c) Loss caused by or resulting Under SECTION I - COVERAGE, SUP- With respect to the insurance provided by lowing: from water that leaks or PLEMENTARY PAYMENTS - COVER- this section of the endorsement, the fol- a. Insurance under this provision is af- flows from plumbing, heat- AGES A AND B: lowing additional provisions apply. forded only until the 180th day after ing, air conditioning, or fire you acquire or form the organization protection systems caused a. Paragraph 2. is replaced by the fol- a. The Limits of Insurance shown in the lowing: Declarations are replaced by the limo the end of the policy period, by u or unless: resulting from freezing, its designated in Section B. Limits of whichever is earlier; Up to the limit shown in Section B. Insurance, 6. Voluntary Property ert 1) You did your best to Limits of Insurance, 4.a. Bail Bonds ry P y 8. Waiver of Subrogation of bail Damage and Care, Custody or maintain heat in the of this endorsement for cost se of accidents Control Liability Coverage of this SECTION IV - COMMERCIAL GENERAL building or structure; or bonds required becau endorsement with respect to cover- LIABILITY CONDITIONS. 9. Transfer of or traffic law violations arising out of age provided by this endorsement. Rights of Recovery Against Others to 2) You drained the equip- the use of any vehicle to which the These limits are inclusive of and not Us is hereby amended by the addition of ment and shut off the Bodily Injury Liability Coverage ap- in addition to the limits being re- the following: water supply if the heat plies. We do not have to furnish placed. The Limits of Insurance was not maintained. these bonds. shown in Section B. Limits of Inuur- We waive any right of recovery we may (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- ance, 6. Voluntary Property Dam- injuhavery or dabecausemage e arising payments out of your make nfor lowin age and Care, Custody or Control er 9 ng operations or "your work" done under 1) Plumbing, heating, air Liability Coverage of this endorse- conditioning, fire pro- All reasonable expenses incurred by ment fix the most we will pay in any a written contract requiring such waiver tection systems. or the insured at our request to assist us one "occurrence" regardless of the with that person or organization and in- other equipment or ap- in the investigation or defense of the number of: eluded in the products-completed opera- other or claim or "suit", including actual loss of lions hazard However, our rights may earnings up to the limit shown in Sec- (1) Insureds: only be waived prior to the "occurrence" 2) The interior of any on B. Limits of Insurance, 4.b. giving rise to the injury or damage for ng or structure, or 'ions of Earnings of this endorsement (2) Or made or "suits' brought, which we make payment under this Cov- buildito personal property in per day because of time off from r erage Part. The insured must do nothing the building or structure work. (3) Persons or organizations making after a loss to impair our rights. At our re- caused by or resulting claims or bringing "suits'. quest, the insured will bring "suit"or trans- from rain, snow, sleet 5. Medical Payments fer those rights to us and help us enforce or ice, whether driven The Medical Expense Limit of Any One b. Deductible Clause those rights. by wind or not. Person as stated in the Declarations is (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- c. Limit of Insurance amended to the limit shown in Section B. on your behalf applies only to the fied Relationships Limits of Insurance, 5. Medical Pay- amount of damages for each by added to The Damage to Premises Re.^.?=d to merits of this endorsement. "occurrence" which are in excess a. The following liI -WHO IS here AN INSURED: You Limit as shown in the Declara- of the deductible amount stated SECTION I tions is amended as follows: 6. Voluntary Property Damage and Care, in Section B. Limits of Insur- Custody or Control Liability Coverage (1) Any person organization - (2) Paragraph 6. of SECTION III - ante. 6. Voluntary Property scribed in Paragraph 9.a.(2) bo be- LIMITS OF INSURANCE is a. Voluntary Property Damage Cov- Damage and Care, Custody or low (hereinafter referred to as hereby deleted and replaced by erage Control Liability Coverage of additional insured) whom you are the following: this endorsement. The limits of required to add as an additional We will pay for "property damage" to insurance will not be reduced by insured under this Coverage Part 6. Subject to S. above, the property of others arising out of op- the application of such deducti- by reason of: Damage to Premises orations incidental to the insured's ble amount. Rented to You Limit is the business when: (a) A written contract or agree- most we will pay under (2) Condition 2. Duties in the Event ment: or COVERAGE A. BODILY (1) Damage is caused by the in- of Occurrence. Offense, Claim con- INJURY AND PROPERTY sured; or or Suit, applies to each claim or (b) An oral agreement or con- , for (2) Damage occurs while in the in- "suit" irrespective of the amount. itronsudrance where showing certificate DAMAGE LIABILITY, because of "prop- sured's possession. We may pay any art or all of the wing that per- damages e an damage" to premises deductible e (3) Y aYmouPnt to effect set- son additional organization zation has as been while rented to you or tem- With your consent, we will make porarily occupied by you these payments regardless of fault. Clement of any claim or "suit" issued, permission of the and, upon notification of the a tion taken, you shall promptly re- is an insured, provided with owner, arising out of any imburse us for such part of the includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission Page 9 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 10 of 16 (a) The written or oral contract or use of equipment leased e) Any failure to Part with respect or agreement is' to you by such person(s) or make such inspec- to such products. organizations(s). However, tans, adjustments, (d) Any state or political subdi- 1 Currently in effect or tests or servicing this insurance does not ap- vision with which you have becomes effective dur- ply to any "occurrence" as the vendor has agreed per Paragraph ing the policy period; which takes place after the agreed to make or the e fol o- and equipment lease expires. normally under- suran)ce, above subject to provide - takes to make in prior to an (c) Any person or organization the usual course of lowing additional provision: 2 Executed "occurrence" or offense (referred to below as ven- business, in con- This insurance to which this insurance doh with whom you have necion with the applies only and ) Y with respell to the following would apply, agreed per Paragraph distribution or sale hazards for which the state (b} They are not specifically 9.a.(1) above to provide in- of the products, or political subdivision has d are as an n additional in- surance, but only with re- issued a permit in connec- name name under any other r- sPect to "bodily injury' or f) Demonstration, in- lion with premises you own. sured pro- 'property ert damage" arising stallation, servicing vision of, or endorsement p y rent control and i which to, this Coverage out of "your products" which repair opera- this insurance applies added to s: are distribute:) or sold in the ti lions, except such Part. regular course of the ven- operations per- 1) The existence, mainte- (2) Only the following persons or or- der's business, subject to formed at the ven- nance., repair, construc- ganizations are additional inuu- ine oilowing a6ditional ex- ddl'b premises in Lion, erection, or re- eds under this endorsement, and elusions: connection with moval of advertising insurance coverage provided to the sale of the signs, awnings, cano- such additional insureds is limo 1) The insurance afforded product, pies, cellar entrances, the vendor does not coal holes, driveways, ited as provided herein: Products which, apply to: 9) manholes, marquees, after distribution or a) "Bodily injury" or sale by you, have hoist away openings, (a) The whom mayounager have or lessor reed of a per for sidewalk vaults, street premises leased le you with "property which the ven-mage" l been labeled or labeled or used re- as banners, or decorations Paragraph 9.a.(1) above to and similar exposures; provide insurance, but only doh is obligated to container, part or or with respect to liability aris- pay damages ingredient of any ing out of the ownership, reason of the ass- i- other thing or sub- 2) The construction, - maintenance or use of that sumption of liability stance by or for lion, or removal of f ele- a premises leased to a a contract or the vendor; or vators; or part you, of subject to the followin agreement - This ~ g exclusion does not h) "Bodily injury" or 3) The ownership, main- additional exclusions: apply to liability for "property damage" tenance, or use of any This insurance does not ap- damages that the arising out of the elevators covered by ply to, vendor would have negligence.. acts or this insurance. in the absence of omissions of the 1) Any "occurrence" which the contract or vendor, its em- (e) Any state or political subdi- takes place after you agreement, ployees or anyone vision with which you have cease to be a tenant in else acting on its agreed per Paragraph that premises. b) Any express war- behalf- 9.a.(1) above to provide.n- raniv unauthorized surance. subject to the fol- 2) Structural alterations, by you: 2) This insurance does not lowing provisions: new construction or apply to any insured demolition operations c) Any physical or person or organization: 1) This insurance applies performed by or on be- ch-mical change only with respect to op- half of such additional in the product a) From whom you erations performed by insured. made intentionally have acquired you or on your behalf bvI,ievendoc such products, or for which the state or (b) Any person or organization any Ingredient.. political subdivision has from which you lease d) Repackaging, ex- part or container. issued a permit. equipment with whom you dept when un- entering into, ac- have agreed per Paragraph packed solely for cornpanying or 2) This insurance does not 9.a.(1) above to provide in- th,, purpose of in- containing such apply to "bodily injury", surance. Such person(s) or sp6.:tion, demon- products. or "property damage" or organization(s) are insureds, stration, testing, or "personal and advertis- but only to the extent that the substitution of b) When liability in- ing injury" arising out of the liability for "bodily injury", parts under in- eluded within the operations performed "property damage" or "per- structions from the "products- for the state or political sonal and advertising injury" manufacturer, and completed opera- subdivision. is caused by your negli- then repackaged dons hazard" has genre, acts or omissions in in 'he original con- been excluded un- (f) For "your work" performed the maintenance, operation tamer, der this Coverage in Oregon, any person or Includes copyrighted material of Inswn ice Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc , with its permissicn_ Page 11 of 16 GA 233 OR 09 10 Services Office. Inc., with its permission- Page 12 of 16 organization with which you (a) Subparagraphs (e). (f) and chitectural or engi- to other insurance have agreed per Paragraph primary P (g) ' o not apply to "bodily in- neering activities. available to the ; dditiona! 9.a.(1) above to provide in- jury' or "property damage" surance, but only to the ex- included within the "prod- 3) Professional services insured except: a tent that the liability is ucts-completed operations do not include services 1) As othenvis,provided caused by "your work" per- hazard"; within construction in SECTION IV formed for that additional in- means, methods, tech- COMMERCIAL GEN- sured and only to the extent (b) Subparagraphs (a), (d), (e) niques. sequences and ERAL LIABILITY that such liability is caused and (g) do not apply to "bbd- procedures employed CONDITIONS, 5. by your negligence or the ily injury", "property dam- by you in connection Other Insurance, b. negligence of those acting age" or "personal and ad- Excess Insurance: or with construction work on your behalf. A person or vedising injury' arising out you perform. organization's status as an of the sole negligence or willful misconduct of the ad- (d) Subparagraphs (f) and (g) 2) cFor any ollectiblethE~r valid and insured under this provision insurance of this endorsement contin- ditional insured or its "em- do not apply to "bodily in- available to the addi- ues for only the period of ployees", or jury' or "property damage" tional insured as an ad- time required by the written arising out of "your work" for ditional insured by at- contract or agreement, but (c) Subparagraph (f) and (g) do which a consolidated (wrap- riot apply to 'bodily injury", up) insurance program has dorseme orsement of to an another in no event beyond the expi- er ration date of this Coverage "Property damage" or "per- been provided by the rime al and advertisiny prime insurance policy that is Part . If there is no written son al injury" contractor /project manager written on an excess contract or agreement, or if arising out of: or owner of the construction basis- In such case, the no period of time is required 1) The rendering of, or project in which you are in- coverage provided un- b y the written contract or volved. > failure to render. any agreement, a person or w- der this endorsement rofessional services shall also be excess. P b. Only with regard to insurance pro- ganization's status as an in- by you or on your be- vided to an additional insured desig- (2) Condition 11. Conformance to sured under this endorse- half, but only with re- nated under Paragraph 9.a.(2) Sub- ment ends when Specific Written Contract or your op- spect to either or both paragraphs (f) and (g) above, SEC- orations for that insured are of the following opera- TION III - LIMITS OF INSURANCE is Agreement is hereby added: completed, tions: amended to include: 11. Conformance to Specific (g) For "your work" performed Written Contract or a) Providing engi- The limits applicable to the additional in the "coverage territory" neering, architec- insured are those specified in the Agreement but not in Oregon, any per- tural or surveying written contract or agreement or in a. With respect to addi- son or organization with services to others, the Declarations of this Coverage tional insu-eds de- which you have agreed per and Part, whichever are less. If no limits scribed in Paragraph Paragraph 9.a above are specified in the written contract or 9.a.(2)(f) above only: provide insurance, but only y b) Providing, hiring agreement, or if there is no written with respect to liability errs- independent t pro- contract or agreement, the limits ap- If a written contract or ing out of "your work" per- ionals pro- plicable to the additional insured are agreement between hared furred for that additional e- vide, engineering, those specified in the Declarations of you and the additional you or on your - architectural or this Coverage Part. The limits of in- insured specifies that half. A person or organizze- surveying services tion's stands an insured surance are inclusive of and not in coverage for the addi- connection with : under this crov ision of this censtrurl!en wort; addition to the limits of insurance tional insured endorsement continues for you perform, shown in the Dedaralior,s. (1) Be provided by the only the period of time re- c. SECTION IV - COMMERCIAL GEN. Insurance Ser- 2) Subject to Paragraph 3) vices Office addi- tract o by the written con- below, professional ERAL LIABILITY CONDITIONS is event tional insured form tractor agreement, but in no services include: hereby amended as follows: beyond the expiration number CG 32 61, date this Coverage Part. a) Preparing, approv- 1 Condition 5. Other Insurance is CG 32 62 or CG If there e is no written contract ing, or failing to amended to include. 32 63: or or agreement, or if no period prepare or ap- (a) Where required by a written (2) Include coverage of time is required by the prove, maps, shop contract or agreement, this for completed op- written contract or agree- drawings, opin- insurance is primary and / or erations; or rnent, a person or organiza- ions, reports, sur- noncontributory as respects tion's status as an insured veys, field orders, any other insurance (3) Include coverage under this endorsement thane orders, or y policy for "your work", 9 issued to the additional in- ends when your operations drawings and sured, and such other in- and where the limits or for that insured are com- specifications; and surance policy shall be ex- eted. coverage provided to cess and / or noncontribut- b) Supervisory or in- the additional insured is (3) Any insurance provided to an spection activities ing, whichever applies, with more restrictive than additional insured designated performed as part this insurance. was specifically re- under Paragraph 9.a.(2). of any related ar- (b) Any insurance provided by quired in that written this endorsement shall be contract or agreement, the terms of Para- Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 13 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 14 of 16 graphs 9.a.(3)(a) or 9.b. agreement specifies (2) Deductible Clause a. Nurses; above, or any combina- the Insurance Services tion thereof, shall be in- Office additional in- (a) Our obligation to pay darn- terpreted as providing sured form number CG ages on your behalf applies b• Emergency Medical Technicians; or the limits or coverage 20 10 but does not only to the amount of darn- c. Paramedics, required by the terms of specify which edition, or ages for each "occurrence" the written contract or specifies an edition that which are in excess of the in the jurisdiction where an "occurrence" agreement, but only to does not exist, Para- Deductible amount stated in or offense to w?tich this insurance applies takes place . the extent that such lim- graphs 9.a.3.b. and Section B. Limits of Insur- its or coverage is in- 9.b- of this endorse- ante, 11. of this endorse- 13. Broadened Notice of Occurrence cluded within the terms ment shall not apply ment. The limits of insur- of the Coverage Part to and Paragraph anoe will not be reduced by Paragraph a. of Condition 2. Duties In which this endorsement 9.a.(3)(a) of this en- the application of such De- the Event of Occurrence, Offense. is attached. dorsement shall apply, ductible amount. Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- b. With respect to addi- 10. Broadened Contractual Liability -Work (b) Condition 2. Duties in the TIONS) is herebydeleted and replaced by tional insureds de- Within 50' of Railroad Property Event of Occurrence. Of- the following: scribed in Paragraph fense, Claim or Suit. ap- 9.a.(2)(g) above only: It is hereby agreed that Paragraph f.(1) of plies to each clairn or "suit" a. You must see to it that we are notified Definition 12. "Insured contract" (SEC- irrespective as soon as practicable of an "occur- of the amount. !f a svritt_n xn[ract or TIOK - CEFIf:IT1ONS) Is deleted. ranee" or an :,f;ense which may result agreement between (c) We may pay any part or all in a claim. To the extent possible, no- you and the additional 11. Property Damage to Borrowed Equip- of the deductible amount to tice should include. insured specifies that ment effect settlement of any coverage for the addi- claim or "suit" and. upon no- (1) How, when and where the "oc- tional insured: a. The following is hereby added to Ex- cb;sion j, Damage to Property of tification of fire action taken, currence" or offense took place; a. provided by the Paragraph 2.. Exclusions of SEC- you shall promptly reim- burse us for such part of the (2) The names and addresses of Insurance S- - TION BI -COVERAGES, COVERAGE any injured persons and wit- vices Office addidi- AODILY INJURY AND PROP- deductible amount as has nesses;and tional insured form EBRTY DAMAGE LIABILITY: been paid by us. number CG 20 10 12. Employees as Insureds - Specified (3) The nature and location of any or CG 20 37 Paragraphs (3) and (4) of this exclu Health Care Services injury or damage arising out of (where edition soon do not apply to tools or equip- the "occurrence" or offense. specified), or ment loaned to you, provided they are It is hereby agreed that Paragraph not being used to perform operations 2.a.(1)(d) of SECTION II - WHO IS AN This requirement applies oily when b. Include coverage at the time of loss. the "occurrence" or offense is known INSURED. does not apply to your "em for completed op- to an "authorized representa,ive". of n the sura endnce pro- ployeecare s" services who ces on your provide ur behalf professionasal health erations: or b. With respell section the insurance vidad by this se duly li- c. Include coverage ment, the following additional provi- tensed: for "your work". sions apply: and where the limits or (1) The Limits of insurance shown in coverage provided to the Declarations are replaced by the additional insured is the limits designated in Section more restrictive than B. Limits of Insurance. 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These i~mits are in- the terms of Para- clusive of and not in addition to graphs 9.a.(3)(a), the limits being replaced The 9.a.(3)(b) or 9.b. a'oove, Lirnits of Insurance shown in or any combination section B. Limits of Insurance, thereof. shall be inter- 11. cf this endorsement fix the preted as providing the most we will pay in any one "uc- limits or coverage re- currerce-" regardless of the quired by the terms of number of the written contract or (a) fisureds: agreement, but only to the extent that such lim- (b) Claims made or "suits" its or coverage is in- brought: or cluded within the terms of the Coverage Part to (c) Persons or organizations which this endorsement nuking claims or bring is attached. If, however, "suits"_ the written contract or Includes copyrighted material of Insurance Includes copyrighte,l material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission Page 15 of 16 GA 233 OR 09 10 Services Office. Inc , :%ith its permission. Page 16 of 16