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HomeMy WebLinkAboutInsurance Certificate: C&S Fire-Safe Services C&SFIRE-01 LMEDFORD ACvRL7 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDrrYYY) 10/4/2016 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: Medford Office PHONE FAX PayneWest Insurance, Inc. (MA Lo Ext): (541) 77'9-1321 A/C No ; (541) 779-9187 38 North Central Ave. ADDRESS: Medford, OR 97501 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Associated Industries Ins Co INSURED INSURER B : Western National Assurance CO 24465 C & S Fire-Safe Services LLC INSURER c : AIG Excess Liability Ins Intl Limited 4019 Hooker Rd INSURER D : SAIF 36196 Roseburg, OR 97470 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 UBR 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 X DAMAGE RENTED CLAIMS-MADE OCCUR X AES1036489 10/30/2015 10/30/2016 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 7 JJECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO X CPP100074806 10/30/2015 10/30/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C X EXCESS LIAB CLAIMS-MADE EBU086678809 10130/2015 10/30/2016 AGGREGATE $ DED X RETENTION $ 0 Aggregate $ 2,000,000 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE O D ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 969337 10/01/2016 10/01/2017 E.L. EACH ACCIDENT $ 1,000,000 ,0FFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) E .L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mere space is required) Additional Insured endorsement CG2033 07/04 attached Additional Insured - Completed Operations CG2037 07/04 Waiver of Transfer of Rights endorsement CG2404 05/09 attached Auto Additional Insured and Waiver of Transfer or Rights endorsement WNCA27 11/12- attached 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 y Attn: Dale Peters ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main 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 WN CA 27 11 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BUSINESS AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Business Auto Coverage Form identified in this endorsement will be amended as shown below. SECTION II - LIABILITY COVERAGE f. Any "employee" of yours is an "insured" while AMENDMENTS using a covered "auto" you don't own, hire or borrow in your business or your personal A. Who Is An Insured -amended affairs, SECTION II - LIABILITY COVERAGE, Item A. g. Any "employee" of yours is an "insured" while Coverage, 1. Who Is An Insured is amended to operating a covered "auto" hired or rented add: under a contract or agreement in the d. Any legally incorporated subsidiary of yours in "employee's" name, with your permission, which you own more than 50% of the voting while performing duties related to the conduct stock on the effective date of this coverage of your business. form. B. Blanket Additional Insured However, "insured" does not include any Section II - LIABILITY COVERAGE, Item A. subsidiary of yours that is an "insured" under Coverage, 1. Who Is An Insured, paragraph c. any other automobile liability policy, or would is amended to add the following: be an "insured" under such policy but for termination of such policy or the exhaustion Any person or organization who is required under on such policy's limits of insurance. a written contract or agreement between you and that person or organization, that is signed and e. Any organization which is newly acquired or executed by you before the "bodily injury" or formed by you and over which you maintain "property damage" occurs and that is in effect majority ownership. However, coverage during the policy period, to be named as an under this provision: additional insured is an "insured" for Liability (1) is afforded only for the first 180 days after Coverage, but only for damages to which this you acquire or form the organization or insurance applies and only to the extent that until the end of the policy period, persons or organization qualifies as an "insured" whichever comes first; under the Who Is An Insured provision contained in Section II. (2) does not apply to "bodily injury" or "property damage" that results from an C. Liability Coverage Extensions - 44 accident" that occurred before you Supplementary Payments formed or acquired the organization; SECTION II - LIABILITY COVERAGE, Item A. (3) does not apply to any newly acquired or Coverage, 2. Coverage Extensions, a. formed organization that is a joint venture Supplementary Payments is amended by or partnership; and replacing subparagraphs (2) and (4) with the following: (4) does not apply to an "insured" under any other automobile liability policy, or would (2) Up to $5,000 for cost of bail bonds (including be an "insured" under such a policy but bonds for related traffic law violations) required for termination of such policy or the because of an "accident" we cover. We do exhaustion of such policy's limits of not have to furnish these bonds. insurance. (4) All reasonable expenses incurred by the WN CA 27 11 12 Includes copyrighted material of Insurance Services Office, with its permission Page 2 of 5 WN CA 27 11 12 B. Blanket Waiver of Subrogation D. Employee Hired Auto Section IV - BUSINESS AUTO CONDITIONS, SECTION IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights of B. General Conditions, S. Other Insurance, b. is Recovery Against Others to Us, is amended by deleted and replace by the following: adding the following exception: b. For Hired Auto Physical Damage Coverage, However, we waive any right of recovery we may the following are deemed to be a covered have against any person or organization to the "autos" you own: extent required of you by a written contract signed and executed prior to any "accident" or "loss", (1) Any covered "auto" you lease, hire, rent provided that the "accident" or "loss" arises out of or borrow. operations contemplated by such contract. The (2) Any covered "auto" hired or rented by waiver applies only to the person or organization your "employee" under a contract in that designated in such contract. individual "employee's" name, with your C. Unintentional Failure to Disclose Hazards permission, while performing duties related to the conduct of your business. SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, However, any "auto" that is leased, hired, rented Misrepresentation Or Fraud, is amended to add or borrowed with a driver is not a covered "auto". the following paragraph: If you unintentionally fail to disclose any hazards SECTION V - DEFINITIONS AMENDMENTS existing at the inception date of the policy, or A. "Bodily Injury" Redefined To Include Mental during the policy period in connection with any Anguish additional hazards, we will not deny coverage under this Coverage Part because of such failure. SECTION V - DEFINITIONS, C. "Bodily Injury" is deleted and replaced by the following: C. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. "Bodily injury" includes mental anguish or other mental injury resulting from such bodily injury. WN CA 27 11 12 Includes copyrighted material of Insurance Services Office, with its permission Page 5 of 5 Document editions: 04/01/13 1107/01/04 10/01/01 07/01/98 103/01/97 f ISO I Commercial General Liability Forms 07/01/04 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this; endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, 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. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location 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 a part of the same project. CG 20 33 07 04 ©Insurance Services Office, Inc. POLICY NUMBER: AES1036489 00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: All persons or organizations where required by written contract with the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization s : Location And Description Of Completed Operations All persons or organizations where written contract with the Named Insured requires additional insured completed operations. This form does not apply to your work on "residential property". Information required to complete this Schedule, if not shown above, will be! shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: AES1036489 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD-PARTY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured (Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing work.) Paragraph 4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission