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HomeMy WebLinkAboutInsurance Certificate: Jackson County Child Abuse Task Force l ® DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE `1. 11/9/2016 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 have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER Brown & Brown Northwest N AME: Sand L. Orr 3256 Hillcrest Park Drive PHONE a N Ex : 541-494-2687 No): 541-494-2787 Medford, OR 97504 E-MAIL ADDRESS: sort bbnw.com INSURER(S) AFFORDING COVERAGE NAIC # www.bbnw.com INSURER A : Great American Assurance Co 26344 INSURED INSURER B : SAIF Corporation 36196 Jackson County Child Abuse Task Force Children's Advocacy Center of Jackson County INSURER C 816 W 10th Street INSURER D : Medford OR 97501 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 32776780 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 INSD SUWVD ER POLICY NUMBER MPOLICY EFF M DDfYYYY MM/DDY EXP LTR /YYYY LIMITS A ✓ COMMERCIAL GENERAL LIABILITY ✓ PAC0629478 11/1/2016 11/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 _7 CLAIMS-MADE V/ OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 ✓ POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 3,000,000 JECT F-I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY ✓ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION 601577 1/1/2017 1/1/2018 ✓ STATUTE EORH AND EMPLOYERS' LIABILITY Y I N ANYFROPRIETC)R/PARTNER/EXECUTiVE E.L. EACH ACCIDENT u 5500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Professional Liability PAC0629478 11/1/2016 11/1/2017 $1,000,000/$3,000,000 A Abuse & Molestation Liability PAC0629478 11/1/2016 11/1/2017 $1,000,000/$3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder included as respects General Liability when required by written agreement per endorsement 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 its officers & employees ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE Sandy L. Orr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD "~777F7Rn I IF-T7 rT./ATTrPn/vnnc/nnrrcr/wr I Q-A— T. n,-- I TT/o/~nTC - 1-T I I - , ..c C S1*03/26/09*MAC5373631-06 739929001 *D/B ORIG IMAGE COPY 0694932 GREAT AMERICAN ASSURANCE CO Administrative Offices 580 Walnut Street Cincinnati, Ohio 45202 GREATAMERICAN. Tel: 1-513-369-5000 INSURANCE GROUP CG 82 24 (Ed. 12 01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SOCIAL SERVICE AGENCY GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following provision is added to SECTION (2) With respect to the insurance af- II - WHO IS AN INSURED forded the Additional Insured identified in Paragraph A.(1) of 5. AUTOMATIC ADDITIONAL INSUREDS) this endorsement, the following additional provisions apply: a. Additional Insured - Manager or Lessor of Premises (a) This insurance applies only to liability arising out of the (1) This policy is amended to include ownership, maintenance or as an insured any person or or- use of that portion of the ganization (hereinafter called Ad- premises leased to you. ditional Insured) from whom you lease or rent property and which (b) The Limits of Insurance ap- requires you to add such person plicable to the Additional In- or organization as an Additional sured are the lesser of those Insured on this policy under: specified in the written con- tract or agreement or in the (a) a written contract; or Declarations for this policy and subject to all the terms, (b) an oral agreement or con- conditions, and exclusions tract where a Certificate of for this policy. The Limits of Insurance showing that per- Insurance applicable to the son or organization as an Additional Insured are inciu- Additional Insured has been sive of and not in addition to issued; the Limits of Insurance shown in the Declarations. but the written or oral contract or agreement must be an "insured (c) In no event shall the cov- contract," and, erages or Limits of Insurance in this Coverage Form be in- (i) currently in effect or be- creased by such contract. come effective during the term of this policy; and (d) Coverage provided herein is excess over any other valid (ii) executed prior to the "bodily and collectible insurance injury," "property damage," available to the Additional In- "personal and advertising in- sured whether the other in- jury." surance is primary, excess, Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services ~ `Office, Inc., 2001 n.-,- i II/Q n 1 r i,.17(ri~AIPrT)[lI Pa4A 2 of 5 C S1*03/26/09*MAC5373631-06 739929001 *D/B ORIG IMAGE COPY 0694932 GREAT AMERICAN ASSURANCE CO contingent or on any other tomarily provided by the basis unless a written con- policy forms specified in and tractual arrangement specifi- required by the contract. cally requires this insurance to be primary. (c) In no event shall the cov- erages of Limits of Insurance (3) This insurance does not apply to: in this Coverage Form be in- creased by such contract. (a) Any "occurrence" or offense which takes place after you c. Additional Insured - Contractual cease to be a tenant in that Obligations premises. (1) This policy is amended to include (b) Structural alterations, new as an Insured any person or or- construction or demolition ganization (hereinafter called Ad- operations performed by or ditional Insured) that you are re- Insured." of the "Additional quired by a written "insured con- n." tract" to include as an Insured, b. Additional Insured - Funding subject to all of the following Sources provisions: (1) This policy is amended to include (a) Coverage is limited to liability as an Insured any Funding Source arising out of: which requires you in a written (i) your ongoing oper- contract to name the Funding ations performed for Source (hereinafter called Addi- such Additional Insured; tional Insured) as an Insured but or only with respect to liability aris- ing out of your premises, "your (ii) that Insured's financial work" for such Additional Insured, control of you; or or acts or omissions of such Ad- ditional Insured in connection with (iii) the maintenance, opera- the general supervision of "your tion or use by you of work" and only to the extent set equipment leased to forth as follows: you by such Additional Insured; or (a) The Limits of Insurance ap- plicable to the Additional In- (iv) a state or political sub- sured are the lesser of those division permit issued specified in the written con- to you. tract or agreement or in the Declarations for this policy (b) Coverage does not apply to and subject to all the terms, any "occurrence" or offense: conditions, and exclusions for this policy. The Limits of (1) which took place be- Insurance applicable to the fore the execution of, Additional Insured are inclu- or subsequent to the sive of and not in addition to completion or expira- the Limits of Insurance tion of, the written "in- shown in the Declarations. sured contract", or (b) The coverage provided to (ii) which takes place after the Additional Insured(s) is you cease to be a ten- not greater than that cus- ant in that premises. Includes copyrighted material of Insurance Service Office with its permission. tt~~ ~1 ~ Copyright, Insurance Services Office, Inc., 2001 -A? 7K RA9 iDA7 flPX+TnA, l91Q1&VTTCWVTAQ I c,„a.. T. n,-r I 1 i /o/~-a 1 1.-r!C?i rOirno~rr%f -AA i - C * S1*03/26/09*MAC5373631-06 739929001 *D/B ORIG IMAGE COPY 0694932 GREAT AMERICAN ASSURANCE CO (c) With respect to architects, work" done under a contract for that engineers, or surveyors, person or organization and included in coverage does not apply to the "products-completed operations "Bodily Injury," "Property hazard." Damage," "Personal and Ad- vertising Injury" arising out 3. NON-OWNED OR CHARTERED WATER- of the rendering or the fail- CRAFT ure to render any profes- sional services by or for you Section I - Coverages, Coverage A, Item including: 2.g.(2) is replaced with: (i) the preparing, approv- (2) A watercraft you do not own that is: ing, or failing to pre- pare or approve maps, (a) less than 51 feet long; and drawings, opinions, re- ports, surveys, change (b) not being used to carry persons or orders, designs or property for a charge. specifications; and 4. BROADENED PERSONAL AND ADVERTISING (Ii) supervisory, inspection, INJURY or engineering services. Unless "Personal and Advertising Injury" is ex- If an Additional Insured endorsement is at- cluded from this policy: tached to this policy and specifically names a person or organization as an Insured, then the SECTION V - DEFINITIONS Item 14. is re- coverage in Section II - WHO IS AN placed by: INSURED 5. Automatic Additional Insured(s) does not apply to that person or organization. 14. "Personal and Advertising Injury" means injury, including consequential "bodily in- 2. BLANKET WAIVER OF SUBROGATION jury," arising out of one or more of the following offenses: SECTION IV - COMMERCIAL GENERAL a. false arrest, detention or imprison- LIABILITY CONDITIONS, Item 8. is replaced ment; with: b. malicious prosecution; 8. Transfer of Rights of Recovery Against Others to us and Blanket Waiver of c. the wrongful eviction from, wrongful Subrogation entry into, or invasion of the right of private occupancy of a room, dwelling a. If an Insured has rights to recover all or premises that a person occupies by or part of any payment we have made or on behalf of its owner, landlord or under this Coverage Part, those rights lessor; are transferred to us. The Insured must do nothing after loss to impair them. d. oral, written, televised, videotaped, or At our request, the Insured will bring electronic publication of material, in "suit" or transfer those rights to us and any manner, that slanders or libels a help us enforce them. person or organization or disparages a person's or organization's goods, pro- b. If required by a written "insured con- ducts or services; tract", we waive any right of recovery we may have against any person or e. oral, written, televised, videotaped, or organization because of payments we electronic publication of material, in make for injury or damage arising out any manner, that violates a person's of your ongoing operations or "your right of privacy; or Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 11 /o /,)nl r 11 • 1 ~ l PWRP(PPIP) (71 Pa" 4 of 5 C S1*03/26/09*MAC5373631-06 739929001 *D/B ORIG IMAGE COPY 0694932 GREAT AMERICAN ASSURANCE CO f. mental injury, mental anguish, humili- Subject to 5. above, the Damage to Prem- ation, or shock, if directly resulting ises Rented to You Limit is the most we from Items 14.a. through 14.e. will pay under Coverage A for damages because of "property damage" to your g. the use of another's advertising idea in building, or to personal property of others your "advertisement"; or in your care, custody and control while at premises rented to you or temporarily h. infringing upon another's copyright, occupied by you with permission of the trade dress or slogan in your "adver- owner, arising out of any one fire. tisement." The Damage to Premises Rented To You 5. MENTAL INJURY, MENTAL ANGUISH, Limit is replaced by the following Damage HUMILIATION, OR SHOCK INCLUDED IN to Premises Rented To You Limit. BODILY INJURY DEFINITION The Damage to Premises Rented To You Section V - Definitions, Item 3. is replaced Limit is the greater of: with: (1) $300,000; or 3. "Bodily injury" means physical injury, sick- ness, or disease, including death of a per- (2) the amount shown in the Declarations son. "Bodily injury" also means mental in- for Damage to Premises Rented to jury, mental anguish, humiliation, or shock You Limit. if directly resulting from physical injury, sickness, or disease to that person. B. This provision is subject to all the terms of SECTION III - LIMITS OF INSURANCE. 6. MEDICAL PAYMENTS C. This provision 5. does not apply if Damage to Premises Rent to You Liability of COV- A. The Medical Expense Limit in Paragraph 7. ERAGE A (SECTION I) is excluded either of SECTION III - LIMITS OF INSURANCE by the provisions of the Coverage Part or is replaced by the following Medical Ex- by endorsement. pense Limit. The Medical Expense Limit provided by 8. SUPPLEMENTARY PAYMENTS this policy shall be the greater of: A. In the SUPPLEMENTARY PAYMENTS - a. $10,000; or COVERAGES A and B provision, Item 1.b., and 1.d are replaced with: b. The amount shown in the Declarations 1.b. Up to $500 for cost of bail bonds for Medical Expense Limit. required because of accidents or traf- fic law violations arising out of the use B. This provision 7. is subject to all the terms of any vehicle to which the Bodily In- jury Liability Coverage applies. We do not have to furnish these bonds. C. This provision 7. does not apply if COVERAGE C. MEDICAL PAYMENTS is 1.d. All reasonable expenses incurred by excluded either by the provisions of the the Insured at our request to assist us Coverage Part or by endorsement. in the investigation or defense of the claim or "suit," including actual loss of 7. DAMAGE TO PREMISES RENTED TO YOU earnings up to $500 a day because of LIMIT time off work. A. SECTION III - LIMITS OF INSURANCE, This endorsement does not change any other Item 6. is replaced with: provision of the policy. Includes copyrighted material of Insurance Service Office with its permission. ni~ !~,~.J~, Copyright, Insurance Services Office, Inc., 2001 320G8(82 1Q47 4~T011GP1+ usX1~p~ Sandy L. Orr 1 11/9/2016 11:17(Rage( vaf P41 5 of 5