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HomeMy WebLinkAboutInsurance Certificate: Pacific Paving i Client#: 176077 PACIPAVI2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/10/2017 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: Nikki Russell Propel Insurance PHONE 800 499-0933 A/c, No : 866 577-1326 A/C, No, Ext Medford Commercial Insurance E-MAIL ADDRESS: nikki.russell@propelinsurance.com P O Box 936 j INSURER(S) AFFORDING COVERAGE NAIC # Medford, OR 97501 INSURER A: Western National Assurance Comp 24465 INSURED INSURER B : Western National Insurance Grou Pacific Paving, Inc iINSURER C : PO Box 2370 INSURER D White City, OR 97503 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 CONTRACTOR 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 LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY CPP107021804 3/20/2017 03/20/201 EACH OCCURRENCE $1,000,000 l DAMAGE TO RENTED CLAIMS-MADE L X J PREMISES Ea occurrence $300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X PRO PRODUCTS - COMP/OP AGG $2,000,000 ~ ~ POLICY JECT LOC _ OTHER: _ $ A AUTOMOBILE LIABILITY CPP106912804 3/20/2017 03/20/201 Ea acccidentSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY (Per person) $ r ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ K HIRED AUTOS X AUTOS Per accident B X UMBRELLA LIAB OCCUR UMB101591303 3/20/2017 03/201201 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION $10000 $ -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. D_ ISFASE - EA EMPLOYE_F $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland is hereby named as additional insured per Endorsement CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kari Olson Purchasing Rep ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland, OR 97520-2014 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2618215/M2618097 LAB00 This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY WN GL 49 07 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sion applies: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement 1. "Bodily injury", "property damage" or "personal that such person or organization be added as an and advertising injury" arising out of the ren- additional insured on your policy. Such person or dering of, or the failure to render, any profes- organization is an additional insured only with re- sional architectural, engineering or surveying spect to liability for "bodily injury", "property dam- services, including: age" or "personal and advertising injury" caused, a. The preparing, approving, or failing to pre- in whole or in part, by: pare or approve, maps, shop drawings, 1. Your acts or omissions; or opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and specifica- behalf; tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional This exclusion applies even if the claims insured under this endorsement ends when your against an additional insured allege negli- operations for that additional insured are complet- gence or other wrongdoing in the supervision, ed. hiring, employment, training or monitoring of However: others by that insured, if the "occurrence" 1. The insurance afforded to such additional in- which caused the "bodily injury" or "property damage", only applies to the extent permitted by or the offense which caused the law; and "personal and advertising injury", involved the rendering of or failure to render any profes- 2. If coverage provided to the additional insured sional services by you with respect to your is required by a contract or agreement, the in- providing engineering, architectural or survey- suranCe afforded to such additional insured ing services in your capacity as an engineer, will not be broader than that which you are re- architect or surveyor. quired by the contract or agreement to provide for such additional insured. WN GL 49 07 15 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. "Bodily injury" or "property damage" occurring D. The following is added to the Other Insurance after: Condition and supersedes any provision to the a. All work, including materials, parts or contrary: equipment furnished in connection with Primary And Noncontributory Insurance such work, on the project (other than ser- This insurance is primary to and will not seek vice, maintenance or repairs) to be per- any contribution from any other insurance formed by or on behalf of the additional in- available to an additional insured under your sured(s) at the location of the covered operations has been completed; policy provided that: or b. That portion of "your work" out of which (1) The additional insured is a Named Insured the injury or damage arises has been put under such other insurance; and to its intended use by any person or or- (2) You have agreed in writing in a contract or ganization other than another contractor or agreement that this insurance would be subcontractor engaged in performing op- primary and would not seek contribution erations for a principal as a part of the from any other insurance available to the same project. additional insured. C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: 1. The minimum amount required by the contract or agreement; or 2. The Limits of Insurance shown in the Declara- tions; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. WN GL 49 07 15 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WN CA 27 06 16 BUSINESS AUTO ENHANCEMENT ENDORSEMENT The Business Auto Enhancement Endorsement is an optional endorsement that provides coverage enhancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this summary, refer to following endorsement for changes in your policy. SUMMARY OF COVERAGES PAGE Accidental Airbag Deployment Coverage 4 Auto Loan/Lease Gap Coverage 4 Blanket Additional Insured 2 Blanket Waiver of Subrogation 5 Broadened Definition of Insured includes: Newly Acquired Organizations for up to 180 Days 2 Employees as Insureds 2 Subsidiaries in Which You Own 50% or More 2 Deductible Waiver for Glass Repair 3 Employee Hired Auto 2,5 Fellow Employee Coverage 3 Hired Auto Physical Damage Coverage 4 Knowledge of Accident, Claim, Suit or Loss 5 Loss Of Use Expenses - Amended 3 Personal Effects 3 Rental Reimbursement Coverage 4 Supplementary Payments - Amended: Bail Bonds up to $5,000 2 Loss of Earnings up to $500/Day 2 Transportation Expense Limits - Amended 3 Unintentional Failure to Disclose Hazards 5 WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 WN CA 27 06 16 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 - COVERED AUTOS LIABILITY g. Any "employee" of yours is an "insured" while COVERAGE AMENDMENTS operating a covered "auto" hired or rented under a contract or agreement in the A. Who Is An Insured "employee's" name, with your permission, SECTION II - COVERED AUTOS LIABILITY while performing duties related to the conduct COVERAGE, A. Coverage, 1. Who Is An Insured of your business. is amended to add: B. Blanket Additional Insured d. Any legally incorporated subsidiary of yours in SECTION II - COVERED AUTOS LIABILITY which you own more than 50% of the voting COVERAGE, A. Coverage, 1. Who Is An stock on the effective date of this coverage Insured, paragraph c. is amended to add the form. following: However, "insured" does not include any Any person or organization who is required under a subsidiary of yours that is an "insured" under written contract or agreement between you and any other automobile liability policy, or would that person or organization, that is signed and be an "insured" under such policy but for executed by you before the "bodily injury" or termination of such policy or the exhaustion on "property damage" occurs and that is in effect such policy's limits of insurance. during the policy period, to be named as an e. Any organization which is newly acquired or additional insured is an "insured" for Liability formed by you and over which you maintain Coverage, but only for damages to which this majority ownership. However, coverage under insurance applies and only to the extent that this provision: persons or organization qualifies as an "insured" under the Who Is An insured provision contained in (1) is afforded only for the first 180 days after Section II. you acquire or form the organization or until the end of the policy period, C. Liability Coverage Extensions - Supplementary whichever comes first; Payments (2) does not apply to "bodily injury" or SECTION II - COVERED AUTOS LIABILITY "property damage" that results from an COVERAGE, A. Coverage, 2. Coverage "accident" that occurred before you formed Extensions, a. Supplementary Payments is or acquired the organization; amended by replacing subparagraphs (2) and (4) with the following: (3) does not apply to any newly acquired or formed organization that is a joint venture (2) Up to $5,000 for cost of bail bonds (including or partnership; and bonds for related traffic law violations) required because of an "accident" we cover. We do not (4) does not apply to an "insured" under any have to furnish these bonds. other automobile liability policy, or would be an "insured" under such a policy but for (4) All reasonable expenses incurred by the termination of such policy or the "insured" at our request, including actual loss exhaustion of such policy's limits of of earnings up to $500 a day because of time insurance. off from work. f. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 5 D. Fellow Employee Coverage D. Glass Repair - Deductible Waiver SECTION II - COVERED AUTOS LIABILITY SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, S. Fellow COVERAGE, A. Coverage, 3. Glass Breakage - Employee, the following is added: Hitting A Bird Or Animal - Falling Objects Or Missiles, is amended by adding the following: Co-Employee Lawsuit Defense Cost Reimbursement No deductible will apply to glass breakage if such glass is repaired, in a manner acceptable to us, if a suit seeking damages for "bodily injury" to any rather than replaced. fellow "employee" of the "insured" arising out of and in the course of the fellow "employee's" E. Hired Auto Physical Damage employment or while performing duties related to the conduct of your business, or a suit seeking SECTION III - PHYSICAL DAMAGE damages brought by the spouse, child, parent, COVERAGE, A. Coverage is amended by adding brother or sister of that fellow "employee", is the following: brought against you, we will reimburse reasonable S. Hired Auto Physical Damage costs that you incur in the defense of such matters. Any reimbursement made pursuant to If hired "autos" are covered "autos" for Liability this sub-section will be in addition to the limits of Coverage and if Comprehensive, Specified liability set forth in the Declarations. Causes of Loss, or Collision coverages are provided under this coverage form for any SECTION III - PHYSICAL DAMAGE COVERAGE "auto" you own, then the Physical Damage AMENDMENTS Coverages provided are extended to "autos" you hire of like kind and use, subject to the A. Transportation Expense - Limits Amended following: SECTION III - PHYSICAL DAMAGE a. The most we will pay for any one "loss" is COVERAGE, A. Coverage, 4. Coverage $50,000 or the actual cash value or cost to Extensions, a. Transportation Expenses is repair or replace, whichever is less, minus a deductible; amended by replacing $20 per day/$600 maximum limit with $50 per day/$1000 maximum. b. The deductible will be equal to the largest deductible applicable to any owned "auto" B. Hired Auto Physical Damage - Loss Of Use for that coverage. Any Comprehensive Expenses - Limits Amended deductible does not apply to "loss" caused SECTION III - PHYSICAL DAMAGE by fire or lightening; COVERAGE, A. Coverage, 4. Coverage c. Hired Auto Physical Damage coverage is Extensions, b. Loss of Use Expenses is excess over any other collectible amended by replacing the $20 per day/$600 insurance; and maximum limit with $50 per day/$750 maximum limit. d. Subject to the above limit, deductible and excess provisions we will provide C. Personal Effects Coverage coverage equal to the broadest coverage SECTION III - PHYSICAL DAMAGE applicable to any covered "auto" you own. COVERAGE, A. Coverage, 4. Coverage If a limit for Hired Auto Physical Damage is Extensions is amended by adding the following: indicated in the Declarations, then that limit replaces, and is not added to, the $50,000 limit c. Personal Effects indicated above. We will pay up to $500 for "loss" to personal effects, which are: (1) Owned by an "insured"; and (2) In or on your covered "auto." This coverage applies only in the event of the total theft of your covered "auto." No deductible applies to this coverage WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 F. Rental Reimbursement G. Accidental Airbag Deployment Coverage, . SECTION III - PHYSICAL DAMAGE COVERAGE SECTION III - PHYSICAL DAMAGE A. Coverage, is amended by adding the following: COVERAGE, A. Coverage is amended by adding 6. Rental Reimbursement the following: This coverage applies only to a covered "auto" 7. Accidental Airbag Deployment Coverage of the private passenger or light truck type as We will pay to reset or replace factory installed follows: airbag(s) in any covered "auto" for accidental discharge, other than discharge due to a a. We will pay for rental reimbursement collision loss. expenses incurred by you for the rental of a private passenger or light truck type This coverage is applicable only if "auto" because of "loss" to a covered comprehensive coverage applies to the private passenger or light truck type covered "auto". "auto". Payment applies in addition to the otherwise applicable amount of each This coverage is excess over any other coverage you have on a covered private collectible insurance or reimbursement by passenger or light truck type "auto." No manufacturer's warranty. deductibles apply to this coverage. H. Auto Loan/Lease Gap Coverage b. We will pay only for those expenses SECTION III PHYSICAL DAMAGE COVERAGE, incurred during the policy period beginning 24 hours after the "loss" and ending, Item A., Coverage, is amended by adding the regardless of the policy's expiration, with following: the lesser of the following number of days: g, Auto Loan/Lease Gap Coverage (1) The number of days reasonably This coverage applies only to a covered "auto" required to repair or replace the described or designated in the Schedule or in covered private passenger or light the Declarations as including physical damage truck type "auto". If "loss" is caused coverage. by theft, this number of days is added to the number of days it takes to In the event of a covered total "loss" to a locate the covered private passenger covered "auto" described or designated in the or light truck type "auto" and return it Schedule or in the Declarations, we will pay to you; or any unpaid amount due on the lease or loan (2) 30 days. for a covered "auto" less: c. Our payment is limited to the lesser of the a. The amount paid under the Physical following amounts: Damage Coverage Section on the policy; and (1) Necessary and actual expenses b. Any: incurred, or (2) $50 per day, up to a maximum of (1) Overdue lease/loan payments at the $1,000. time of the "loss"; d. This coverage does not apply while there (2) Financial penalties imposed under a are spare or reserve private passenger or lease for excessive use, abnormal light truck type "autos" available to you for wear and tear or high mileage; your operations. (3) Security deposits not returned by the e. If "loss" results from the total theft of a lessor; covered "auto" of the private passenger or light truck type, we will pay under this (4) Costs for extended warranties, Credit coverage only that amount of your rental Life Insurance, Health, Accident or reimbursement expenses which is not Disability Insurance purchased with already provided for under SECTION III - the loan or lease; and PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions. (5) Carry-over balances from previous loans or leases. For the purposes of this Rental Reimbursement coverage, light truck is defined as a truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as the maximum loaded weight the auto is designed to carry. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 5 SECTION IV BUSINESS AUTO CONDITIONS C. Unintentional Failure to Disclose Hazards AMENDMENTS SECTION IV - BUSINESS AUTO CONDITIONS, A. Duties In The Event Of Accident, Claim, Suit Or B. General Conditions, 2. Concealment, Loss Amended Misrepresentation Or Fraud, is amended by SECTION IV - BUSINESS AUTO CONDITIONS, adding the following paragraph: A. Loss Conditions, 2. Duties In The Event Of If you unintentionally fail to disclose any hazards Accident, Claim, Suit Or Loss, a. is amended by existing at the inception date of the policy, or adding the following: during the policy period in connection with any additional hazards, we will not deny coverage This condition applies only when the "accident" or under this Coverage Part because of such failure. "loss" is known to: (1) You, if you are an individual; D. Employee Hired Auto (2) A partner, if you are a partnership; SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, (3) An executive officer or insurance manager, if paragraph b. is deleted and replace by the you are a corporation; or following: (4) A member or manager, if you are a limited b. For Hired Auto Physical Damage Coverage, liability company. the following are deemed to be a covered "autos" you own: But, this section does not amend the provisions relating to notification of police, protection or (1) Any covered "auto" you lease, hire, rent or examination of the property which was subject to borrow. the "loss". (2) Any covered "auto" hired or rented by your B. Blanket Waiver of Subrogation "employee" under a contract in that individual "employee's" name, with your Section IV - BUSINESS AUTO CONDITIONS, A. permission, while performing duties related Loss Conditions, S. Transfer of Rights of to the conduct of your business. Recovery Against Others to Us, is amended by adding the following exception: However, any "auto" that is leased, hired, rented or borrowed with a driver is not a However, we waive any right of recovery we may covered "auto". have against any person or organization to the extent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 This page has been left blank intentionally. •