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HomeMy WebLinkAboutInsurance Certificate: Laurelwood Restaurants Inc PROPEL INSURANCE PAGE 3 OF 22 Client#:167062 LAURREST DATE (MM1DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 5!22!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 Sarah Plummer NAME: Propel Insurance PHONE g00 499-0933 Fax 866 577-1326 (A/C, No, Ext): (A1C, No): Portland Commercial Insurance E~+IAIL Sarah. lummer ro elinsurance.com ADDRESS: p ~p p 805 SW Broadway, Suite 2300 INSURER(S) AFFORDING COVERAGE NAIC # Portland, OR 97205-3363 INSURERa :Cincinnati Insurance Company 10677 INSURED INSURERS : Oh10 SeCUrlty Insurance Company 124082 Laurelwood Restaurants Inc INSURER C ; 5115 NE Sandy Blvd INSURER D ; Portland, OR 97213 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY 0389245 610312017 06!0312018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS~~ADE ~ X OCCUR PREMISES Ea occurrence $SOO,000 MED EXP (Any one person) $1 O,OOO PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 nPRO- PRODUCTS -COMP/OF AGG $ 2,000,000 POLICY I I JECT LOC OTHER $ A AUTOMOBILE LIABILITY 0389245 610312017 0610312018 Ea aBadeDtsINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURI' (Per person) $ ALL GWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OVNdED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident A UMBRELLA LIAB OCCUR 0389245 610312017 0610312018 EACH OCCURRENCE $5 OOO 000 - L _ EXCESS LIAB II CLAIMS-MADE AGGREGATE $S,000,OOO DED RETENTION $ $ B WORKERS COMPENSATION XWS56347331 1101!2017 01/0112018 X STATUTE ERH AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A LIQUOR LIABILITY 0389245 6/0312017 06!0312018 EA CO CAUSE $1,000,000 AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Additional Named Insureds: ICO Properties LLC. (LLC), Laurelwood Brewing Co. (DBA), Laurelwood Public House 8~ Brewery (DBA), Laurelwood SE Public House (DBA). Project ~ Ashland Culinary Festival CERTIFICATE HOLDER CANCELLAl10N Clt of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520-0000 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #52714623IM2711510 RCA00 PROPEL INSURANCE PAGE 4 OF 22 This page has been left blank intentionally. PROPEL INSURANCE PAGE 5 OF 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENDED LIABILITY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A Endorsement - Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liadlity Coverage 2 2. Unintentional Failure to Disdose Hazards 8 3. Damage to Premises Rented to You 8 4. Supplementary Payments 9 5. 180 Day Coverage for Newly Formed or Acquired Organizations 9 6. Waiver of Subrogation 9 7. Automatic Additional Insured -Specified Relationships : .................................10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; and • State or Political Subdivisions -Permits Relating to Premises 8. Property Damage to Borrowed Equipment ........................................................................................12 9. Employees as Insureds -Specified Health Care Services : .............................................................13 • Nurses; • Emergency Medical Technicians; and • Paramedics 10. Broadened Notice of Occurrence ......................................................................................................13 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1, 000, 000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a, The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 8. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10,000 Deductible $ 250 Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 1 of 13 PROPEL INSURANCE PAGE 6 OF 22 C. Coverages 2) Occurred prior to the ef- fective date of this en- 1. Employee Benefit Liability Coverage dorsement provided: a. The following is added to SECTION I a) You did not have - COVERAGES: Employee Benefit knowledge of a Liability Coverage. claim or "suit" on or (1) Insuring Agreement before the effective date of this en- (a) We will pay those sums that dorsement. the insured becomes legally obligated to pay as dam- You will be ages caused by any act, er- deemed to have ror or omission of the in- knowledge of a sured, or of any other per- claim or "suit' son for whose acts the in- when any "author- sured is legally liable, to ized representa- which this insurance applies. tive"; We will have the right and i) Reports all, or duty to defend the insured an rt of the a ainst an "suit" seelan y ~ ' g Y g act, error or those damages. However, omission to us we will have no duty to de- or any other fend against any "suit" seek- insurer; ing damages to which this insurance does not apply. ii} Receives a We may, at our discretion, written or ver- investigate any report of an bal demand or act, error or omission and claim for dam- settleany claim or "suit" that ages because may result. But: of the act, er- ror or ornis- 1) The amount we will pay sion; and for damages is limited as described in SEC- b) There is no other TION III -LIMITS OF applicable insur- INSURANCE; and ance_ 2} Our right and duty to (2) Exclusions defend ends when we have used up the appli- This insurance does not apply to: cable limit of insurance (a) Bodily Injury, Property in the payment of judg- Damage or Personal and menu or settlements. Advertising Injury No other obligation or liabil- "Bodily injury", "property ity to pay sums or perform damage" or "personal and acts or services is covered advertising injury". unless expliatly provided for under Supplementary Pay- (b) Dishonest, Fraudulent, menu. Criminal or Malicious Act (b) This insurance applies to Damages arising out of any damages only if the act, er- intentional, dishonest, ror or omission, is negli- fraudulent, criminal or mali- gently committed in the cious act, error or omission, "administration" of your "ern- committed by any insured, ployee benefit program"; including the willful or reck- and less violation of any statute. 1) Occurs during the policy period; or Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 2 of 13 PROPEL INSURANCE PAGE 7 OF 22 (c) Failure to Perform aCon- effort and cooperation of the tract insured, from the applicable funds accrued or other col- Damages arising out of fail- lectible insurance. ure of performance of con- tract by any insurer. (i) Taxes, Fines or Penalties (d) Insufficiency of Funds Taxes, fines or penalties, in- cluding those imposed un- Damages arising out of an der the Internal Revenue insufficiency of funds to Code or any similar state or meet any obligations under local law. any plan included in the "employee benefit program". (j) Employment-Related Prac- tices (e) Inadequacy of Perform- ance of Investment 1 Ad- Any liability arising out of vice Given with Respect to any: Participation (1) Refusal to employ; Any Bairn based upon: (2) Termination of em plod 1) Failure of any invest- ment; ment to perform; (3) Coercion, demotion, 2) Errors in providing in- evaluation, reassign- formation on past per- ment, discipline, defa- forrnance of investment motion, harassment, vehicles; or humiliation, discrimina- tion or other employ- 3) Advice given to any ment -related practices, person with respect to acts or omissions; or that person's decision to participate or not to par- (4) Consequential liability ticipate in any plan in- as a result of (1), (2) or cluded in the "employee (3) above. benefit program". This exclusion applies (f) Workers' Compensation whether the insured may be and Similar Laws held liable as an employer or in any other capacity and Any claim arising out of your to any obligation to share failure to comply with the damages with or repay mandatory provisions of any someone else who must pay workers' compensation, un- damages because of the in- employment compensation Jury insurance, social security or disability benefits law or any (3) Supplementary Payments similar law. SECTION I -COVERAGES, (g) ERISA SUPPLEMENTARY PAYMENTS - COVERAGES A AND B also Damages for which any in- apply to this Coverage. sured is liable because of li- ability imposed on a fidud- b. Who is an Insured ary by the Employee Re- tirement Income Security As respects Employee Benefit Liabil- Act of 1974, as now or ity Coverage, SECTION II -WHO IS hereafter amended, or by AN INSURED is deleted in its entirety any similar federal, state or and replaced by the following: local laws. (1 } If you are designated in the Dec- (h) Available Benefits larations as: Any claim for benefits to the (a) An individual, you and your extent that such benefits are spouse are insureds, but available, with reasonable only with respect to the oon- Includescopyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 3 of 13 PROPEL INSURANCE PAGE 8 OF 22 duck of a business of which liability company, and over which you are the sole owner. you maintain ownership or major- ity interest, will qualify as a (b) A partnership or joint ven- Named Insured if no other similar ture, you are an insured. insurance applies to that organi- Your members, your part- zation. However, coverage un- ners, and their spouses are der this provision; also insureds but only with respect to the conduct of (a) Is afforded only until the your business. 180th day after you acquire or form the organization or (c) A limited liability company, the end of the policy period, you are an insured. Your whichever is earlier; and members are also insureds, but only with respect to the (b) Qces not apply to any act, conduct of your business. error or omission that was Your managers are insur- committed before you ac- eds, but only with respect to quired or formed the organi- their duties as your manag- zation. ers. c. Limits of Insurance (d) An organization other than a partnership, joint venture or As respects Employee Benefit Liabil- limited liability company, you ity Coverage, SECTION III -LIMITS are an insured. Your "ex_ OF INSURANCE is deleted in its en- eaative officers" and direc- tirety and replaced by the following: tors are insureds, but only (1) The Limits of Insurance shown in with respect to their duties Section B. Limits of Insurance, as your officers or directors. 1. Employee Benefit Liability Your stockholders are also Coverage and the rules below fx insureds, but only with re- the most we will pay regardless sped to their liability as of the number of: stockholders. (a) Insureds; (e) A trust, you are an insured. Your trustees are also in- (b) Claims made or "suits" sureds, but only with respect brought; to their duties as trustees. (c) Persons or organizations (2} Each of the following is also an making daims or bringing insured: "suits"; (a) Each of your "employees" (d) Acts, errors or omissions; or who is or was authorized to administer your "employee (e) Benefits included in your benefit program" "employee benefit program". (b) Any persons, organizations (2) The Aggregate Limit shown in or "employees" having Section B. Limits of Insurance, proper temporary authoriza- 1. Employee Benefit Liability tion to administer your "ern- Coverage of this endorsement is ployee benefit program" if the most we will pay for all dam- you die, but only until your ages because of acts, errors or legal representative is ap- omissions negligently committed pointed. in the "administration" of your "employee benefit program". (c} Your legal representative if you die, but only with re- (3) Subje~ to the limit described in sped to duties as such. (2} above, the Each Employee That representative will have Limit shown in Section B. Limits all your rights and duties of Insurance, 1. Employee under this Coverage Part. Benefit Liability Coverage of this endorsement is the most we (3) Any organization you newly ac- will pay for all damages sus- quire or form, other than apart- tained by any one "employee", nership, joint venture or limited including damages sustained by Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 4 of 13 PROPEL INSURANCE PAGE 9 OF 22 such "employee's" dependents (d) We may pay any part or all and beneficiaries, as a result of: of the deductible amount to effect settlement of any (a) An act, error or omission; or claim or "suit" and, upon no- b) A series of related acts, er- tification of the action taken, rors or omissions, regard- you shall promptly reim- less of the amount of time burse us for such part of the that lapses between such deductible amount as we acts, errors or omissions. have paid. negligently committed in the d. Additional Conditions "administration" of your "em- As respects Employee Benefit Li- ployee benefit program". ability Coverage, SECTION IV - However, the amount paid under COMMERCIAL GENERAL LIABIL- this endorsement shall not ex- ITY CONDITIONS is amended as fol- ceed, and will be subject to the lows: limits and restrictions that apply (1) Item 2. Duties in the Event of to the payment of benefits in any Occurrence Offense Claim or plan included in the "employee Suit is deleted in its entirety and benefit program. replaced by the following: (4) Deductible Amount 2. Duties in the Event of an (a) Our obligation to pay darn- Act, Error or Omission, or ages on behalf of the in- Claim or Sint sured applies only to the a. You must see to it that amount of damages in ex- we are notified as soon cess of the deductible as practicable of an act, amount stated in the Decla- error or omission which rations as applicable to may result in a claim. Each Employee. The limits To the extent possible, of insurance shall not be re- notice should include: duced by the amount of this deductible. (1) What the act, error or omission was (b) The deductible amount and when it oc- stated in the Declarations curred; and applies to all damages sus- tained by any one "em- (2) The names and ployee", including such "em- addresses of and ployee's" dependents and one who may suf- beneficiaries, because of all fer damages as a acts, errors or omissions to result of the act, which this insurance applies. error or omission. (c) The terms of this insurance, b. If a claim is made or including those with respect "suit" is brought against to: any insured, you must: 1) Our right and duty to (1) Immediately record defend the insured the specifics of the against any "suits" claim or "suit" and seelang those dam- the date received; ages; and and 2) Your duties, and the du- (2) Notify us as soon ties of any other in- as practicable. volved insured, in the event of an act, error or You must see to it that omission, or claim, we receive written nod tice of the claim or suit apply irrespective of the ap- as soon as practicable. plication of the deductible amount- c. You and any other in- volvedinsured must: Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 5 of 13 PROPEL INSURANCE PAGE 10 OF 22 (1) Immediately send method described in b. us copies of any below. demands, notices, b. Method of Sharing summonses or le- gal papers re- If all of the other insur- ceived in connec- anoe permits contribu- tion with the claim tion b ual shares, or "suit"; y ~ we will follow this (2) Authorize us to ob- method also. Under tain records and this approach each in- otherinformation; surer contributes equal amounts until it has (3) Cooperate with us paid its applicable limit in the investigation of insurance or none of or settlementof the the loss remains, claim or defense whichever comes first. against the "suit"; If any of the other in- and surance does not permit (4) Assist us, upon our contribution by equal request, in the en- shares, we will contrib- forcement of any ute by limits. Under this right against any method, each insurer's person or organi- share is based on the zation which may ratio of its applicable be liable to the in- limit of insurance to the sured because of total applicable limits of an act, error or insurance of all insur- ornission to which ers. this insurance may also apply. c. No Coverage d. No insured will, except This insurance shall not at that insured's own cover any loss for which cost, voluntarily make a the insured is entitled to payment, assume any recovery under any obligation, or incur any other insurance in force expense without .our previous to the effective consent. date of this Coverage Part. (2) Item 5. Other Insurance is de- leted in its entirety and replaced e. Additional Definitions by the following: As respects Employee Benefit Li- s. Other Insurance ability Coverage, SECTION V - DEFINITIONS is amended as follows: If other valid and collectible insurance is available to the The following definitions are insured for a loss we cover added: under this Coverage Part, 'Administration" means: our obligations are limited as follows: a. Providing information to "employees", including a. Primary Insurance their dependents and This insurance is pri- beneficiaries, with re- mary except when c. sped to eligibility for or below applies. If this scope of "employee benefit programs"; insurance is primary, our obligations are not b. Interpreting the "ern- affected unless any of ployee benefit pro- the other insurance is grams"; also primary. Then, we will share with all that c. Handling records in other insurance by the connection with the Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page fi of 13 PROPEL INSURANCE PAGE 11 OF 22 "employee benefit pro- benefits and such bene- grams"; or fits are made generally available to all "employ- d. Effecting, continuing or ees" who are eligible terminating any "em- under the plan for such ployee's" participation in benefits; any benefit included in the "employee benefit c. Unemployment insur- program". once, soaal security benefits, workers' com- However, "administration" pensation and disability does not incude: benefits; and a. Handling payroll deduc- d. Vacation plans, includ- tions; or ing buy and sell pro- b. The failure to effect or grams; leave of ab- maintain any insurance senoe programs, includ- or adequate limits of ing military, maternity, coverage of insurance, family, and civil leave; including but not limited tuition assistance plans; to unemployment insur- transportation and ante, soaal security health club subsidies. benefits, workers' tom- (2~ The following definitions are de- pensation and disability leted in their entirety and re- benefits. placed by the following: 2. "Cafeteria plans" means 21. "Suit' means a civil proceed- plans authorized by applica- ing in which money dam- ble law to allow "employees" ages because of an act, er- to elect to pay for certain ror or omission to which this benefits with pre-tax dollars. insurance applies are al- 3. "Employee benefit pro- leged. "Suit" includes: grams" means a program a. An arbitration proceed- providing same of all of the ing in which such darn- follawing benefits to "em- ages are claimed and to ployees", whether provided which the insured must through a "cafeteria plan" or submit or does submit otherwise: with our consent; a. Group life insurance; b. Any other alternative group accident or health dispute resolution pro- insurance; dental, vision ceeding in which such and hearing plans; and damages are claimed flexible spending ac- and to which the in- counts; provided that no sured submits with our one other than an "em- consent; or ployee" may subscribe to such benefits and c. An appeal of a civil pro- such benefits are made ceeding. generally available to 8. "Employee" means a person those employees who actively employed, formerly satisfy the plans eligibil- ity requirements; employed, on leave of ab- sence or disabled, or retired. b. Profit sharing plans, "Employee" includes a employee savings "leased worhr". "Em- plans, employee stock ployee" does not include a ownership plans, pen- 'temporary worker" sion plans and stock subscription plans, pro- 2. Unintentional Failure to Disclose Haz- vided that no one other ands than an "employee" SECTION IV -COMMERCIAL GENERAL may subscribe to such LIABILITY CONDITIONS, 7. Representa- Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 7 of 13 PROPEL INSURANCE PAGE 12 OF 22 tions is hereby amended by the addition to damage or de- ofthe following: stroy self; Based on our dependence upon your rep- c) Smog; resentations as to existing hazards, if un- intentionally you should fail to disdose all d} Mechanical break such hazards at the inception date of your down including policy, we will not reject coverage under rupture or bursting this Coverage Part based solely on such caused by oen- trifugalforce; failure. 3. Damage to Premises Rented to You e) Settling, cracking, shrinking or ex- a. The last Subparagraph of Paragraph pansion; or SECTION I -COVERAGES, COV- ERAGE ABODILY INJURY AND f) Nesting or infesta- PROPERTY DAMAGE LIABILITY 2., tion, or discharge Exclusions is hereby deleted and or release of waste replaced by the following: products or secre- tions, by insects, Exclusions c. through q. do not apply birds, rodents or to damage by fire, explosion, light- other animals. Wing, smoke or soot to premises while rented to you or temporarily occupied (b) Loss caused directly or indi- byyou with permission of the owner. rectly by any of the follov~ ing: b. The insurance provided under SEC- TION I -COVERAGES, COVERAGE 1) Earthquake, volcanic A. BODILY INJURY AND PROP- eruption, landslide or ERTY DAMAGE LIABILITY applies any other earth move- to "property damage" arising out of ment; water damage to premises that are 2) Water that backs up or both rented to and occupied by you. overflows from a sewer, (1) As respects Water Damage Le- drain orsump; gal Liability, as provided in Para- 3} Water under the ground graph 3.b. above: surface pressing on, or The exclusions under SECTION I flowing or seeping -COVERAGES, COVERAGE A. through: BODILY INJURY AND PROP- a} Foundations, walls, ERTY DAMAGE LIABILITY, 2. floors or paved Exclusions, other than i. War surfaces; and the Nuclear Energy Liabil- ity Exclusion, are deleted and b) Basements, the following are added: whether paved or not; or This insurance does not apply to: (a) "Property damage": c} Doors, windows ar other openings. 1 } Assumed in any con- (c) Loss caused by or resulting tray; or from water that leaks or 2} Loss caused by or re- flcNVS from plumbing, heat- sulting from any of the ing, air conditioning, or fire following: protection systems caused by or resulting from freezing, a) Wear and tear; unless: b) Rust, corrosion, 1 } You did your best to fungus, decay, de- maintain heat in the terioration, hidden building or structure; or or latent defect or any quality inprop- 2} You drained the equip- erty that causes it ment and shut off the Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 8 of 13 PROPEL INSURANCE PAGE 13 OF 22 water supply if the heat the use of any vehicle to which the was not maintained. Bodily Injury Liability Coverage ap- plies. We do not have to furnish (d } Loss to or damage to: these bonds. 1) Plumbing, heating, air b. Paragraph 4. is replaced by the fol- conditioning, fire protec- lowing: tion systems, or other equipment or appli- All reasonable expenses incurred by antes; or the insured at our request to assist us in the investigation or defense of the 2) The interior of any claim or "suit', including actual loss of building or structure, or earnings up to the limit shown inSec- to personal property in tion B. Limits of Insurance, 4.b. the building or structure Loss of Earnings of this endorsement caused by or resulting per day because of time off from from rain, snow, sleet or work ioe, whether driven by wind or not. 5. 180 Day Coverage for Newly Formed or c. Limit of Insurance Acquired Organizations The Damage to Premises Rented to SECTION II - UVHO IS AN INSURED is amended as folio You Limit as shown in the Declara- tions isamended as follows: Subparagraph a. of Paragraph 4. is (2) Paragraph 6. of SECTION III - hereby deleted and replaced by the fol- LIMITS OF INSURANCE is lowing. hereby deleted and replaced by a. Insurance under this provision is af- the fdlowing: forded only until the 180th day after you acquire or form the organization 6. Subject to 5. above, the or the end of the policy period, which- Damage to Premises ever is earlier; Rented to You Limit is the most we will pay under 6. Vllaiver of Subrogation COVERAGE A. BODILY SECTION IV -COMMERCIAL GENERAL INJURY AND PROPERTY LIABILITY CONDITIONS, 9. Transfer of DAMAGE LIABILITY for damages because of "prop- Rights of Recovery Against Others to erty damage" to premises Us is hereby amended by the addition of while rented to you or tem- the following: porarily occupied by you We waive any right of recovery we may with permission of the have because of payments we make for owner, arising out of any injury or damage arising out of your ongo- one "occurrence" to which ing operations or "your work" done under this insurance applies. a written contract requiring such waiver (3} The most we will pay is limited as with that person or organization and in- described in Section B. Limits of cluded in the "products-completed opera- Insurance, 3. Damage to Prem- tions hazard". However, our rights may ises Rented to You of this en- only be waived prior to the "occurrence" dorsement. giving rise to the injury or damage for which we make payment under this Cov- 4. Supplementary Payments erage Part. The insured must do nothing Under SECTION I -COVERAGE, SUP- after a loss to impair our rights. At our re- PLEMENTARY PAYMENTS -COVER- quest, the insured will bring "suit" or trans- AGES AAND B: fer those rights to us and help us enforce those rights. a. Paragraph 2. is replaced by the fol- 7. Automatic Additional Insured - Speci- lowing: Pied Relationships Up to the limit shown in Section B. a. The following is hereby added to Limits of Insurance, 4.a. Bail Bonds SECTION II -WHO IS AN INSURED: of this endorsement for cost of bail bonds required because of accidents (1) Any person or organization de- or traffic law violations arising out of saibed in Paragraph 7.a.(2} be- Includescopyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 9 of 13 PROPEL INSURANCE PAGE 14 OF 22 low (hereinafter referred to as demolition operations additional insured) whom you are performed by or on be- required to add as an additional half of such additional insured under this Coverage Part insured. by reason of: (b) Any person or organization (a) A written contract or agree- from which you lease ment; or equipment with whom you have agreed per Paragraph (b) An oral agreement or con- 7.a.(1) above to provide in- trac~ where a certificate of surance. Such person(s) or insurance showing that per- organizations} are insureds son or organization as an solely with respect to their additional insured has been liability arising out of the issued, maintenance, operation or is an insured, provided: use by you of equipment leased to you by such per- (a) The written or oral contract son(s) or organizations}. or agreement is: However, this insurance 1 Current) in effect or does not apply to any "oc- y currence" which takes place becomes effective dur- after the equipment lease ing the policy period; expires. and 2 Executed riot to an (c) Any person or organization p (referred to below as ven- "occurrence" or offense dot} with whom you have to which this insurance agreed per Paragraph would apply; and 7.a.(1) above to provide in- (b) They are not speafically surance, but only with re- named as an additional in- sped to "bodily injury" or sured under any other provi- "property damage" arising sion of, or endorsement out of "your products" which added to, this Coverage are distributed or sold in the Part. regular course of the ven- dor's business, subject to (2) Only the following persons or or- the following additional ex- ganizations are additional insur- clusions: eds under this endorsement, and insurance coverage provided to 1) The insurance afforded such additional insureds is lirn- the vendor does not ited as provided herein: apply to: (a} The manager or lessor of a a) "Bodily injury" or premises leased to you with "property damage" whom you have agreed per for which the ven- Paragraph 7.a.(1) above to dot is obligated to provide insurance, but only pay damages by with respect to liability aris- reason of the as- ing out of the ownership, sumption of liability maintenance or use of that in a contract or part of a premises leased to agreement. This you, subject to the following exdusion does not additional exclusions: apply to liability for damages that the This insurance does not ap- vendor would have ply to: in the absence of 1) Any "occurrence" which aheeementact or takes place after you g ' cease to be a tenant in b) Any express war- that premises. ranty unauthorized by you; 2) Structural alterations, new construction or Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 10 of 13 PROPEL INSURANCE PAGE 15 OF 22 c) Any physical or Hying or containing chemical change in such products; or the product made intentionally by the b) When liability in- vendor; cluded within the products- d} Repackaging, completed opera- unless unpacked tions hazard" has solely for the pur- been excluded un- pose of inspection, der this Coverage demonstration, Part with respect to testing, or the sub- such products. stitution of parts under instructions (d} Any state or political subdi- frorn the manufac- vision with which you have turer, and then re- agreed per Paragraph packaged in the 7.a.(1 } above to provide in- original container; surance, subject to the fol- lowingadditional provision: e) Any failure to make such inspections, This insurance applies only adjustments, tests with respect to the following or servicing as the hazards for which the state vendor has agreed or political subdivision has to make or nor- issued a permit in connec- mally undertakes tion with premises you own, to make in the .rent or control and to which usual course of this insuranceapplies: business, in con- 1) The existence, mainte- nection with the Hance, repair, construc- distribution or sale tion, erection, or re- ofthe products; moval of advertising f} Demonstration, in- signs, awnings, cano- stallation, serviang pies, cellar entrances, or repair opera- coal hales, driveways, tions, except such manholes, marquees, operations per- hoist away openings, formed at the ven- sidewalk vaults, street dor's premises in banners, or decorations connection with the and similar exposures; sale of the product; or g} Products which, af- 2) The construction, erec- ter distribution or tion, or removal of ele- sale by you, have vators; or been labeled or re- 3) The ownership, mainte- labeled or used as Hance, or use of any a container, part or elevators covered by ingredient of any this insurance. other thing or sub- stance by or for the (3} Any insurance provided to vendor. an additional insured desig- 2 This insurance does not Hated under Paragraph 7.a.(2) Subparagraphs (a), apply to any insured (b)and (d}does not apply to person or organization: "bodily injury", "property a) From whom you damage" or, "personal and have acquired advertising injury" arising out suc#~ products, or of the sole negligence or any ingredient, part willful misconduct of the ad- enter- ditional insured or their or container, ing into, accompa- agents, employees or any Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 11 of 13 PROPEL INSURANCE PAGE 16 OF 22 other representative of the (1) The Limits of Insurance shown in additional insured. the Declarations are replaced by b. SECTION IV -COMMERCIAL GEN- the limits designated in Property ERAL LIABILITY CONDITIONS is Damage to Borrowed Equip- ment Section B. Limits of In- hereby amended as follows: surance, 8. Property Damage Condition 5. Other Insurance is to Borrowed Equipment of this amended to include: endorsement with respect to coverage provided by this en- (1) Where required by a written con- dorsement. These limits are in- trac~ or agreement, this insur- clusive of and not in addition to anoe is primary and / or noncon- the limits being replaced, The tributory as respects any other Limits of Insurance shown in insurance policy issued to the Section B. Limits of Insurance, additional insured, and such 8. Property Damage to Bor- other insurance policy shall be rowed Equipment of this en- excess and / or noncontributing, dorsement fix the most we will whichever applies, with this in- pay in any one "occurrence" re- surance. gardless of the number of: (2} Any insurance provided by this (a} Insureds; endorsement shall be primary to other insurance available to the (b} Claims made or "suits" additional insured except: brought; or (a) As othennrise provided in (c} Persons or organizations SECTION IV - COMMER- making claims or bring CIAL GENERAL LIABILITY "suits". CONDITIONS, 5. Other In- (2} Deductible Clause surance, b. Excess Insur- ance; or (a) Our obligation to pay dam- ages on your behalf applies (b) For any other valid and col- only to the amount of dam- lectible insurance available ages for each "occurrence" to the additional insured as which are in excess of the an additional insured by at- deductible amount stated in tachment of an endorsement Section B. Limits of Insur- to another insurance policy ante, 8. Property Damage that is written on an excess to Borrowed Equipment of basis. In such case, the this endorsement. The lim- coverage provided under its of insurance will not be this endorsement shall also reduced by the application be excess. of such deductible amount. 8. Property Damage to Borrowed Equip- (b) SECTION I -COMMERCIAL ment LIABILITY CONDITIONS 2. a. The following is hereby added to Ex- Duties in the Event of Oc- clusion j. Damage to Properly of currence, Offense, Claim Paragraph 2., Exclusions SECTION or Suit, applies to each I -COVERAGES, COVERAGE A. - claim or "suit" irrespective of BODILY INJURY AND PROPERTY the amount. DAMAGE LIABILITY: (c) We may pay any part or all Paragraphs (3) and (4) of this exclu- of the deductible amount to sion do not apply to tools or equip- effect settlement of any ment loaned to you, provided they are claim or "suit" and, upon no- not being used to perform operations tification of the action taken, at the time of loss. you shall promptly reim- burse us for such part of the b. UVith respect to the insurance pro- deductible amount as has vided by this section of the endorse- been paid by us. ment, the following additional provi- sionsapply: 9. Employees as Insureds -Specified Health Care Services Includes copyrighted material of Insurance GA 227 02 07 Services Office, Inc., with its permission. Page 12 of 13 PROPEL INSURANCE PAGE 17 OF 22 It is hereby agreed that Paragraph 2.a.(1 } a. You must see to it that we are notified (d) of SECTION II -WHO IS AN IN- as soon as practicable of an "occur- SURED, does not apply to your "employ- rence" or an offense which may result ees" who provide professional health care in a claim. To the extent possible, services on your behalf as duly licensed: notice should indude: a. Nurses; (1) How, when and where the "oc- currence" oroffense took place; b. Emergency Medical Technicians; or (2} The names and addresses of c. Paramedics, any injured persons and wit- in the jurisdiction where an "occurrence" nesses; and or offense to which this insurance applies (3) The nature and location of any takes place. ir~ury or damage arising out of 14. Broadened Notice of Occurrence the "occurrence"oroffense. Paragraph a. of Condition 2. Duties in the This requirement applies only when Event of Occurrence, Offense, Clairn or the "occurrence" or offense is known Suit (SECTION IV -COMMERCIAL to an "authorized representative". GENERAL LIABILITY CONDITIONS} is hereby deleted and replaced by the fol- lowing: Includes copyrighted material of Insurance GA 227 02 47 Services Office, Inc., with its permission. Page 13 of 13 PROPEL INSURANCE PAGE 18 OF ZZ This page has been left blank intentionally. PROPEL INSURANCE PAGE 19 OF 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CinciPlus BUSINESS AUTO EXPANDED COVERAGE (XC®} ENDORSEMENT This endorsement modifies insurance provided by 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_ A Who is an Insured -Amended personal affairs, provided you do not own, hire or borrow that "auto". SECTION II -LIABILITY COVERAGE, A. Coverage,1. Who is an Insured is amended B. Liability Coverage Extensions - Supple- byadding the following: mentary Payments -Higher Limits The following are "insureds": SECTION II -LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Sup- t. Any subsidiary which is a legally incorpo- elementary Payments is amended by: rated entity of which you own a financial interest of more than 50% of the voting 1. Replacing the $2,000 Limit of Insurance stock on the effective date of this cover- for bail bonds with $4,000 in (2); and age form. 2. Replacing the $250 Limit of Insurance for However, the insurance afforded by this reasonable expenses with $500 in (4). provision does not apply to any subsidiary that is an "insured" under any other auto- C. Amended Fellow Employee Exclusion mobile liability policy, or would be an "in- SECTION II -LIABILITY COVERAGE B. Ex- sured" under such policy but for terming- ' tion of such policy or the exhaustion of clusions, 5. Fellow Employee is amended by adding the following. such policy's limits of insurance. 2, Any organization that is newly acquired or But this exclusion does not apply if the bodily injury results from the use of a formed by you and over which you main- covered "auto" you own or hire. Coverage twin majority a~vnership. is excess over any other collectible insur- The insurance provided by this provision: ante. a, Is effective on the date of acquisition D. Hired Auto -Physical Damage or formation, and is afforded for 180 If hired "autos" are covered "autos" for Liability days after such date; Coverage, then Comprehensive and Collision b. Does not apply to "bodily injury" or Physical Damage Coverages as provided un- "property damage" resulting from an der SECTION III -PHYSICAL DAMAGE "accident" that occurred before you COVERAGE of this Coverage Part are ex- acquired or formed the organization; tended to "autos" you hire of the private pas- senger type or light truck (10,000 pounds or c. Does not apply to any newly acquired less gross vehicle weight) type, subject to the or formed organization that is a joint following: venture or partnership; and 1. The most we will pay for "lost' to any d. Does not apply to an insured under hired "auto" is $35,000 or the actual cash any other automobile liability policy, value or cost to repair or replace, which- orwould be an insured under such a ever is the least, minus a deductible. policy but for the termination of such policy or the exhaustion of such pol- 2. The deductible will be equal to the largest icy's limits of insurance. deductible applicable to any owned "auto" of the private passenger type or light truck 3. Any of your "employees" while using a type for that coverage, or $1,000, which- covered "auto" in your business or your ever is less. Includes copyrighted material of ISO AA 265 04 09 Properties, Inc., with its permission. Page 1 of 3 PROPEL INSURANCE PAGE 20 OF 22 3. Hired Auto -Physical Damage coverage 5. We will pay under this coverage only that is excess over any other collectible insur- amount of your rental reimbursement ex- anoe. penses which is not already provided for under SECTION III -PHYSICAL DAM- 4. Subject to the above limit, deductible, and AGE COVERAGE, A. Coverage, 4. Cov- excess provisions we will provide cover- erage Extensions. age equal to the broadest coverage appli- cable to any covered "auto" you own of F. Transportation Expense -Higher Limits the private passenger type or light truck SECTION III -PHYSICAL DAMAGE COV- typeinsured under this policy. ERAGE, A. Coverage, 4. Coverage Exten- Coverage includes loss of use of that hired sions is amended by replacing $20 per day auto, provided it results from an "accident" for with $50 per day, and $600 maximum with which you are legally liable and as a result of $1,500 maximum in Extension a. Transpor- which amonetary loss is sustained by the tation Expenses. leasing or rental concern. The most we will pay for any one "accident" is $1,000. G. Airbag Coverage If a limit for Hired Auto -Physical Damage is SECTION III -PHYSICAL DAMAGE COV- shown in the Schedule, then that limit re- ERAGE, B. Exclusions, 3.a. is amended by places, and is not added to, the $35,000 limit adding the following; indicated above. However, the mechanical and electrical break E. Rental Reimbursement down portion of this exclusion does not apply to the accidental discharge of an airbag. This SECTION III -PHYSICAL DAMAGE is coverage for airbags is excess over any other amended by adding the following: collectible insurance or warranty. 1. We will pay for rental reimbursement ex- H. Loan or Lease Gap Coverage penses incurred by you for the rental of a private passenger type "auto" because of 1. SECTION III -PHYSICAL DAMAGE a "loss" to a covered private passenger COVERAGE, C. Limit of Insurance is type auto . Payment applies in addition deleted in its entirety and replaced by the to the otherwise applicable amount of following, but only for private passenger each coverage you have on a covered type "autos" with an original loan or lease, private passenger type "auto". No de- and only in the event of a "total lost' to ductible applies to this coverage. such a private passenger type "auto": 2. We will pay only for those expenses in- a. The most we will pay for "loss" in any curred during the policy period beginning one "acddent" is the greater of: 24 hours after the "loss" and ending, re- The amount due under the terms gardless of the policy's expiration, with of the lease or loan to which the lesser of the following number of your covered private passenger days: type "auto" is subject, but will not a. The number of days reasonably re- include: quired to repair the covered private (a} Overdue lease or loan pay- passenger type "auto". If "loss" is ments; caused by theft, this number of days is added to the number of days it (b} Financial penalties imposed takes to locate the covered private under the lease due to high passenger type "auto" and return it to mileage, excessive use or you; or abnormal wear and tear; b. 30 days. (c) Security deposits not re- funded by the lessor; 3. Our payment is limited to the lesser of the following amounts: (d) Costs for extended warran- ties, Credit Life Insurance, a. Necessary and actual expenses in- Heath, Accident or Disabil- curred; or ity Insurance purchased b. $40 per day. with the loan or lease; and 4. This coverage does not apply while there (e) Carry over balances from are spare or reserve private passenger previous loans or leases, or type "autos" available to you for your op- (2) Actual cash value of the stolen erations. or damaged property. Includes copyrighted material of ISO AA 265 04 09 Properties, Inc., with its permission. Page 2 of 3 PROPEL INSURANCE PAGE Z1 OF ZZ b. An adjustment for depreciation and 2. A partner, if you are a partnership; physical condition will be made in de- termining actual cash value at the 3. An executive officer or insurance man- time of "loss" ager, if you are a corporation; or 2. SECTION V -DEFINITIONS is amended 4. A member or manager, if you area lim- by adding the following, but only for the ited liability company. purposes of this Loan or Lease Gap K. Unintentional Failure to Disclose Hazards Coverage: SECTION IV -BUSINESS AUTO CONDI- "Total loss" means a "loss" in which the TIONS, B. General Condifions is amended cost of repairs plus the salvage value ex- by adding the following: ceeds the actual cash value. If you unintentionally fail to disclose any haz- I. Glass Repair - Waiver of Deductible arils existing on the effective date of this Cov- SECTION III -PHYSICAL DAMAGE COV- erage Form, we will not deny coverage under ERAGE, D. Deductible is amended by adding this Coverage Form because of such failure. the following: L. Mental Anguish Resulting from Bodily In- No deductible applies to glass damage if the 1urY glass is repaired in a manner acceptable to us SECTION V -DEFINITIONS, C. "Bodily in- ratherthanreplaced. jury" is deleted in its entirety and replaced by J. Duties in the Event of an Accident, Claim, the following: Suitor Loss -Amended "Bodily injury" means bodily injury, sickness or SECTION IV -BUSINESS AUTO CONDI- disease sustained by a person, inducting men- TIONS, A. Loss Conditions, 2. Duties in the tal anguish and death sustained by the same Event of Accident Claim Suitor Loss a. is person that results from such bodily injury, amended by adding thefollowing: ~ siclmess or disease. "Bodily injury" does not include mental anguish or death that does not This condition applies only when the "aca- result from bodily injury, sickness or disease. dent" or "loss" is kn~vn to: 1. You, if you are an individual; Includes copyrighted material of ISO AA 265 04 09 Properties, Inc., with its permission. Page 3 of 3 PROPEL INSURANCE PAGE 2Z OF 22 This page has been left blank intentionally. ~~ROPEL INSURANCE PAGE 1 OF 22 ■ ■ : ■ _ ■ ■ To: Fax Number: 5414885311 From: Rubi Chavez-Aguilar Fax Number: 866.577.1326 Company: Propel Insurance Date: May 22, 2017 Subject: 17118 Laurelwood Restaurants Inc -COI City of Ashland Total Pages: 22 Memo: Hello, Attached is the renewal certificate for the above insured. Please let me know if you have any questions. Thank you! Rubi Aguilar on behalf of Sarah Plummer Propel Insurance Account Assistant Commercial Insurance 805 SW Broadway, Suite 2300 Portland, OR 97205-3363 971.352.8542 Direct 866.577.1326 Fax Unrelentingly Unconventional [http.l/www.propelinsurance.com/EMLogos/propel-icon-21x21.png] <http:llwww. propelinsurance.com/> [http://www.propelinsurance.com/EMLogoslpropel-linkedin-r-21 x21.png] <http:/lwww.linkedin.com/companylpropel-insurance> [http://www.propelinsurance.comlEMLogos/propel-twitter-21x21.png] <http:l/twitter.comlPropellns> NOTICE: This communication including any attachments may contain privileged or confidential information. If you are not the intended recipient, or believe that you received this communication in error, please advise the sender immediately and delete or destroy the communication you received without copying or disclosing the contents. Thank you. PROPEL INSURANCE PAGE 2 OF 22 NOTICE: This communication including any attachments may contain privileged or confidential information. If you are not the intended recipient, or believe that you received this communication in error, please advise the sender immediately and delete or destroy the communication you received without copying or disclosing the contents. Thank you.