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HomeMy WebLinkAboutInsurance Certificate: CPS HR Consulting ~ DATE (MMIDDIYYYY) ~ CERTIFICATE OF LIABILITY INSURANCE 6/20/2017 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 endorsements . PRODUCER NAMEACT Heather Crane Edgewood Partners Ins. Center PHONE .916-974-4617 a x License Number- 0629370 E-MAIL @ p PO Box 13847 . heather.crane a icbrokers.com Sacramento CA 95853 INSURERS AFFORDING COVERAGE NAIC # INSURER A :Travelers Propert Casualt Co of A 25674 INSURED COOPPERS INSURER B :Llo ds of London 85202 Cooperative Personnel Services INSURER C DBA: CPS HR Consulting 241 Lathrop Way INSURER D Sacramento CA 95815 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1878704255 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 A DL U POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 6307704A197 71112017 711/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence $500,000 X Deductibile: $0 MED EXP (Any one person) $10,000 PERSONAL&ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ~ JE ~ ~ LOC PRODUCTS -COMP/OP AGG ' $2,000,000 OTHER: $ 171112017 71112018 COMBINED SI~I LE LIMIT ' 000,000 A AUTOMOBILE LIABILITY it Bh7/04A197 Ea accident ANY AUTO BODILY INJURY (Per person) i $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS i X NON-OWNED I Pea ctlenl AMAGE i $ X HIRED AUTOS AUTOS ~ A UMBRELLA LIAB X OCCUR CUP3J482477 711/2017 71112018 EACH OCCURRENCE $6,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $6,000,000 DED X RETENTION $ n/a I~ $ A WORKERS COMPENSATION UB1176A220 71112017 71112018 X AND EMPLOYERS' LIABILITY Y ~ N STATUTE ERH ANY PROPRIETORIPARTNERIEXECUTIVE ❑ E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N 1 A (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 B Prof Liab -Claims Matle W18DC5170301 71112017 711/2018 Per ClaimlAgg $5,000,000 A Retro Date -1011311989 UB1176A220 71112017 7/112018 Deductible Per Claim $75,000 Stop Gap - Only ND, OH, WA, WY DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Additional Insured: City of Ashland, Oregon and its elected officials, officers and employees. When required by written contract, Additional Insured status with primary coverage applies to General Liability and Automobile Liability and Waiver of Subrogation applies to General Liability, Automobile Liability, and Workers' Compensation, all per the attached endorsements. 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 Attn: Kari Olson ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CaMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iti, The nature and location of any injury or this endorsement is primary to "other insu- damage arising out of the "'occurrence" or ante" available to the additional insured offense. which covers that person or organization as a b~ If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following dotlnition is added to SECTION V. i. immediately record the specifics of the -DEFINITIONS: claim or "suit" and the date received; andWritten contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or "suit" as person ar organization as an additional in- sured an this Coverage Part, provided that soon as practicable. the "bodily injury" and '"property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation ar settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insuretl must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ~ 2[}05 The St. Paul Travelers Companies, Inc. CG D2 46 08 X05 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SER~IIDE INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OE COVERAGE -This endorsement broadens coverage. However, coverage far any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded ar limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded ar limited by such an endorsement. The following listing is a general caver- agedescription only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- darsementand the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named insured I. Amended Bodily Injury Definition B. Blanket Additional insured -Broad Farm Vendors J. Bodily injury Ta Co-Employees And Ca-Volunteer C. Damage To Premises Rented To You Workers • Perils of fire, explosion, lightning, smoke, K. Aircraft Chartered With Crew water L. Non-Owned Watercraft -Increased From 25 Feet • Limit increased to $300,000 To 50 Feet D. Blanket Waiver Of Subrogation M. Increased Supplementary Payments E. Blanket Additional Insured -Owners, Managers Cast of bail bands increased to $2,500 Or Lessors Of Premises Loss of earnings increased to $500 per day F. Blanket Additional Insured -Lessors Of Leased N. Knowledge And Native Of Occurrence Or Offense Equipment G. Incidental Medical Malpractice O. Unintentional Omission H. Personal Injury -Assumed By Contract P. Reasonable Farce - Badiiy Injury Or Property Damage PROVISIONS B. BLANKET ADDITIONAL INSURED -BROAD A. BROADENED NAMED INSURED FORM VENDORS The fallowing is added to SECTION II - WNO IS 1. The following is added to SECTION II -WHO AN INSURED: IS AN INSURED: Any person ar organization that is a vendor and Any organization, other than a partnership or that you have agreed in a written contract or joint venture, aver which you maintain owner- agreement to include as an additional insured an ship ar majority interest on the effective date this Coverage Part is an insured, but only with re- af the policy qualifies as a Named Insured. spect to liability far "bodily injury„ ar "property However, coverage far any such organization damage" that: will cease as of the date during the policy pe- a. is caused by an "'occurrence"'that takes place rind that you no longer maintain ownership of, after you have signed and executed that con- armajority interest in, such organization. tract ar agreement; and 2. The fallowing replaces Paragraph 4.a. of b. Arises out of "your products" which .are ds- SECTION II -WHO IS AN INSURED: tributed ar sold in the regular course of such vendor s business. a. Coverage under this provision is afforded only until the 180th day after you acquire The insurance provided to such vendor is subject ar farm the arganizatian or the end of the to the following provisions: policy period, whichever is earlier, unless a. The limits of insurance provided to such ven- reparted in writing to us within 180 days. dar will be the limits which you agreed to pra- CG D4 6l 4713 2Q13 The Travelers Indemnify Ct~mpany. All right reserved, Page 1 of 7 includes copyrighted material of Insurance Services t?iiic~e,lnc. wtifh ifs permission. COMMERCIAL GENERAL LIABILITY 3. The fallowing replaces Paragraph a. of the a. Is "bodily injury" or "property damage'" caused definition of "insured cantract" in the DEFINI- by an "accurrence" that takes place, or "per- TIONS Section: sonal injury" or "advertising injury" caused by a. A cantract for a lease of premises. How- an offense that is committed, after yau have ever, that portion of the contract fora signed and executed that cantract or agree- lease of premises that indemnifies any meat; and person or organization for damage to b. Arises out of the ownership, maintenance ar premises while rented to yau, ar tempo- use of that part of any premises leased to rarity occupied by you with permission of yau. the owner, caused by: The insurance provided to such premises owner, Fire, manager or lessor is subject to the following pro- VISIanS: Explaslan, a, The limits of insurance pravided to such (3) Lightning; premises owner, manager ar lessor will be (4) Smoke resulting from such fire, ex- the limits which you agreed to provide in the plosion, ar lightning; or written contract or agreement, ar the limits (5) Water. shown an the Declarations of this Coverage Part, whichever are less. is not an "insured contract"; b. The insurance pravided to such premises 4. The fallowing replaces Paragraph 4.b.(1)(b) owner, manager or lessor does not apply ta: of SECTION IV -COMMERCIAL GENERAL (1) "Bodily injury" or "property damage" LIABILITY CONDITIONS: caused by an `"accurrence'" that takes (b) That is insurance far premises rented to place, or "personal injury" or "advertising yau, ar temporarily occupied by yau with injury" caused by an offense that is com- the permission of the awner; muted, after you cease to be a tenant in D. BLANKET WAIVER OF SUBROGATION that premises; or The following is added to Paragraph 8., Transfer Structural alterations, new construction ar Of Rights Of Recovery Against Others To Us, demolition operations performed by or on of SECTION IU -COMMERCIAL GENERAL LI- behalf of such premises owner, manager ABILITY CONDITIONS; ar lessor. We waive any right of recovery we may have c~ The insurance provided to such premises awner, manager or lessor is excess aver any against any persan ar organization because of valid and collectible other insurance available payments we make far injury or damage arising to such premises awner, manager ar lessor, out of premises owned ar occupied by or rented unless yau have agreed in a written cantract or loaned to you; ongoing operations performed for this insurance to apply an a primary or by yau or on your behalf, lane under a cantract contributory basis. with that person ar organization; "your work'"; ar F. BLANKET ADDITIONAL INSURED -LESSORS "your products"'. We waive this right where you OF LEASED ECIUIPMENT have agreed to da sa as part of a written cantract, executed by yau prior to loss. The following is added to SECTION li - WNO IS E. BLANKET ADDITIONAL INSURED -OWNERS, AN INSURED: MANAGERS OR LESSORS OF PREMISES Any persan or organization that is an equipment The fallowin is added to SECTION II -WHO IS lessor and that you have agreed in a written ton- g tract or agreement to include as an additional in- AN INSURED: cured an this Coverage Part is an insured, but Any person ar organization that is a premises only with respect to liability for "bodily injury", awner, manager or lessor and that yau have "'property damage" "persanal injury" or "advertis- agreed in a written contract ar agreement to ing injury" chat: name as an additional insured an this Coverage a. Is "bodily injury" or'"property damage caused Part is an insured, but only with respect to liability by an "accurrence" that takes place, ar °per- far bodily injury , property damage , personal canal injury'" or "advertising injury"' caused by injury" or "advertising injury" that: an offense that is committed, after yau have CG D~ ~7 O7 13 ~ 2013 The Travelers Indemnity Company. All right reserved. Page ~ of ~ Includes cc~pyrightetl rnateriaE of Insurance Services Office, Inc. with its permission: GOMMERGIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under GOVERAGE C. for "bodily injury" or "property damage'" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag• or the Products-Gompleted Operations Ag• gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. Hated Project General Aggregate Limit. E. Far the purposes of this endorsement the Defini• G. Part 2. of SEGTION III -LIMITS OF INSURANGE tions Section is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B; and agreement. For the purposes of detem~ining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION Ij and for all "projec#" that includes premises involving the medical expenses caused by accidents same or connecting tats, or premises whose con- under COVERAGE C (SECTION I~ which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated "project" shown in the considered a single "project". SCHEDULE above. F. The provisions of SEGTION III LiMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard° is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, ZOg4 GG D211 11104 COMMERCIAL AUTO THIS Et~DOI~SEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL IN~UR~D - PRIMACY AND NON~~ONTRIBUTORY WITH OTHER INSIJ~AN~E This endorsement modifies insurance provided under the following:, BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph 8.5., Other 1. The fallowing is added to Paragraph A.1.c., Who Insurance of SECTION IV -BUSINESS AUTO Is An Insured, of SECTION ll -COVERED CONDITIONS: AUTOS LIABILITY COVERAGE. Regardless of the provisions of paragraph a. and Any person or organization who is required under paragraph d. of this part 5.Other Insurance, this a written contract ar agreement between you and insurance is primary to and non-contributory with that person or organization, that is signed and applicable other insurance under which an addi- executed by you before the "bodily injury" or tional insured person or organization is the first "property damage"' occurs and that is in effect named insured when the written contract or during the policy period, to be named as an addi- agreement between you and that person or or- tianal insured is an "insured" for Covered Autos ganizatian, that is signed and executed by you Liability Coverage, but only for damages to which before the "bodily injury" or "property damage„ this insurance applies and only to the extent that person or organization qualifies as an "insured" occurs and that is in effect during the policy pe- under the ~ltlho Is An Insured provision contained rind, requires this insurance to be primary and in SECTION ll. non-contributory: CA T4 74 15 ~ 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes ~copyrighled material of Insurance Services b#fce, Inc. pith i#s permission. yIIC~R~~ERS CC}MPEIVSATIaN ~~~~F~~~'~ ~ AND oxs Tow~R s~uAR~ EMPLOYERS I.IABII.ITY POLICY fiARTF~RD, CT 4613 ENDORSEMENT WC 99 03 76 ( A~ - 001 POLICY NUMBER: {PJUB-11~~A22-0-170 111IAIVER R~~IT TC? REG~4'VER ~Rt~M CJTHE~S ~~I~C3~tSEMEN~`-C~41aF'tJ~~VIA~ ~BI.~►NK~~' ~A[V~R~ 1Ne have the right to recover our payments from anyflne liable far an injury covered by this policy We will neat enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall b~ 05 , 00 °l~ of the California workers" Compensation pre- miUt71. SChedUle Person ar Or~~nizatlon Job Description ANY PERSON OR tJRGANI2ATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, The information below is required only when this endorsement is issued subsequent to preparation of the pollcy.} Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company countersigned by DATE OF ISSUE: 71112017 ST ASSIGN: Page 1 of 1 W't?RKERS CC3MPENSATIt~N T~~Y ~ AND oxs To~R s~u~s EMPLOYERS LIABILITY POLICY >~FO~, cT ENDQRSEMENT WC 43 03 05 #44~ PCJLICY NUMBER: iPJUH-1176A22.0-179 UTAH WAIVES 5U8RC~GATI~N ENDt~RSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A.of the Information Pale. We have the right to recover our payments from anyone liable for an injury covered by this policy. Vile will not enforce our right against the person or organization Warned in the Schedule. `his agreement applies only to the extent that you perform work under a written contract that rewires you to obtain this agreement from us.) This agreement shall npt orate directly or indirectly to benefit anyone not named in the Schedule.. fur waiver of rights does not release your employees' .rights against third parties and does not release our authority as trustee of claims against third parties. Schedule Designated Person: Designated Organization:. A~'1' PERS{~N OR 4RGA~NIZATIt9N Ri~R WIiICC~II THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS Tfl FURNISH THIS WAIVER. DATE OF ISSUE; ?1112017 ST ASSIGN; Page 1 of 1