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HomeMy WebLinkAboutInsurance Certificate: Pacific Electrical Contractors PROPEL INSURANCE PAGE 3 OF 24 Client#:175583 PACIELEC3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDJYYYY) 0612112017 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 NAMEACT Marcia Hawkins Propel Insurance PHONE 54194-7731 FaX 866 577-1326 {AlC, No, Ext): (A/C, No): Medford Commercial Insurance E~u1AIL marcia.hawkins ro elinsurance.com ADDRESS; ~p p P 0 Box 936 INSURER(S) AFFORDING COVERAGE NAIC ~ Medford, OR 97501 INSURERA:CincinnatilnsuranceCompany 10677 INSURED INSURER B :Ace American Insurance Company 22667 Pacific Electrical Contractors Inc INSURER C dba ORPAC Systems INSURER D ; 920 S. Grape St. INSURER E Medford, OR 97501-3631 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 LTR INSR WVD POLICY NUMBER (MM1DDlYYYY) (MM/DDlYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EPP0260135 7101!2017 0710112018 EACH accuRRENCE $1,000,000 CLAIMS~VIADE D OCCUR PREMISESOEa oNcurrDence $ 500,000 X PD Ded $500 I~~ED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~PRO- n PRODUCTS - COMPlOP AGG $ 2,000,000 POLICY I ~I JECT II LOC OTHER $ AUTOMOBILE LIABILITY EBA0260135 710112017 0710112018 Ea agadeDtsINGLE LIMIT $1,000,000 A BODILY INJURY (Per person) $ X ANY AUTO ALL GW1~ED SCHEDULED BODILY INJURY (Peraccitlent) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OVMJED Per accident HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR EPP0260135 710112017 0710112018 EACH OCCURRENCE $5 000 OOO EXCESS LIAB CLAIMS-MADE AGGREGATE $S,000,OOO DED RETENTION $ InCI. EL $ WORKERS COMPENSATION PER ~ OTH- AND EMPLOYERS' LIABILITY Y f N STATUTE ER ANY PROPRIETORlPARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N!A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Professional Liab TBD 711512017 0711512018 ClaimlAggr. $2,000,000* Contractors Incident - $1,000,000 Pollution A re ate - $1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) *$10,000 SIR; Claims Made Form Retroactive Date: 03!19!08 RE: Ashland Booster Pump Station Integration CERTIFICATE HOLDER CANCELLATION Cit of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE UVILL BE DELIVERED IN 20 East Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Vim' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014!01) 1 of 1 The ACORD name and logo are registered marks of ACORD #527577231M2757676 MMJ00 PROPEL INSURANCE PAGE 4 OF 24 This page has been left blank intentionally. PROPEL INSURANCE PAGE 5 OF 24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A Endorsement - Table of Contents: Covera e: Beg ins on Page: 1. Employee Benefit Liability Coverage ..................................................................................................2 2. Unintentional Failure to Disclose Hazards .........................................................................................8 3. Damage to Premises Rented to You .................................................................................................8 4. Supplementary Payments ..................................................................................................................9 5. Medical Payments . ..............10 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) ......................................................................................................10 7. 180 Day Cc~erage for Newly Formed or Acquired Organizations ...................................................10 8. Waiver of Subrogation .....................................................................................................................10 9. Automatic Additional Insured -Specified Relationships :.................................................................11 X Managers or Lessors of Premises; X Lessor of Leased Equipment; x Vendors; X State or Political Subdivisions -Permits Relating to Premises; X State or Political Subdivisions -Permits; and X Contractors' Operations 10. Broadened Contra~ual Liability-Work Within 50' of Railroad Property ..........................................16 11. Property Damage to Borrowed Equipment ......................................................................................16 12. Employees as Insureds -Specified Health Care Services :.............................................................16 X Nurses; X Emergency Medical Technicians; and X Paramedics 13. Broadened Notice of Occurrence .....................................................................................................16 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, 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 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrightedmaterial of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 1 of 16 PROPEL INSURANCE PAGE 6 OF 24 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b,} Limits of Insurance (Each Occurrence} Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000} $5,000} (c) Gross Sales (d} Units (e) Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM $ 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10, 000 Deductible: $ 250 C. Coverages: 2) Our right and duty to 1. Employee Benefit Liability Coverage defend ends when we a. The followin is added to SECTION I have used up the appli- g cable limit of insurance - COVERAGES: Employee Benefit in the payment of Liability Coverage- judgments or settle- (1) Insuring Agreement ments. (a) We will pay those sums that No other obligation or liabil- the insured becomes legally ity to pay sums or perform obligated to pay as dam- acts or services is covered ages caused by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pad sured, or of any other per- ments. son for whose acts the in- (b) This insurance applies to sured is legally liable, to damages only if the act, er- which this insurance ap- ror or omission, is negli- plies. We will have the right gently committed in the and duty to defend the in- "administration" of your sured against any "suit" "employee benefit program"; seelang those damages. and However, we will have no duty to defend against any 1) Occurs during the pol- "suit" seelang damages to icy period; or which this insurance does not apply. We may, at our 2) Occurred prior to the discretion, investigate any effective date of this report of an act, error or endorsement provided: omission and settle any a) You did not have claim or "suit" that may re- knowledge of a sult. But: claim or "suit' on 1) The amount we will pay or before the ef- for damages is limited fective date of this as described in SEC- endorsement. TION III -LIMITS OF You will be INSURANCE; and deemed to have Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 2 of 16 PROPEL INSURANCE PAGE 7 OF 24 la~owledge of a 1) Failure of any invest- claim or "suit" ment to perform; when any "author- ized represents- 2) Errors in providing in- tive"; formation on past per- formance of investment i) Reports all, or vehicles; or any part, of the act, error or 3) Advice given to any omission to us person with respect to or any other that person's decision insurer; to participate or not to participate in any plan ii) Receives a included in the "em- written or ver- ployee benefit pro- bal demand or gram". claim for dam- ages because (f} Workers' Compensation of the act, error and Similar Laws or omission; Any daim arising out of your and failure to comply with the b} There is no other mandatory provisions of any applicable insur- workers' compensation, un- ance. employment compensation insurance, social security or (2} Exclusions disability benefits law or any similar law. This insurance does not apply to: (a) Bodily Injury, Property (g} ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fidud- "Bodily injury", "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury!'. Act of 1974, as now or (b} Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any intentional, dishonest, (h) Available Benefits fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent thatsuch benefits are committed by any insured, available, with reasonable including the willful or reck effort and cooperation ofthe less violation of any statute. insured, from the applicable (c) Failure to Perform aCon- funds accrued or other ool- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, track by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local laW insufficiency of funds to meet any obligations under (j) Employment-Related any plan included in the Practices "employee benefit program". Any liability arising out of (e} Inadequacy of Perform- any: ance of Investment I Ad- (1) Refusal to employ; vice Given With Respect to Participation (2) Termination of ern- ployment; Any claim based upon: Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 3 of 16 PROPEL INSURANCE PAGE 8 OF 24 (3} Coercion, demotion, tors are insureds, but only evaluation, reassign- with respect to their duties ment, discipline, defa- as your officers or directors. rnation, harassment, Your stockholders are also humiliation, discrimina- insureds, but only with re- tion or other employ sped to their liability as ment-related practices, stockholders. acts or omissions; or (e) A trust, ynu are an insured. (4) Consequential liability Your trustees are also in- as aresult of (1), (2) or sureds, but only with respect (3}above. to their duties as trustees. This exclusion applies (2) Each of the following is also an whether the insured may be insured: held liable as an employer or in any other capacity and (a} Each of your "employees" to any obligation to share who is or was authorized to damages with or repay administer your "employee someone else who must benefit program". pay damages because of (b) Any persons, organizations the injury. or "employees" having (3} Supplementary Payments proper temporary authoriza- tion to administer your "em- SECTION I -COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS - COVERAGES A AND legal representative is ap- Balso apply to this Coverage. pointed. b. Who is an Insured (c} Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- sped to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its entirety have all your rights and du- and replaced bythe following: ties under this Coverage (1) If you are designated in the Dec- Part. larations as: (3} Any organization you newly ac- (a} An individual, }~u and your quire or form, other than apart- spouse are insureds, but nership, joint venture or limited only with Arespect to the con- liability company, and over which duct of a business of which ynu maintain ownership or rna- you are the sole owner. jority interest, will qualify as a Named Insured if no other simi- (b) Apartnership or joint ven- lar insurance applies to that or- ture, you are an insured. ganization. However, coverage Your members, your part- under this provision: Hers, and their spouses are also insureds but only with (a) Is afforded only until the respect to the induct of 180th day after you acquire your business. or form the organization or the end of the policy period, (c) A limited liability company, whichever is earlier; and yeu are an insured. Your members are also insureds, (b} Does not apply to any act, but only with respect to the error or omission that was conduct of your business. committed before you ac- Your managers are insur- quired or formed the organi- eds, but only with respect to zation. their duties as your manag- c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d} An organization other than a ity Coverage, SECTION III -LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limitedliability company, you tirety and replaced bythe following: are an insured. Your "ex- ea~tive officers" and direc- Includescopyrighted material of Insurance GA233 OR 0910 Services Office, Inc., with its permission. Page4 of 16 PROPEL INSURANCE PAGE 9 OF 24 (1 } The Limits of Insurance shown in amount stated in the Decla- Sec~ion B. Limits of Insurance, rations as applicable to 1. Employee Benefit Liability Each Employee. The limits Coverage and the rules below of insurance shall not be re- fix the most we will pay regard- duped by the amount of this less of the number of: deductible. (a) Insureds; (b) The deductible amount stated in the Declarations (b} Claims made or "suits" applies to all damages sus- brought; twined by any one "em- (c) Persons or organizations ployee", including such making claims or bringing "employee's" dependents "suits"; and beneficiaries, because of all acts, errors or omis- (d) Acts, errors or omissions; or sions to which this insur- ance applies. (e) Benefits included in your "employee benefit prograrn". (c) The terms of this insurance, including those with respect (2) The Aggregate Limit shown in to: Section B. Limits of Insurance, 1. Employee Benefit Liability 1) our right and duty to Coverage of this endorsement is defend the insured the most we will pay for all darn- against any "suits" ages because of acts, errors or seelang those darn- omissions negligently committed ages; and in the "administration" of your "employee benefit program". 2) Your duties, and the duties of any other in- (3) Subject to the limit described in volved insured, in the (2} above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission, or claim, of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of this endorsement is the most we plication of the deductible will pay for all damages sus- amount. twined by any one "employee", (d) VVe may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficaries, as a result of: claim or "suit" and, upon no- (a} An act, error or omission; or tification of the action taken, you shall promptly reim- (b) A series of related acts, er- burse us for such part of the tors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such acts, errors or omissions, d. Additional Conditions negligently committed in the As respects Employee Benefit Li- "administration" of your "em_ ability Coverage, SECTION IV - COMMERCIAL GENERAL LIABIL- ployee benef~ program . ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- ceed, and will be subject to the (1) Item 2. Duties in the Event of limits and restrictions that apply Occurrence, Offense, Claim or to the payment of benefits in any Suit is deleted in its entirety and plan included in the "employee replaced by the following: benefit program"_ 2. Duties in the Event of an (4) Deductible Amount Act, Error or Omission, or Claim or Suit (a} Our obligation to pay dam- ages on behalf of the in- a. You must see to it that sured applies only to the we are notified as soon amount of damages in ex- as practicable of an a~, cess of the deductible error or omission which Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 5 of 16 PROPEL INSURANCE PAGE 10 OF 24 may result in a claim. surance may also To the extent possible, apply. notice should include: d. No insured will, except (1) What the act, error at that insured's own or omission was cost, voluntarily make a and when it oc- payment, assume any curred; and obligation, or incur any (2) The names and copsent v+nthout our addresses of and one who may suf- (2) Item 5. Other Insurance is de- fer damages as a leted in its entirety and replaced result of the act, by the following: error or omission- 5. Other Insurance b. If a daim is made or "suit" is brought against If other valid and collectible any insured, you must: insurance is available to the insured for a loss we cover (1) Immediately re- under this Coverage Part, cord the specifics our obligations are limited of the claim or as follows: "suit" and the date received; and a. Primary Insurance (2) Notify us as soon This insurance is pri- aspracticable. many except when c. below applies. If this in- You must see to it that surance is primary, our we receive written no- obligations are not af- tice of the daim or fectetl unless any of the "suit" as soon as practi- other insurance is also cable. primary. Then, we will share with all that other c. You and any other in- insurance by the volved insured must: method described in b. (1) Immediately send below. us copies of any b. Method of Sharing demands, notices, summonses or le- If all of the other insur- gal papers re- ante permits contribu- ceived in connec- tion by equal shares, tion with the claim we will follow this or "suit"; method also. Under this approach each insurer (2) Authorize us to ob- contributes equal tain records and amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of whichever comes first. the claim or de- If any of the other in- fense against the surance does not per- "suit"; and mit contribution by (4) Assist us, upon equal shares, we will our request, in the contribute by limits. enforcement of Under this method, any right against each insurer's share is any person or or- based on the ratio of its ganization which applicable limit of in- may be liable to surance to the total ap- the insured be- pliable limits of insur- ance ofall insurers. cause of an act, error or omission c. No Coverage to which this in- Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 6 of 16 PROPEL INSURANCE PAGE 11 OF 24 This insurance shall not providing some or all of the cover any loss for followir~ benefits to "em- which the insured is en- ployees", whether provided titled to recovery under through a "cafeteria plan" or any other insurance in otherwise: force previous to the ef- fective date of this a. Group life insurance; Coverage Part. group accident or health insurance; den- e. Additional Definitions tal, vision and hearing As res ects Em to ee Benefit Li- plans; and flexible P P Y spending ac~unts; ability Coverage, SECTION V - provided that no one DEFINITIONS is amended as fol- other than an "em- lows: ployee" may subscribe (1) The following definitions are to such benefits and added: such benefits are made generally available to 1. "Administration" means: those "employees" who a. Providing information to satisfy the plan's eligi- bility requirements; "employees", including their dependents and b. Profit sharing plans, beneficiaries, with re- employee savings spec# to eligibility for or plans, employee stock scope of "employee ownership plans, pen- benefit programs"; sion plans and stock b. Inter retin the "ern- subscription plans, pro- p g vided that no one other ployee benefit pro- than an "employee" grams"; may subscribe to such c. Handling records in benefits and such connection with the .benefits are made gen- "employee benefit pro- erally available to all grams"; or employees who are eligible under the plan d. Effecting, continuing or for such benefits; terminating any "em- ployee's" partidpation c. Unemployment insur- in any benefit included anoe, social security in the "employee bene- benefits, workers' com- fitprogram". pensation and disability benefits; and However, "administration" does not include: d. Vacation plans, includ- ing buy and sell pro- s, Handling payroll deduc- grams; leave of ab- tions; or sen~ programs, in- b. The failure to effect or cluding military, mater- nity; family, and civil maintain any insurance leave; tuition assistance or adequate limits of plans; transportation coverage of insurance, and health club subsi- including but not limited dies. to unemployment in- surance, social security (2) The following definitions are de- benefits, workers' com- leted in their entirety and re- pensation and disability placed by the following: benefits. 21. "Suit" means a civil pro- 2. "Cafeteria plans" means ceeding in which money plan authorized by applica- damages because of an ac#, ble law to allcxv "employees" error or omission to which to elect to pay for certain this insurance applies are benefits with pre-tax dollars. alleged. "Suit" includes: 3. "Employee benefit pro- a. An arbitration proceed- grams" means a program ing in which such dam- Includescopyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 7 of 16 PROPEL INSURANCE PAGE 12 OF 24 ages are claimed and The exdusions under SECTION to which the insured I -COVERAGES, COVERAGE must submit or does A BODILY INJURY AND submit with our con- PROPERTY DAMAGE LIABIL- sent; ITY, 2. Exclusions, other than i. b. Any other alternative War and the Nuclear Energy Liability Exclusion, are deleted dispute resolution pro- and the following are added: ceeding in which such damages are claimed This insurance does not apply to: and to which the in- sured submits with our (a) "Property damage": consent; or 1) Assumed in any con- c. An appeal of a civil pro- track; or ceeding. 2) Loss caused by or re- 8. "Employee" means a person suiting from any of the actively employed, formerly following: employed, on leave of ab- a) Wear and tear; sense or disabled, or re- tired. "Employee" includes a b) Rust, corrosion, "leased worker". "Employee" fungus, decay, de- does not include a "tempo- terioration, hidden rary worker". or latent defect or 2. Unintentional Failure to Disclose Haz- any quality in ands property that causes it to dam- SECTION IV -COMMERCIAL GENERAL age or destroy it- LIABILITY CONDITIONS, 7. Represen- self; tations is hereby amended by the addi- c) Smog; tion of the following: Based on our de endence u on ur re - d) Mechanical break p p ~ p down including resentations as to existing hazards, if un- rupture or bursting intentionally ybu should fail to disdose all caused by cen- such hazards at the inception date of your trifugal force; policy, we will not reject coverage under this Coverage Part based solely on sudl e) Settling, cracking, failure. shrinking or ex- 3. Damage to Premises Rented to You pansion; or a. The last Subparagraph of Paragraph f) Nesting or infesta- 2. SECTION I -COVERAGES, tion, or discharge COVERAGE A -BODILY INJURY or release of waste AND PROPERTY DAMAGE, 2. LI- products or secre- tions, by insects, ABILITY Exclusions is hereby de- birds, rodents or leted and replaced bythe following: other animals. Exclusions c, through q, do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follaw- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, vdcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; TION I -COVERAGES, COVERAGE Q BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflowsfrom a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented tp and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in Para- through: graph 3.b. above: Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 8 of 16 PROPEL INSURANCE PAGE 13 OF 24 a} Foundations, one "occurrence" to which walls, floors or this insurance applies. paved surfaces; (3) The amount we will pay is limited b) Basements, as described in Section B. Lim- whether paved or its of Insurance, 3. Damage to not; or Premises Rented to You of this endorsement. c) Doors, windows or other openings. 4. Supplementary Payments (c) Loss caused by or resulting Under SECTION I -COVERAGE, SUP- from water that leaks or PLEMENTARY PAYMENTS - COVER- flcNVS from plumbing, heat- AGES A AND B: ing, air conditioning, or fire protection sy~ems caused a. Paragraph 2, is replaced by the fol- by or resulting from freezing, lowing: unless: Up to the limit shown in Section B. 1) You did your best to Limits of Insurance, 4.a. Bail Bonds maintain heat in the of this endorsement for cost of bail building or structure; or bonds required because of accidents or traffic law violations arising out of 2) You drained the equip- the use of any vehicle to which the ment and shut off the Bodily Injury Liability Coverage ap- water supply if the heat plies. We do not have to furnish was not maintained. these bonds. (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- lowing: 1) Plumbing, heating, air conditioning, fire pro- All reasonable expenses incurred by tection systems, or the insured at our requestto assist us other equipment or ap- in the investigation or defense of the pliances; or claim or "suit", including actual loss of earnings up to the limit shown in Sec- t) The interior of any tion B. Limits of Insurance, 4.b. building or structure, or Loss of Earnings of this endorsement to personal property in per day because of time off from the building or structure work. caused by or resulting from rain, snow, sleet 5. Medical Payments or ice, whether driven by wind or not. The Medical Expense Limit of Any One Person as stated in the Declarations is c. Limit of Insurance amended to the limit shown in Section B. The Dama e to Premises Rented to Limits of Insurance, 5. Medical Pay- g ments of this endorsement. You Limit as shown in the Dedara- tionsisarnended asfollows: 6. Voluntary Property Damage and Care, (2) Paragraph 6. of SECTION III - Custody or Control Liability Coverage LIMITS OF INSURANCE is a. Voluntary Property Damage Cov- hereby deleted and replaced by erage the fdlowing: We will pay for "property damage" to 6. Subject to 5. above, the property of others arising out of op- Damage to Premises erations incidental to the insured's Rented to You Li rnit is the business when: most we will pay under COVERAGE A. BODILY (1) Damage is caused by the in- INJURY AND PROPERTY sured; or DAMAGE LIABILITY, for (2) Damage occurs while in the in- damages because of "prop- sured's possession. erty damage to premises while rented to you or tern- With your consent, we will males porarily occupied by you these payments regardless of fault. with permission of the owner, arising out of any Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 9 of 16 PROPEL INSURANCE PAGE 14 OF 24 b. Care, Custody or Control Liability deductible amount as has been Coverage paid by us. SECTION I -COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or ERAGE A. BODILY INJURY AND Acquired Organizations PROPERTY DAMAGE LIABILITY, 2. SECTION II -WHO IS AN INSURED is Exclusions, j. Dama a to Property, amended as follows: Subparagraphs (3), (4~ and (5} do not apply to "property damage" to the Subparagraph a. of Paragraph 4. is property of others described therein. hereby deleted and replaced by the fol- With respect to the insurance provided by lowing: this section of the endorsement, the fol- a, Insurance under this provision is af- lowingadditional provisions apply: forded only until the 180th day after a. The Limits of Insurance shown in the ynu acquire or form the organization Declarations are replaced by the lirn- or the end of the policy period, its designated in Section B. Limits of whichever is earlier; Insurance, 6. Voluntary Property 8, Waiver of Subrogation Damage and Care, Custody or Control Liability Coverage of this SECTION IV -COMMERCIAL GENERAL endorsement with respect to cover- LIABILITY CONDITIONS, 9. Transfer of age provided by this endorsement. Rights of Recovery Against Others to These limits are inclusive of and not Us is hereby amended by the addition of in addition to the limits being re- the following: placed. The Limits of Insurance shown in Section B. Limits of Insur- We waive any right of recovery we may ance, 6. Voluntary Property Dam- have because of payments we make for age and Care, Custody or Control injury or damage arising out of your ongo- Liability Coverage of this endorse- ing operations or "your work" done under ment fix the most we will pay in any a written contract requiring such waiver with that person or organization and in- one occurrence regardless of the number of: cluded in the "products-completed opera- tions hazard". However, our rights may (1) Insureds; only be waived prior to the "occurrence" giving rise to the injury or damage for (2) Claims made or suits brought; which we make payment under this Cov- or erage Part. The insured must do nothing (3) Persons or organizations making after a loss to impair our rights. At our re- claims or bringing "suit'. quest, the insured will bring "suit" ortrans- ferthose rights to us and help us enforce b. Deductible Clause those rights. (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- on your behalf appliesonlytothe fled Relationships amount of damages for each "occurrence" which are in excess a. The following is hereby added to of the deductible amount stated SECTION II -WHO IS AN INSURED: in Section B. Limits of Insur- (1) Any person or organization de- ance, 6. Voluntary Property saibed in Paragraph 9.a.(2) be- Damage and Care, Custody or low (hereinafter referred to as Control Liability Coverage of additional insured) whom you are this endorsement. The limits of required to add as an additional insurance will not be reduced by insured under this Coverage Part the application of such deducti- by reason of: ble amount. (2} Condition 2. Duties in the Event (a} A ntttoe~ contract or agree- m , of Occurrence, Offense, Claim or Suit, applies to each claim or (b} An oral agreement or con- "suit"irrespective of the amount. track where a certificate of insurance showing that per- (3) We may pay any part or all of the son or organization as an deductible amount to effect set- additional insured has been Clement of any claim or "suit" issued, and, upon notification of the ac- tiontaken, you shall promptly re- is an insured, provided: imburse us for such part of the Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 10 of 16 PROPEL INSURANCE PAGE 15 OF 24 (a} The written or oral contract or use of equipment leased or agreement is: to you by such person(s) or 1 Current) in effect or organizations(s). However, y this insurance does not ap- becomes effective dur- ply to any "occurrence" ing the policy period; which takes place after the and equipment lease expires. 2} Executed prior to an (c) Any person or organization "occurrence" or offense (referred to below as ven- to which this insurance clot) with whom you have would apply; and agreed per Paragraph (b) They are not specifically 9.a.(1 }above to provide in- named as an additional in- surance, but only with re- sured under any other pro- sped to "bodily injury" or vision of, or endorsement "property damage" arising added to, this Coverage out of "your products" which Part. are distributed or sold in the regular course of the ven- (t) Only the following persons or or- dot's business, subject to ganizations are additional insur- the following additional ex- edsunder this endorsement, and clusions: insurance coverage provided to such additional insureds is lirn- 1) The insurance afforded ited as provided herein: the vendor does not apply to: (a} The manager or lessor of a premises leased to ynu with a) "Bodily injury" or whom you have agreed per "property damage" Paragraph 9.a.(1 }above to for which the ven- provide insurance, but only dot is obligated to with respec# to liability aris- pay damages by ing out of the ownership, reason of the as- rnaintenance or use of that sumption of liability part of a premises leased to in a contract or you, subject to the following agreement. This additional exclusions: exclusion does not apply to liability for This insurance does not ap- damages that the ply to: vendor would have in the absence of 1 } Any "occurrence" which the oontrac~ or takes place after you agreement; cease to be a tenant in that premises. b} Any express war- ranty unauthorized 2) Structural alterations, by you; new construction or demolition operations c) Any physical or performed by or on be- chemical change half of such additional in the product insured. made intentionally (b} Any person or organization by thevendor; from which you lease d) Repackaging, ex- equipment with whom you cept when un- have agreed per Paragraph packed solely for 9.a.(1 }above to provide in- the purpose of in- surance. Such person(s) or spec~ion, demon- organization(s) are insureds, stration, testing, or but only to the extent that the substitution of the liabilityfor "bodily injury'; parts under in- "property damage" or "per- structions from the sonal and advertising injury" manufacturer, and is caused by your negli- then repackaged Bence, acts or omissions in in the original con- the maintenance, operation tainer; Includes copyrighted material of Insurance GA 233 OR 4910 Services Office, Inc., with its permission. Page 11 of 1G PROPEL INSURANCE PAGE 16 OF 24 e) Any failure to Part with respect make such inspec- to such products. bons, adjustments, tests or servicing (d} Any state or political subdi- as the vendor has vision with which you have agreed to males or agreed per Paragraph normally under- 9.a.(1 }above to provide in- takes to make in surance, subject to the fol- theusual course of lowing additional provision: business, in con- This insurance applies only nection with the with respect to the following distribution or sale hazards for which the state of the products; or political subdivision has f) Demonstration, in- issued a permit in connec- stallation, servicing Lion with premises you own, or repair opera- rent or control and to which bons, except such this insurance applies: operations per- 1) The existence, mainte- formed at the ven- Hance, repair, construc- dor's premises in tion, erection, or re- connection with moval of advertising the sale of the signs, awnings, cano- product; pies, cellar entrances, g) Products which, coal holes, driveways, after distribution or manholes, marquees, sale by you, have hoist away openings, been labeled or re- sidewalk vaults, street labeled or used as banners, or decorations a container, part or and similar exposures; ingredient of any or other thing or sub- 2) The construction, erec- stance by or for tion, or removal of ele- thevendor; or vators; or h) "Bodily injury" or 3) The ownership, main- . "property damage" tenanoe, or use of any arising out of the elevators covered by negligence, acts or this insurance. omissions of the vendor, its em- (e} Any state or political subdi- ployees or anyone vision with which you have else acting on its agreed per Paragraph behalf. 9.a.(1 }above to provide in- 2 This insurance does not surance, subject to the fol- lowing provisions: apply to any insured person or organization: 1 } This insurance applies a From whom ou only with respect to op- y erations performed by have acquired you or on your behalf such products, or for which the state or any ingredient, political subdivision has part or container, issued a permit. entering into, ac- companying or 2) This insurance does not containing such apply to "bodily injury" products; or "property damage" or "personal and advertis- b) When liability in- ing injury" arising out of cluded within the operations performed "products- for the state or political completed opera- subdivision. bons hazard" has been excluded un- (fl For "your worK' performed der this Coverage in Oregon, any person or Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 12 of 16 PROPEL INSURANCE PAGE 17 OF 24 organization with which you (a} Subparagraphs (e), (f) and have agreed per Paragraph (g) do not apply to "bodily in- 9.a.(1)above to provide in- jury!' or "property damage" surance, but only to the ex- included within the "prod- tent that the liability is ucts-completed operations caused by "your work' per- hazard"; formed for that additional in- sured and only to the extent (b) Subparagraphs (a), (d}, (e} that such liability is caused and (g} do not apply to "bod- by your negligence or the ily injury", "property dam- negligence of those acting age" or "personal and ad- on your behalf. A person or vertising injury" arising out organization's status as an of the sole negligence or insured under this provision willful misconduct of the ad- of this endorsement contin- ditional insured or its "em- ues for only the period of ployees"; or time required by the written (c} Subparagraph (fl and (g} do contract or agreement, but not apply to bodily injury , in no event beyond the expi- "property damage" or "per- ration date of this Coverage Part. If there is no written sonal and advertising injury arising out of: contract or agreement, or if no period of time is required 1) The rendering of, or by the written contrac# or failure to render, any agreement, a person or or- professional services ganization's status as an in- by you or on your be- sured under this endorse- half, but only with re- ment ends when your op- sped to either or both erations for that insured are of the following opera- completed. tions: (g} For "your worK' performed a) Providing engi- in the "coverage territory" neering, architec- but not in Oregon, any per- tural or surveying son or organization with services to others; which you have agreed per and Paragraph 9.a.(1 } above to b Providin or hirin provide insurance, but only } g, g with respect to liability aris- independent pro- ing out of "your work" per- fessionals to pro- formed for that additional in- vide, engineering, sured by you or on your be- architectural or half. A person or organiza- surveying services tion's status as an insured in connection with under this provision of this construction work endorsement continues for ynu perform. only the period of time re- 2} Subject to Paragraph 3} quired by the written con- below, professional track or agreement, but in no services include: event beyond the expiration date of this Coverage Part. a) Preparing, approv- Ifthere is no written contract ing, or failing to or agreement, or if no period prepare or ap- of time is required by the prove, maps, shop written contract or agree- drawings, opin- ment, aperson or organiza- ions, reports, sur- tion's status as an insured vey~ field orders, under this endorsement change orders, or ends when your operations drawings and for that insured are corn- spedfications; and pleted. b) Supervisory or in- (3) Any insurance provided to an spec~ion activities additional insured designated performed as part under Paragraph 9.a.(2): of any related ar- Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 13 of 16 PROPEL INSURANCE PAGE 18 OF 24 chitectural or engi- primary to other insurance neering activities. available to the additional 3) .Professional services insured except: do not indude services 1) As otherv+nse provided within construction in SECTION IV - means, methods, tech- COMMERCIAL GEN- niques, sequences and ERAL LIABILITY procedures employed CONDITIONS, 5. by you in connection Other Insurance, b. with construction work Excess Insurance; or you perform. 2) For any other valid and (d) Subparagraphs (f} and (g} collectible insurance do not apply to "bodily in- available to the addi- jury' or "property damage" tional insured as an ad- arising out of "yourwork' for ditional insured by at- which aconsolidated (wrap- tachment of an en- up) insurance program has dorsement to another been provided by the prime insurance policy that is contractor /project manager written on an excess or owner of the construction basis. In such case, the project in which you are in- coverage provided un- volved. der this endorsement b. Only with regard to insurance pro- shall also be excess. vided to an additional insured desig- (2) Condition 11. Conformance to Hated under Paragraph 9.a.(2) Sub- Specific Written Contract or paragraphs (f) and (g} above, SEC- Agreement is herebyadded: TION III - LIMITS OF INSURANCE is amended to include: 11. Conformance to tpecifo~ Written Contra The limits applicable to the additional Agreement insured are those specified in the written contract or agreement or in a. With respect to addi- the Declarations of this Coverage tional insureds de- part, whichever are less. If no limits scribed in Paragraph are speafied in the written contract or 9.a.(2Xf) above only: agreement, or if there is no written If a written contract or contract or agreement, the limits ap- agreement between pliable to the additional insured are you and the additional those specified in the Declarations of insured specifies that this Coverage Part. The limits of in- coverage for the addi- surance are inclusive of and not in tional insured: addition to the limits of insurance shown in the Dedarations. (1 } Be provided by the c. SECTION IV -COMMERCIAL GEN- Insurance Ser- vices Office addi- ERAL LIABILITY CONDITIONS is tional insured form hereby amended as follows: number CG 32 61, (1) Condition 5.Other Insurance is CG 32 62 or CG amended to include: 3263; or (a} Where required by a written (2) Include coverage contract or agreement, this for completed op- insurance is primaryand / or erations; or noncontributory as respects (3) Include coverage any other insurance policy for "your work"; issued to the additional in- sured, and such other in- and where the limits or surance policy shall be ex- coverage provided to cess and / or noncontribut- the additional insured is ing, whichever applies, with more restrictive than this insurance. was specifically re- b Any insurance rovided b quired in that written p y contract or agreement, this endorsement shall be the terms of Para- Includescopyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 14 of 16 PROPEL INSURANCE PAGE 19 OF 24 graphs 9.a.(3}(a) or 9.b. agreement species above, or any oombina- the Insurance Services tion thereof, shall be in- .Office additional in- terpreted as providing sured form number CG the limits or coverage 20 10 but does not required bythe terms of speafywhich edition, or the written contract or speafies an edition that agreement, but only to does not exist, Para- theextent that such lirn- graphs 9.a.3.b. and its or coverage is in- 9.b. of this endorse- - cluded within the terms ment shall not apply of the Coverage Part to and Paragraph which this endorsement 9.a.(3Xa) of this en- isattached. dorsement shall apply. b. With respect to addi- 10. Broadened Contractual Liability -Work tional insureds de- Within 50' of Railroad Property scribed in Paragraph 9.a.(2}(g) aboveonly: It is hereby agreed that Paragraph f.(1} of Definition 12. "Insured contract" (SEC- If awritten contract or TION V -DEFINITIONS) is deleted. agreement between you and the additional 11. Property Damage to Borrowed Equip- insured specifies that meet coverage for the addi- a. The following is hereby added to Ex- tionalinsured: clusion j. Damage to Property of a. Be provided by the Paragraph 2., Exclusions of SEC- Insurance Ser- TION I -COVERAGES, COVERAGE vices Office addi- Q BODILY INJURY AND PROP- tional insured form ERTY DAMAGE LIABILITY: number CG 20 10 Paragraphs (3) and (4) of this exdu- or CG 20 37 sion do not apply to tools or equip- (where edition ment loaned to you, provided they are speafied); or not being used to perform operations b. Include coverage at the time of loss. for completed op- b. With respect to the insurance pro- erations; or vided by this section of the endorse- s. Include coverage ment, the following additional provi- for "your worK'; sions apply: and where the limits or (1} The Limits of insurance shown in coverage provided to the Declarations are replaced by the additional insured is the limits designated in Section more restrictive than B. Limits of Insurance, 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These limits are in- the terms of Para- clusive of and not in addition to graphs 9.a.(3}(a), the limits being replaced. The 9.a.(3}(b) or9.b. above, Limits of Insurance shown in or any combination Section B. Limits of Insurance, thereof, shall be inter- 11. of this endorsement fix the preted as providing the most we will pay in any one "oc- limits or coverage re- currenoe" regardless of the quired by the terms of number of: the written contract or (a) Insureds; agreement, but only to the extent that such lim- (b) Claims made or "suits" its or coverage is in- brought; or cluded within the terms of the Coverage Part to (c) Persons or organizations which this endorsement making claims or bring is attached. If, however, "suits". the written contract or Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 15 of 16 PROPEL INSURANCE PAGE 20 OF 24 (2) Deductible Clause a. Nurses; (a) Our obligation to pay dam- b. Emergency Medical Technicians; or ages on your behalf applies only to the amount of darn- c. Paramedics, ages for each "occurrence" in the jurisdiction where an "occurrence" which are in excess of the or offense to which this insurance applies Deductible amount stated in takes place. Section B. Limits of Insur- ance, 11. of this endorse- 13. Broadened Notice of Occurrence ment, The limits of insur- ance will not be reduced by Paragraph a. of Condition 2. Duties in the application of such De- the Event of Occurrence, Offense, ducfible amount. Claim or Suit SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- (b) Condition 2. Duties in the TIONS) is hereby deleted and replaced by Event of Occurrence, Of- the following: fense, Claim or Suit, ap- plies to each claim or "suit" a. You must see to it that we are notified irrespective of the amount. as soon as practicable of an "occur- rence" or anoffense which may result (c) We may pay any part or all in a claim. To the extent possible, Ho- of the deductible amount to tioe should include: effect settlement of any claim or "suit" and, upon no- (1) How, when and where the "oc- tification of the action taken, currence" or offense took place; you shall promptly reim- (2) The names and addresses of burse us for such part of the any injured persons and wit- deductible amount as has nesses; and been paid by us. 12. Em to ees as Insureds S ecified (3) The nature and location of any P Y - P injury or damage arising out of Health Care Services the "occurrence" or offense. It is hereby agreed that Paragraph This requirement applies only when 2.a.(1 Xd) of SECTION II -WHO IS AN the "occurrence" or offense is known INSURED, does not apply to your "em- to an "authorized representative" ployees" who provide professional health care services on your behalf as duly li- censed: Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 16 of 16 PROPEL INSURANCE PAGE 21 OF Z4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESSAUTO COVERAGE FORM GARAGE COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below, Endorsement Effective: Policy Number: Named Insured: Countersigned by: (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION II -LIABILITY COVERAGE, A. Cover- age, I. Who is an Insured is amended to include as an insured any person or organization with which you have agreed in a valid written contract to provide insurance as is afforded by this policy. This provision is limited to the scope of the valid written contract. This provision does not apply unless the valid ~Nritten contract has been executed prior to the "bodily injury" or "property damage". AA 4171 11 05 PROPEL INSURANCE PAGE 22 OF Z4 This page has been left blank intentionally. PROPEL INSURANCE PAGE 23 OF 24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION -AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number: Named Insured: Countersigned by: (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Blanket Waiver of Subrogation of payments we make for "bodily injury" or SECTION IV -BUSINESS AUTO CONDI- "property damage" arising out of the operation of a covered auto when you have assumed TIONS, A. Loss Conditions, 5. Transfer of liability for such bodily injury or property Rights of Recovery Against Others to Us is damage" under an "insured contract", pro- amended by the addition of the following: vided the "bodily injury" or "property damage" We waive any right of recovery we may have occurs subsequent to the execution of the "in- against any person or organization because sured contract". AA 4172 09 09 PROPEL INSURANCE PAGE 24 OF 24 This page has been left blank intentionally.