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HomeMy WebLinkAboutInsurance Certificate: Key Manufacturing & Rentals, Inc. KEYMANU-01 BRANDI ,d►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/09/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hagan Hamilton Insurance PHONE FAX PO BOX 847 (A/C, No, Ext): (503) 538-4455 (AIC, No): Mcminnville, OR 97128 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: EMC Insurance Companies 25186 INSURED INSURER B : SAI F 36196 Key Manufacturing & Rentals, Inc. INSURER C : 20850 SW 115th Ave. #190 INSURER D: Tualatin, OR 97062 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 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. SD WVD SUER INSR TYPE OF INSURANCE INADDL LTR NSD POLICY NUMBER MPM/OLICY EFF POLICY EXP DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 5X79810 04/01/2018 04/01/2019 DAMAGETORENTED 500,000 X X PREMISES Ea occurrence $ MED EXP An one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO- 2,000,000 X POLICY ~ JECT F LOC PRODUCTS -COMP/OP AGG $ OTHER EPLI $ 100,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO 5X79810 04/01/2018 04/01/2019 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 5X79810 04/01/2018 04/01/2018 AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION STATUTE OERH AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ 854251 01/1512018 09/01/2015 E.L. EACH ACCIDENT S 500'000 OFFICERIMEMBER EXCLUDED? N /A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, Oregon and its elected officials, officers and employee are additional insured with primary and noncontributory coverage including a Waiver of Subrogation per forms CG7578. 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 Y ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD Ail, COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ELITE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include the following clarifications and extensions of coverage. The provisions of the Coverage Form apply unless modified by endorsement. A. EXPECTED OR INTENDED INJURY The aggregate limit listed above is the most we will Section I - Coverage A, Exclusion a. is amended pay for all damages because of "property damage" as follows: to property in the care custody and control of or property loaned to an insured during the policy a. "Bodily injury" or "property damage" expected period. or intended from the standpoint of an insured. This exclusion does not apply to "bodily injury" Any payment we make for damages because of or "property damage" resulting from the use of "property damage" to property in the care, custody reasonable force to protect persons or property. and control of or property loaned to an insured will apply against the General Aggregate Limit shown in B. NON-OWNED WATERCRAFT the declarations. Section I - Coverage A, Exclusion g.(2) is b. Our obligation to pay damages on your behalf amended as follows: applies only to the amount of damages in (2) A watercraft you do not own that is: excess of the deductible amount listed above. (a) Less than 60 feet long; and We may pay any part or all of the deductible amount listed above. We may pay any part or (b) Not being used to carry person(s) or all of the deductible amount to effect settlement property for a charge; of any claim or "suit" and upon notification by C. EXTENDED PROPERTY DAMAGE COVERAGE us, you will promptly reimburse us for that part Section I - Coverage A, Exclusions j.(3) and (4) is of the deductible we paid. amended to add the following: c. If two or more coverages apply under one Paragraphs (3) and (4) of this exclusion do not "occurrence", only the highest per claim apply to tools or equipment loaned to you, provided deductible applicable to these coverages will they are not being used to perform operations at apply. the time of loss. d. Insurance provided by this provision is excess over any other insurance, whether primary, SCHEDULE excess, contingent or any other basis. Since Limits Of Insurance Deductible insurance provided by this endorsement is excess, we will have no duty to defend any $5,000 Each Occurrence $250 Per Claim claim or "suit" to which insurance provided by $10,000 Annual Aggregate this endorsement applies if any other insurer has a duty to defend such a claim or "suit". If a. The each occurrence limit listed above is the no other insurer defends, we will undertake to most we will pay for all damages because of do so, but we will be entitled to the insured's "property damage" to property in the care, rights against all those other insurers. custody and control of or property loaned to an D. PROPERTY DAMAGE - ELEVATORS insured as the result of any one "occurrence", regardless of the number of: Section I - Coverage A.2. Exclusions paragraphs (1) insureds; j.(3), j.(4), j.(6) and k. do not apply to use of elevators. This insurance afforded by this provision (2) claims made or "suits" brought; is excess over any valid and collectible property (3) persons or organizations making claims or insurance (including any deductible) available to bringing "suits". the insured and Section IV - Commercial General Liability Conditions Paragraph 4. Other Insurance is changed accordingly. CG7578(6-17) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 6 E. FIRE, LIGHTNING OR EXPLOSION DAMAGE a. Currently in effect or becomes effective Except where it is used in the term "hostile fire", the during the policy period; and word fire includes fire, lightning or explosion wherever b. Executed prior to an "occurrence" or it appears in the Coverage Form. offense to which this insurance would Under Section I - Coverage A, the last paragraph apply. (after the exclusions) is replaced with the following: However, the insurance afforded to such Exclusions c. through n. do not apply to damage by additional insured: fire, smoke or leakage from automatic fire protection a. Only applies to the extent permitted by law; systems to premises while rented to you or and temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this b. Will not be broader than that which you are coverage as described in Section III - Limits of provide required for r the contract or agreement to such additional insured; and Insurance. F. MEDICAL PAYMENTS c. Applies only if the person or organization is not specifically named as an additional If Section I - Coverage C. Medical Payments insured under any other provision of, or Coverage is not otherwise excluded from this endorsement added to, Section II - Who Coverage Form: Is An Insured of this policy. The requirement, in the Insuring Agreement of 2. As provided herein, the insurance coverage Coverage C., that expenses must be incurred and provided to such additional insureds is limited reported to us within one year of the accident date is to: changed to three years. G. SUPPLEMENTARY PAYMENTS a. Any Controlling Interest, but only with respect to their liability arising out of their Supplementary Payments - Coverages A and B financial control of you; or premises they Paragraphs 1.b. and 1.d. are replaced by the own, maintain, or control while you lease or following: occupy these premises. 1.b. Up to $5,000 for cost of bail bonds required This insurance does not apply to structural because of accidents or traffic law violations alterations, new construction and arising out of the use of any vehicle to which the demolition operations performed by or for Bodily Injury Liability Coverage applies. We do that person or organization. not have to furnish these bonds. b. Any architect, engineer, or surveyor 1.d.All reasonable expenses incurred by the insured engaged by you but only with respect to at our request to assist us in the investigation or liability for "bodily injury", "property defense of the claim or "suit", including actual damage" or "personal and advertising loss of earnings up to $500 a day because of injury" caused, in whole or in part, by your time off from work. acts or omissions or the acts or omissions H. SUBSIDIARIES AS INSUREDS of those acting on your behalf: Section II - Who Is An Insured is amended to add (1) In connection with your premises; or the following: (2) In the performance of your ongoing 1.f. Any legally incorporated subsidiary in which you operations. own more than 50% of the voting stock on the With respect to the insurance afforded to effective date of this policy. However, insured these additional insureds, the following does not include any subsidiary that is an insured additional exclusion applies: under any other general liability policy, or would This insurance does not apply to "bodily have been an insured under such a policy but for injury", "property damage" or "personal and termination of that policy or the exhaustion of that advertising injury" arising out of the policy's limits of liability. rendering of or the failure to render any 1. BLANKET ADDITIONAL INSUREDS - AS professional services by or for you, REQUIRED BY CONTRACT including: 1. Section II - Who Is An Insured is amended to (1) The preparing, approving, or failing to include as an additional insured any person(s) or prepare or approve, maps, shop organization(s) subject to provisions in Paragraph drawings, opinions, reports, surveys, 2. below, (hereinafter referred to as additional field orders, change orders or drawings insured) when you and such person(s) or and specifications; or organization(s) have agreed in a written contract or written agreement that such person(s) or (2) Supervisory, inspection, architectural or organization(s) be added as an additional insured engineering activities. on your policy provided that the written contract or agreement is: CG7578(6-17) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 2 of 6 This exclusion applies even if the claims This insurance does not apply to: against any insured allege negligence or (a) "Bodily injury", property damage" or other wrongdoing in the supervision, hiring, employment, training or monitoring- of "personal and advertising injury" others by that insured, if the "occurrence" arising out of operations performed which caused the "bodily injury" for the federal government, state or y ry or municipality; or "property damage", or the offense which caused the "personal and advertising (b) "Bodily injury" or "property damage" injury", involved the rendering of or the included within the "products- failure to render any professional services completed operations hazard". by or for you. e. Any vendor, but only with respect to "bodily c. Any manager or lessor of a premises injury" or "property damage" arising out of leased to you, but only with respect to "your products" which are distributed or sold liability arising out of the ownership, in the regular course of the vendor's maintenance or use of that part of a business. premises leased to you, subject to the With respect to the insurance afforded to following additional exclusions: these vendors, the following additional This insurance does not apply to: exclusions apply: (1) Any "occurrence" which takes place (1) The insurance afforded any vendor does after you cease to be a tenant in that not apply to: premises. (a) "Bodily injury" or "property damage" (2) Structural alterations, new construction for which any vendor is obligated to or demolition operations performed by pay damages by reason of the or on behalf of such additional insured. assumption of liability in a contract or d. Any state or governmental agency or agreement. This exclusion does not subdivision or political subdivision, subject to apply to liability for damages that any vendor would have in the absence of the following: the contract or agreement; (1) This insurance applies only with respect (b) Any express warranty unauthorized to the following hazards for which any by you; state or governmental agency or subdivision or political subdivision has (c) Any physical or chemical change in issued a permit or authorization in the product made intentionally by connection with premises you own, rent any vendor; or control and to which this insurance (d) Repackaging, except when applies: unpacked solely for the purpose of (a) The existence, maintenance, repair, inspection, demonstration, testing, construction, erection or removal of or the substitution of parts under advertising signs, awnings, instructions from the manufacturer, canopies, cellar entrances, coal and then repackaged in the original holes, driveways, manholes, container; marquees, hoist away openings, (e) Any failure to make such sidewalk vaults, street banners or inspections, adjustments, tests or decorations and similar exposures; servicing as any vendor has or agreed to make or normally (b) The construction, erection or undertakes to make in the usual removal of elevators; or course of business, in connection with the distribution or sale of the (c) The ownership, maintenance or use products; of any elevators covered by this insurance. (f) Demonstration, installation, servicing (2) This insurance applies only with respect or repair operations, to operations performed by you or on except such operations performed your behalf for which any state or at any vendor's premises in connection with the sale of the governmental agency or subdivision or product; political subdivision has issued a permit or authorization. (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for any vendor; or CG7578(6-17) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 3 of 6 (h) "Bodily injury" or "property A person's or organization's status as an damage" arising out of the sole additional insured under this endorsement negligence of any vendor for its ends when their contract or agreement with own acts or omissions or those of you for such leased equipment ends. its employees or anyone else With respect to the insurance afforded to acting on its behalf. However, this these additional insureds, this insurance exclusion does not apply to: does not apply to any "occurrence" which (i) The exceptions contained in takes place after the equipment lease Subparagraphs (d) or (f); or expires. (ii) Such inspections, adjustments, i. Any Owners, Lessees, or Contractors for tests or servicing as any whom you are performing operations, but vendor has agreed to make or only with respect to liability for "bodily normally undertakes to make in injury", "property damage" or "personal and the usual course of business, advertising injury" caused, in whole or in in connection with the part, by: distribution or sale of the (1) Your acts or omissions; or products. (2) This insurance does not apply to any (2) The acts omissions of those acting insured person or organization, from on your behalf; whom you have acquired such in the performance of your ongoing products, or any ingredient, part or operations for the additional insured. container, entering into, accompanying A person's or organization's status as an or containing such products. additional insured under this endorsement f. Any Mortgagee, Assignee Or Receiver, but ends when your operations for that only with respect to their liability as additional insured are completed. mortgagee, assignee, or receiver and With respect to the insurance afforded to arising out of the ownership, maintenance, these additional insureds, the following or use of the premises by you. additional exclusions apply: This insurance does not apply to structural This insurance does not apply to: alterations, new construction and demolition operations performed by or for (1) "Bodily injury", "property damage" or that person or organization. "personal and advertising injury" arising g. Any Owners Or Other Interests From out of the rendering of, or the failure to Whom Land Has Been Leased, but only render, any professional architectural, with respect to liability arising out of the engineering or surveying services, ownership, maintenance or use of that part including: of the land leased to you. (a) The preparing, approving, or failing With respect to the insurance afforded to to prepare or approve, maps, shop drawings, opinions, reports, these additional insureds, the following surveys, field orders, change additional exclusions apply: orders or drawings and (1) This insurance does not apply to: specifications; or (a) Any "occurrence" which takes (b) Supervisory, inspection, place after you cease to lease that architectural or engineering land; or activities. (b) Structural alterations, new This exclusion applies even if the claims construction or demolition against any insured allege negligence or operations performed by or on other wrongdoing in the supervision, hiring, behalf of such additional insured. employment, training or monitoring of h. Any person or organization from whom you others by that insured, if the "occurrence" lease equipment, but only with respect to which caused the "bodily injury" or liability for "bodily injury", "property "property damage", or the offense which caused the "personal and advertising damage" or personal and advertising injury", involved the rendering of or the injury" caused, in whole or in part by your failure to render any professional maintenance, operation or use of architectural, engineering or surveying equipment leased to you by such person(s) services or organization(s). . (2) "Bodily injury" or "property damage" occurring after: CG7578(6-17) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 4 of 6 (a) All work, including materials, parts This endorsement shall not increase the or equipment furnished in applicable Limits of Insurance shown in the connection with such work, on the Declarations. project (other than service, J. COVERAGE FOR INJURY TO CO-EMPLOYEES maintenance or repairs) to be AND/OR YOUR OTHER VOLUNTEER WORKERS performed by or on behalf of the additional insured(s) at the location Section II -Who is an Insured, Paragraph 2.a. (1) is of the covered operations has been amended to add the following: completed; or e. Paragraphs (a), (b), and (c) do not apply to your (b) That portion of "your work" out of "employees" or "volunteer workers" with respect which the injury or damage arises to "bodily injury" to a co-"employee" or other has been put to its intended use by "volunteer worker". any person or organization other Damages owed to an injured co-"employee" or than another contractor or "volunteer worker" will be reduced by any subcontractor engaged in amount paid or available to the injured co- performing operations for a "employee" or "volunteer worker" under any principal as a part of the same other valid and collectible insurance. project. K. HEALTH CARE SERVICE PROFESSIONALS AS j. Any Grantor of Licenses to you, but only INSUREDS -INCIDENTAL MALPRACTICE with respect to their liability as grantor of Section II -Who is an Insured, Paragraph 2.a. (1) licenses to you. (d) is amended as follows: Their status as additional insured under This provision does not apply to Nurses, Emergency this endorsement ends when: Medical Technicians, or Paramedics who provide 1. The license granted to you by such professional health care services on your behalf. person(s) or organization(s) expires; or However this exception does not apply if you are in 2. Your license is terminated or revoked the business or occupation of providing any such by such person(s) or organization(s) professional services. prior to expiration of the license as L. NEWLY FORMED OR ACQUIRED stipulated by the contract or ORGANIZATIONS agreement. with Section II - Who Is An Insured, Paragraph 3.a. is k. Any Grantor of Franchise, but only respect to their liability as grantor of a replaced by the following: franchise to you. 3.a. Coverage under this provision is afforded until the end of the policy period. 1. Any Co-owner of Insured Premises, but only with respect to their liability as co- This provision does not apply if newly formed or owner of any insured premises. acquired organizations coverage is excluded either by m. Any Concessionaires Trading Under Your the provisions of the Coverage Form or by Name, but only with respect to their liability endorsements. as a concessionaire trading under your M. DAMAGE TO PREMISES RENTED TO YOU name. Section III - Limits of Insurance, Paragraph 6. is 3. Any insurance provided to any additional replaced by the following: insured does not apply to "bodily injury", Subject to 5.a. above, the Damage To Premises "property damage" or "personal and advertising Rented To You Limit, or $500,000, whichever is injury" arising out of the sole negligence or higher, is the most we will pay under Coverage A for willful misconduct of the additional insured or its damages because of "property damage" to any one agents, "employees" or any other premises, while rented to you, or in the case of representative of the additional insured. damage by fire, smoke or leakage from automatic 4. With respect to the insurance afforded to these protection systems, while rented to you or temporarily additional insureds, the following is added to occupied by you with permission of the owner. Section III - Limits of Insurance: N. MEDICAL PAYMENTS - INCREASED LIMITS If coverage provided to any additional insured Section III - Limits of Insurance, Paragraph 7. is is required by a contract or agreement, the replaced by the following: most we will pay on behalf of the additional 7. Subject to Paragraph 5. above, $10,000 is the insured is the amount of insurance: Medical Expense Limit we will pay under a. Required by the contract or agreement; or Coverage C for all medical expenses because of b. Available under the applicable Limits of "bodily injury" sustained by any one person, Insurance shown in the Declarations; unless the amount shown on the Declarations of whichever is less. this Coverage Part for Medical Expense Limit states: CG7578(6-17) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 5 of 6 (a) No Coverage; or (2) You have agreed in writing in a contract or (b) $1,000; or agreement that this insurance would be primary and would not seek contribution from any other (c) $5,000; or insurance available to the additional insured. (d) A limit higher than $10,000. However, if the additional insured has been 0. DUTIES IN THE EVENT OF OCCURRENCE, added as an additional insured on other OFFENSE, CLAIM OR SUIT policies, whether primary, excess, contingent or on any other basis, this insurance is excess Section IV - Commercial General Liability over any other insurance regardless of the Conditions Paragraph 2. is amended to add the written agreement between you and an following: additional insured. e. The requirement in Condition 2.a. that you must Q. UNINTENTIONAL FAILURE TO DISCLOSE see to it that we are notified as soon as EXPOSURES practicable of an "occurrence" or an offense Section IV - Commercial General Liability which may result in a claim, applies only when Conditions Paragraph 6. Representations is the "occurrence" or offense is known to: amended to add the following: (1) You, if you are an individual or a limited If you unintentionally fail to disclose any exposures liability company; existing at the inception date of your policy, we will not (2) A partner, if you are a partnership; deny coverage under the Coverage Form solely (3) A member or manager, if you are a limited because of such failure to disclose. However, this liability company; provision does not affect our right to collect additional premium or exercise our right of cancellation or non- (4) An "executive officer" or insurance renewal. manager, if you are a corporation; or (5) A trustee, if you are a trust. This provision does not apply to any known injury or damage which is excluded under any other f. The requirement in Condition 2.b. that you provision of this policy. must see to it that we receive notice of a claim R. WAIVER OF TRANSFER OF RIGHTS OF or "suit" as soon as practicable will not be RECOVERY AGAINST OTHERS TO US considered breached unless the breach occurs after such claim or "suit" is known to: Section IV - Commercial General Liability (1) You, if you are an individual or a limited Condition Paragraph 8. Transfer Of Rights Of liability company; Recovery Against Others To Us is amended to add the following: (2) A partner, if you are a partnership; We waive any right of recovery we may have (3) A member or manager, if you are a limited against any person or organization against whom liability company; you have agreed to waive such right of recovery in (4) An "executive officer" or insurance a written contract or agreement because of manager, if you are a corporation; or payments we make for injury or damage arising out (5) A trustee, if you are a trust. of your ongoing operations or "your work" done P. PRIMARY AND NONCONTRIBUTORY - under a contract with that person or organization ADDITIONAL INSURED EXTENSION and included in the "products completed operations hazard". Section IV - Commercial General Liability S. MENTAL ANGUISH Conditions Paragraph 4. Other Insurance is amended to add the following: Section V - Definition 3. is replaced by the following: This insurance is primary to and will not seek "Bodily injury" means bodily injury, sickness or contribution from any other insurance available to disease sustained by a person, including mental an additional insured under your policy provided anguish or death resulting from bodily injury, that: sickness or disease. (1) The additional insured is a Named Insured T. LIBERALIZATION under such other insurance; and If we revise this endorsement to provide greater coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. CG7578(6-17) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 6 of 6