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HomeMy WebLinkAboutInsurance Certificate: Crandall Arambula, P.C. Client#: 328663 CRANDARA2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/01/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Tracy Taylor USI Insurance Services NW PR PHONE 208-917-5692 A 610-362-8530 A/C, No Ext : A/C, No 601 Union Street, Suite 1000 E-MAIL SS: tracy.taylor@usi.com Seattle, WA 98101 INSURER(S) AFFORDING COVERAGE i N_AIC # INSURER A : Travelers Indemnity Company 25658 INSURED INSURER B : Tra-lero Indemnity Company 25658 Crandall Arambula, P.C. 36196 INSURER C : SAIF Corporation 520 SW Yamhill Suite 4 INSURER D XL Specialty Insurance Company 37885 Portland, OR 97204 25615 INSURER E ; Charter Oak Flra Insurance Company INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD (MMIDDfYYM A XI COMMERCIAL GENERAL LIABILITY 6809H808264 5/0412018 05/04/201 EACH OCCURRENCE s2,000,000 CLAIMS-MADE LX OCCUR PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRO. POLICY x JECT _ LOC PRODUCTS - COMP/OPAGG $4,000,000 OTHER: $ INGLE LIMIT 1,000,000 E AUTOMOBILE LIABILITY BA5E990830 5/04/2018 05/04/201 COEa ccMBINEDidentS $ a ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR CUP6B5343251447 5/04/2018 05104/201 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X. RETENTION $10000 C WORKERS COMPENSATION 905493 9/01/2017 09/01/201 X PER OTH-ATUTE AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? F NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 D Professional DPS9913855 5/04/2017 05/04/202 $2,000,000 per claim Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Comp Information Proprietors/Partners/Executive Officers/Members Excluded: George Crandall, President 8t Donald Arambula, Vice Pres General Liability and Excess include automatic additional insure and waiver of subrogation if required by written contract The City of Ashland, Oregon, and its elected officials, officers and employees are named as an Additional Insured on the General Liability Policy, with respects to operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S23027854/M23025251 AXYZP This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURE (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION 11 - WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance" to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or "personal injury"; and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph a.a. of additional insured: SECTION IV - COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily injury", "property damage" or is excess over any valid and collectible other I .personal whether primary, excess, contingent or personal injury" for which such person or an an other basis, that is available to the contract t or organization has assumed liability in a additional insured for a loss we cover. However. if contract agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part e. This insurance does not apply on any basis to must apply on a primary basis or a primary and any person or organization for which non-contributory basis, this insurance is primary coverage as an additional insured specifically to other insurance available to the additional is added by another endorsement to this insured which covers that person or organizations Coverage Part. as a named insured for such loss, and we will not share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs; and "professional services". In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage is 9 sought arises out of an offense committed; Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III - person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 49 15 0 2015 The Travelers Indemnity Company, All rights reserved Page 1 of 2 Includes the copyrighted material of insurance Services Office, Inc., with its permiss;on COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph S., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us. DEFINITIONS Section: of SECTION IV COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused by an offense committed: under a "written contract requiring insurance' with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the "personal injury" offense is committed. Page 2 of 2 0 2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 04 15 Includes Lhe copyrighted material of insurance Services Office, inc., with its pemuss`on COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARCHITECTS, ENGINEERS AND SURVEYORS COVERAGE XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured K. Additional Insured - Lessor Of Leased Equipment B. Incidental Medical Malpractice L Additional Insured - State Or Political C. Reasonable Force - Bodily Injury Or Property Subdivisions - Permits Relating To Premises Damage M. Additional Insured - State Or Political D. Non-Owned Watercraft - Increased To Up To 75 Subdivisions - Permits Relating To Operations feet N. Who Is An Insured - Newly Acquired Or Formed E. Aircraft Chartered With Crew Organizations F. Damage To Premises Rented To You O. Knowledge And Notice Of Occurrence Or Offense G. Malicious Prosecution - Exception To Knowing P. Unintentional Omission Violation Of Rights Of Another Exclusion Q. Waiver Of Transfer Of Rights Of Recovery H. Medical Payments - Increased Limit Against Others To Us When Required By Written 1. Increased Supplementary Payments Contract J. Additional Insured - Owner, Manager Or Lessor R. Amended Insured Contract Definition - Railroad Of Premises Easement PROVISIONS Unless you are in the business or occupation A. BROADENED NAMED INSURED of providing professional health care services, "occurrence" also means an act or omission 1. The following is added to SECTION It - WHO committed in providing or failing to provide IS AN INSURED: first aid or "Good Samaritan services" to a Any organization, other than a partnership or person, joint venture, over which you maintain 2. The following is added to the DEFINITIONS ownership or majority interest on the effective date of the policy qualifies as a Named Section: Insured. However, coverage for any such Good Samaritan services" means any additional organization will cease as of the emergency medical services for which no date during the policy period that you no compensation is demanded or received, longer maintain ownership of, or majority 3. The following is added to Paragraph 2.a.(i) of interest in, such organization, SECTION 11- WHO IS AN INSURED: B. INCIDENTAL MEDICAL MALPRACTICE Unless you are in the business or occupation 1. The following is added to the definition of of providing professional health care services, "occurrence" in the DEFINITIONS Section: Paragraphs (1)(a), (b), (c) and (d) above CG D3 79 01 16 10 2016 The Travelers Indemnity Company- All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY does not apply to any "bodily injury" arising insured. This exclusion does not apply to out of any providing or failing to provide first "bodily injury" or "property damage" resulting aid or "Good Samaritan services" by any of from the use of reasonable force to protect your "employees", other than an employed any person or property. doctor. Any such "employees" providing or D. NON-OWNED WATERCRAFT - INCREASED failing to provide first aid or "Good Samaritan TO UP TO 75 FEET services" during their work hours for you will be deemed to be acting within the scope of 1. The following replaces Paragraph (2) of their employment by you or performing duties Exclusion g., Aircraft, Auto Or Watercraft, related to the conduct of your business, in Paragraph 2. of SECTION I - 4. The following exclusion is added to COVERAGES - COVERAGE A BODILY Paragraph 2., Exclusions, of SECTION I - INJURY AND PROPERTY DAMAGE LIABILITY: COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE (2) A watercraft you do not own that is: LIABILITY in COVERAGES: (a) Less than 75 feet long: and Sale of Pharmaceuticals (b) Not being used to carry any person or "Bodily injury" or "property damage" arising property for a charge; out of the willful violation of a penal statute or 2. The following is added to Paragraph 2. of ordinance relating to the sale of SECTION II -WHO IS AN INSURED: pharmaceuticals committed by, or with the Any person or organization that, with your knowledge or consent of, the insured. express or implied consent, either uses or is 5. The following is added to Paragraph S. of responsible for the use of a watercraft that SECTION III - LIMITS OF INSURANCE: you do not own that is: For the purposes of determining the (a) Less than 75 feet long; and applicable Each Occurrence Limit, all related (b) Not being used to carry any person or acts or omissions committed in the providing property for a charge; or failing to provide first aid or "Good Samaritan services" to any one person will be 3. The following is added to Paragraph 4.b., considered one "occurrence". Excess Insurance, of SECTION IV - 6. The following is added to Paragraph 4.b., COMMERCIAL GENERAL LIABILITY Excess Insurance, of SECTION IV - CONDITIONS: COMMERCIAL GENERAL LIABILITY This insurance is excess over any valid and CONDITIONS: collectible other insurance, whether primary. excess, contingent or on any other basis. that This insurance is excess over any valid and is available to the insured for "bodily injury" collectible other insurance, whether primary, that arises out of the use of a watercraft that excess, contingent or on any other basis, that you do not own that is: is available to any of your "employees" for "bodily injury" that arises out of providing or (a) Less than 75 feet long; and failing to provide first aid or "Good Samaritan (b) Not being used to carry any person or services" to any person to the extent not property for a charge, subject to Paragraph 2.a.(1) of Section If - Who Is An Insured. E. AIRCRAFT CHARTERED WITH CREW C. REASONABLE FORCE - BODILY INJURY OR 1. The following is added to Exclusion g.. PROPERTY DAMAGE Aircraft, Auto Or Watercraft, in Paragraph The following replaces Exclusion a., Expected Or 2. of SECTION I - COVERAGES - Intended Injury, in Paragraph 2. of SECTION I - COVERAGE A BODILY INJURY AND COVERAGES - COVERAGE A BODILY PROPERTY DAMAGE LIABILITY in INJURY AND PROPERTY DAMAGE LIABILITY: COVERAGES: a. Expected Or Intended Injury Or Damage This exclusion does not apply to an aircraft that is: "Bodily injury" or "property damage" expected or intended from the standpoint of the (a) Chartered with crew to any insured; Page 2 of 6 0 2016 The Travelers Indemnity Company. All rights reserved. CG D3 79 01 16 9 to E a6ed 'Panlasel e146u 11V Auedwoo A,, uwapui sieianeJi 8419tOZ V 91. 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Aue al Ma.i3 4l!M paJal,e40 (e) awes a4i Aq pasne3 Alalewlxoid a6ewep Ile of Aldde lllM l!w!l noA O.J. paluaa e to asn jo¢ pamsui of :si a lq lelle4enjie Ae S1 sas!waJd o1 a6ewei3 a41 -.ialeM Jo :6u!uly6li la s! so `ualsaidxa 'aall 43ns woll 6ulllnsaa a~lows 1e43 'slspg jaylo Aue uo ao ju a6ulluo3 'ssa3xa :6ulu146!l :uolsoldxa :ajy Aq pasne3 'jaumo Alewljd JaylayM '93uejnsu! ja41o algsl3allO3 ayl ;o uolsslwaad yllN+ Hors Aq paldm3o Pup p!leA due 19AD ssa3x9 si a3uemsuo sl41 Aluejodwal Jo 'noA of paluai al!gm saslwaid :SNOIIIQN00 auo due of „a6ewep Ayadoid„ to asne3aq AlIIISVI I lVld3N3J -IVI:)H3WWO0 sa6ewep Jol y a6eJano0 japun Aed lpm - Al NOL103S )o "a3uejnsul ssa3x3 am lsow a4l s! l!w!l noA of paluaa saslwaJd -q'i: 4deJ6eJed of pappe s! 6u!MOIIOI a4i 'Z 01 a6eweo ayl 'anage 'S 01 13afgnS •a6.1e43 a jo; Alladoid :33NtldnSNI jO S11W11- III N01103S jo uosaad Aue Aue3 of pasn 6ulaq ION (3) ;o •9 4de16eaed sa3eldal 6ulMollo¢ ayi •Z pup :palnsut Sue Aq pauMO ION (q) Alill9bil Wa3N3~) lVi0a3NV400 COMMERCIAL GENERAL LIABILITY G. MALICIOUS PROSECUTION - EXCEPTION TO insured, but only with respect to liability for "bodily KNOWING VIOLATION OF RIGHTS OF injury". "property damage", "personal injury" or ANOTHER EXCLUSION "advertising injury" that: The following is added to Exclusion a., Knowing a. Is "bodily injury" or "property damage" caused Violation Of Rights Of Another, in Paragraph 2. by an "occurrence" that takes place, or of SECTION I - COVERAGES - COVERAGE B "personal injury" caused by an offense that is PERSONAL AND ADVERTISING INJURY committed, after you have signed that LIABILITY: contract; and This exclusion does not apply to "personal injury" b. Arises out of the ownership, maintenance or caused by malicious prosecution. use of that part of any premises leased to you H. MEDICAL PAYMENTS - INCREASED LIMIT under that written contract. The following replaces Paragraph 7, of SECTION The insurance provided to such premises owner, III - LIMITS OF INSURANCE: manager or lessor is subject to the following 7. Subject to S. above, the Medical Expense provisions: Limit is the most we will pay under Coverage a. The limits of insurance provided to such C. for all medical expenses because of premises owner, manager or lessor will be "bodily injury" sustained by any one person, the limits which you agreed to provide in the and will be the higher of, written contract. or the limits shown on the (a) $10,000; or Declarations of this Coverage Part, whichever are less. (b) The amount shown on the Declarations of b. The insurance provided to such premises this Coverage Part for Medical Expense Limit, owner, manager or lessor does not apply to: 1. INCREASED SUPPLEMENTARY PAYMENTS (1) "Bodily injury" or "property damage" caused by 1. The following replaces laces Paragraph 1.b. of an "occurrence" that takes g p place, or "personal injury" caused by an SUPPLEMENTARY PAYMENTS - offense that is committed, after you COVERAGES A AND B of SECTION I - cease to be a tenant in that premises: or COVERAGES: (2) Structural alterations, new construction or b. Up to $2,500 for cost of batl bonds demolition because of accidents or traffic operations performed by or on law violations arising out of the use of any behalf of such premises owner, manager vehicle to which the Bodily Injury Liability or lessor. Coverage applies. We do not have to c. The insurance provided to such premises furnish these bonds. owner, manager or lessor is excess over any 2. The following replaces Paragraph 1.d. of valid and collectible other insurance available SUPPLEMENTARY PAYMENTS _ to such premises owner, manager or lessor, COVERAGES A AND 8 of SECTION 1 - unless you have agreed in a written contract COVERAGES: for this insurance to apply on a primary or contributory basis. d. All reasonable expenses incurred by the K. ADDITIONAL INSURED - LESSOR OF LEASED insured at our request to assist us in the EQUIPMENT investigation or defense of the claim or "suit", including actual loss of earnings up The following is added to SECTION II - WHO IS to $SOO a day because of time off from AN INSURED: work. Any person or organization that is an equipment J. ADDITIONAL INSURED - OWNER, MANAGER lessor and that you have agreed in a written OR LESSOR OF PREMISES contract to name as an additional insured on this The following is added to SECTION 11 - WHO IS Coverage Part is an insured, but only with respect AN INSURER: to liability for "bodily injury", "property damage", Any person or organization that is a premises "personal injury" or "advertising injury" that. owner, manager or lessor and that you have a. Is "bodily injury" or "property damage" caused agreed in a written contract to name as an by an "occurrence" that takes place, or additional insured on this Coverage Part is an "personal injury" caused by an offense that is Page 4 of 6 0 2016 The Travelers Indemnity Company. All rights reserved. CG D3 79 01 16 COMMERCIAL GENERAL LIABILITY committed, after you have signed that written M. ADDITIONAL INSURED - STATE OR contract; and POLITICAL SUBDIVISIONS - PERMITS b. Is caused, in whole or in part, by acts or RELATING TO OPERATIONS omissions of you or any person or The following is added to Paragraph 2. of organization performing operations on your SECTION II -WHO 15 AN INSURED: behalf, in the maintenance, operation or use Any state or political subdivision that has issued a of equipment !eased to you by such permit with respect to operations performed by equipment lessor. you or on your behalf is an insured, but only with The insurance provided to such equipment lessor respect to "bodily injury", "property damage", is subject to the following provisions: "personal injury" or "advertising injury" arising out of operations performed by you or on your behalf a. The limits of insurance provided to such for which that state or political subdivision has equipment lessor will be the limits which you issued such permit. However, no such state or agreed to provide in the written contract, or political subdivision is an insured for: the limits shown on the Declarations of this (1) "Bodily injury", "property damage", "personal Coverage Part, whichever are less; and injury" or "advertising injury" arising out of b. The insurance provided to such equipment operations performed for that state or political lessor does not apply: subdivision; or (1) To any "bodily injury" or "property (2) "Bodily injury" or "property damage" included damage" caused by an "occurrence" that within the "products - completed operations takes place, or "personal injury" caused hazard". by an offense that is committed, after the N. WHO IS AN INSURED - NEWLY ACQUIRED equipment lease expires: or OR FORMED ORGANIZATIONS (2) If the equipment is leased with an The following replaces Paragraph 4.a. of operator. SECTION Ii - WHO 1S AN INSURED: c. The insurance provided to such equipment a. Coverage under this provision is afforded lessor is excess over any valid and collectible only: other insurance available to such equipment (1) Until the 180th day after you acquire or lessor, unless you have agreed in a written form the organization'or the end of the contract for this insurance to apply on a policy period, whichever is earlier, if you primary or contributory basis, do not report such organization in writing L. ADDITIONAL INSURED - STATE OR to us within 180 days after you acquire or POLITICAL SUBDIVISIONS - PERMITS form it; or RELATING T 0 PREMISES (2) Until the end of the policy period, when The following is added to Paragraph 2. of that date is later than 180 days after you SECTION 11 - WHO IS AN INSURED; acquire or form such organizations, if you report such organization in writing to us Any state or political subdivision that has issued a within 180 days after you acquire or form permit in connection with premises owned or & occupied by, or rented or loaned to, you. is an O. KNOWLEDGE AND NOTICE OF insured, but only with respect to "bodily injury". OCCURRENCE OR OFFENSE "property damage" "personal injury" or "advertising injury" arising out of the existence, The following is added to Paragraph 2., Duties In ownership, use, maintenance, repair, The Event of Occurrence, Offense, Claim Or construction, erection or removal of advertising Suit, of SECTION IV - COMMERCIAL signs, awnings, canopies, cellar entrances. coal GENERAL LIABILITY CONDITIONS: holes, driveways, manholes, marquees, hoist e. The following provisions apply to Paragraph away openings, sidewalk vaults, elevators, street a. above, but only for the purposes of the banners or decorations for which that state or insurance provided under this Coverage Part political subdivision has issued such permit, to you or any insured listed in Paragraph 1. or 2. of Section 11- Who Is An Insured: CG D3 79 01 16 20t6 The Travelers lndemnily Company All nahts reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY (1) Notice to us of such "occurrence" or of an health insurer. This applies only if you offense must be given as soon as subsequently give notice to us of the practicable only after the "occurrence" or "occurrence" or offense as soon as offense is known to you (if you are an practicable after any of the persons individual), any of your partners or described in Paragraphs e. (1) or (2) members who is an individual (if you are a above discovers that the "occurrence" or partnership or joint venture), any of your offense may result in sums to which the managers who is an individual (if you are insurance provided under the Coverage a limited liability company), any of your Part may apply. trustees who is an individual (if you are P. UNINTENTIONAL OMISSION a trust). any of your "executive officers" or The following is added to Paragraph 6., directors (if you are an organization other than a partnership, joint venture, limited Representations, of SECTION IV - liability company or trust), or any COMMERCIAL GENERAL LIABILITY "employee" (such as an insurance, loss CONDITIONS: control or risk manager or administrator) The unintentional omission of, or unintentional authorized by you to give notice of an error in, any information provided by you which "occurrence" or offense. we relied upon in issuing this policy will not Knowledge by any other "employee" of an prejudice your rights under this insurance. "occurrence" or offense does not imply However, this provision does not affect our right that you also have such knowledge, to collect additional premium or to exercise our rights of cancellation or nonrenewal in (2) If you are a partnership, joint venture, accordance with applicable insurance laws or limited liability company or trust. and regulations. none of your partners, joint venture members, managers or trustees are Q WAIVER OF TRANSFER OF RIGHTS OF individuals, notice to us of such RECOVERY AGAINST OTHERS TO US WHEN "occurrence" or offense must be given as REQUIRED BY WRITTEN CONTRACT soon as practicable only after the The following is added to Paragraph Transfer "occurrence" or offense is known by: of Rights of Recovery Against Others to Us, of (a) Any individual who is: SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: (1) A partner or member of any partnership or joint venture: We waive any right of recovery we may have against any person or organization because of (€i) A manager of any limited liability payments we make for injury or damage arising company; out of premises owned or occupied by or rented (ill) A trustee of any trust; or or loaned to you; ongoing operations performed (€v) An executive officer or director of by you or on your behalf, done under a written any other organization; contract with that person or organization; "your work"; or "your products". We waive this right that is your partner, joint venture where you have agreed to do so as part of a member, manager or trustee; or written contract signed by you prior to loss. (b) Any "employee" authorized by such R. AMENDED INSURED CONTRACT DEFINITION partnership, joint venture, limited - RAILROAD EASEMENT liability company, trust or other 1. The following replaces Paragraph c. of the organization to give notice of an "occurrence" or offense. definition of "insured contract" in the DEFINITIONS Section: (3) Notice to us of such "occurrence" or offense will be deemed to be given as c• Any easement or license agreement; soon as practicable if it is given in good 2. Paragraph f.(1) of the definition of "insured faith as soon as practicable to your contract" in the DEFINITIONS Section is workers' compensation, accident, or deleted. Page 6 of 6 r 2016 The Trave:ers Indemnity Company: All rights reserved. CG D3 79 01 16 Client#: 328663 CRANDARA2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE s/o1 (MM/DD/YYYY) MIDDN 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Tracy Taylor USI Insurance Services NW PR AICNo Ext:208-917-5692 p~C,No: 610-362-8530 601 Union Street, Suite 1000 E-MAIL ADDRESS: tracy.taylor@usi.com Seattle, WA 98101 INSURER(S) AFFORDING COVERAGE NAIC p _ INSURER A'Traveleralndemnlty Company 25658 INSURED INSURER B : Travel- Indemnity Company 25658 Crandall Arambula, P.C. 36196 INSURER C : SAW Corporation 520 SW Yamhill Suite 4 INSURER D XL SIeclattyInsurance Company '37885 Portland, OR 97204 INSURER E charter oak Fire Inaoranc. Company 25615 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 SUB POLIC POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DDY EFF MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY 6809H808264 5/04/2018 051041201 EACH OCCURRENCE $2 OOO,OOO F~vl OCCUR PREMISES Ea occurrence $1,000,000 CLAIMS-MADE MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRO- POLICY ~ X JECT LOC PRODUCTS - COMP/OPAGG $4,000,000 OTHER: $ E AUTOMOBILE LIABILITY BA5E990830 5104/2018 05/04/201 COEaMBINED accident SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per X _ B X~I UMBRELLA LIAB X OCCUR CUP665343251447 5/04/2018 05/04/201 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION $10000 $ C WORKERS COMPENSATION 905493 910112017 09/01/201 X PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ~ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 D Professional DPS9913855 510412017 05/04/202 $2,000,000 per claim Liability $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Comp Information Proprietors/Partners/Executive Officers/Members Excluded: George Crandall, President 8r Donald Arambula, Vice Pres General Liability and Excess include automatic additional insure and waiver of subrogation if required by written contract The City of Ashland, Oregon, and its elected officials, officers and employees are named as an Additional Insured on the General Liability Policy, with respects to operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE C*-a . 4,-,- @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S23027854/M23025251 AXYZP This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAR IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION It - WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance" to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury" coverage for that additional insured, and then "property damage" or "personal injury". and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV - COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization: or The insurance provided to the additional insured d. For "bodily injury "property damage" or is excess over any valid and collectible other insurance, whether primary, excess, contingent or personal injury" for which such person or on any other basis, that is available to the organization has assumed liability in a additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part must apply on a primary basis or a primary and e. This insurance does not apply on any basis to non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this as a named insured for such loss, and we will not Coverage Part, share with the other insurance, provided that, f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs. and "professional services". In the event that the Limits of Insurance of the (2) The "personal injury"` for which coverage is g sought arises out of an offense committed, Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III - person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 49 15 0 2015 The Travelers indemnity Company. All rights reserved Page 1 of 2 Includes she copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION- IV COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury" is work" performed by you, or an your behalf, done caused by an offense committed: under a "written contract requiring insurance with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the "personal injury" offense is committed. Page 2 of 2 0 2015 The Travelers Indemnity Company. All rights reserved, CG D3 81 09 15 Includes the copyrigNed material of insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAR IT CAREFULLY. ARCHITECTS, ENGINEERS AND SURVEYORS COVERAGE XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured K. Additional Insured - Lessor Of Leased Equipment B. Incidental Medical Malpractice L. Additional Insured - State Or Political C. Reasonable Force - Bodily Injury Or Property Subdivisions - Permits Relating To Premises Damage M. Additional Insured - State Or Political D. Non-Owned Watercraft - Increased To Up To 75 Subdivisions - Permits Relating To Operations feet N. Who Is An Insured - Newly Acquired Or Formed E. Aircraft Chartered With Crew Organizations F. Damage To Premises Rented To You O. Knowledge And Notice Of Occurrence Or Offense G. Malicious Prosecution - Exception To Knowing P. Unintentional Omission Violation Of Rights Of Another Exclusion Q. Waiver Of Transfer Of Rights Of Recovery H. Medical Payments - Increased Limit Against Others To Us When Required By Written 1. Increased Supplementary Payments Contract J. Additional Insured - Owner, Manager Or Lessor R. Amended Insured Contract Definition - Railroad Of Premises Easement PROVISIONS Unless you are in the business or occupation A. BROADENED NAMED INSURED of providing professional health care services, "occurrence" also means an act or omission 1. The following is added to SECTION 11 - WHO committed in providing or failing to provide IS AN INSURED: first aid or "Good Samaritan services" to a Any organization, other than a partnership or person.. joint venture, over which you maintain 2. The following is added to the DEFINITIONS ownership or majority interest on the effective Section: date of the policy qualifies as a Named Insured. However, coverage for any such 'Good Samaritan services" means any additional organization will cease as of the emergency medical services for which no date during the policy period that you no compensation is demanded or received. longer maintain ownership of, or majority 3. The following is added to Paragraph 2.a.(1) of interest in, such organization.. SECTION 11- WHO IS AN INSURED: B. INCIDENTAL MEDICAL MALPRACTICE Unless you are in the business or occupation 1. The following is added to the definition of of providing professional health care services. "occurrence" in the DEFINITIONS Section: Paragraphs (1)(a), (b), (c) and (d) above CG D3 79 01 16 ~ 2016 The Travelers Indemnity Company All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY does not apply to any "bodily injury" arising insured. This exclusion does not apply to out of any providing or failing to provide first "bodily injury" or "property damage" resulting aid or "Good Samaritan services" by any of from the use of reasonable force to protect your "employees", other than an employed any person or property. doctor. Any such "employees" providing or D. NON-OWNED WATERCRAFT - INCREASED failing to provide first aid or "Good Samaritan TO UP TO 75 FEET services" during their work hours for you will be deemed to be acting within the scope of 1. The following replaces Paragraph (2) of their employment by you or performing duties Exclusion g., Aircraft, Auto Or Watercraft, related to the conduct of your business, in Paragraph 2. of SECTION I - 4. The following exclusion is added to COVERAGES - COVERAGE A BODILY Paragraph 2., Exclusions, of SECTION I - INJURY AND PROPERTY DAMAGE LIABILITY: COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE (2) A watercraft you do not own that is: LIABILITY in COVERAGES: (a) Less than 75 feet long; and Salve of Pharmaceuticals (b) Not being used to carry any person or "Bodily injury" or "property damage" arising property for a charge; out of the willful violation of a penal statute or 2. The following is added to Paragraph 2. of ordinance relating to the sale of SECTION II -WHO IS AN INSURED: pharmaceuticals committed by, or with the Any person or organization that, with your knowledge or consent of, the insured. express or implied consent, either uses or is S. The following is added to Paragraph S. of responsible for the use of a watercraft that SECTION III - LIMITS OF INSURANCE: you do not own that is: For the purposes of determining the (a) Less than 75 feet long; and applicable Each Occurrence Limit, all related (b) Not being used to carry any person or acts or omissions committed in the providing property for a charge; or failing to provide first aid or "Good Samaritan services" to any one person will be 3. The following is added to Paragraph 4.b., considered one "occurrence". Excess Insurance, of SECTION IV - 6. The following is added to Paragraph 4.b., COMMERCIAL GENERAL LIABILITY CONDITIONS: Excess Insurance, of SECTION IV - COMMERCIAL GENERAL LIABILITY This insurance is excess over any valid and CONDITIONS: collectible other insurance, whether primary, excess, contingent or on any other basis, that This insurance is excess over any valid and is available to the insured for "bodily injury" collectible other insurance, whether primary, that arises out of the use of a watercraft that excess, contingent or on any other basis, that you do not own that is is available to any of your "employees" for "bodily injury" that arises out of providing or (a) Less than 75 feet long; and failing to provide first aid or "Good Samaritan (b) Not being used to carry any person or services" to any person to the extent not property for a charge. subject to Paragraph 2.a.(1) of Section 11 - Who Is An Insured. E. AIRCRAFT CHARTERED WITH CREW C. REASONABLE FORCE - BODILY INJURY OR 1. The following is added to Exclusion g., PROPERTY DAMAGE Aircraft, Auto Or Watercraft, in Paragraph The following replaces Exclusion a., Expected Or 2. of SECTION F - COVERAGES - Intended Injury, in Paragraph 2. of SECTION I - COVERAGE A BODILY INJURY AND COVERAGES - COVERAGE A BODILY PROPERTY DAMAGE LIABILITY in COVERAGES: INJURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft a. Expected Or Intended Injury Or Damage that is: "Bodily injury" or "property damage" expected or intended from the standpoint of the (a) Chartered with crew to any insured; Page 2 of 6 Q 2016 The Travelers Indemnity Company. ASS rights reserved. CG D3 79 01 16 COMMERCIAL GENERAL LIABILITY (b) Not owned by any insured: and 2. The following replaces Paragraph 6. of (c) Not being used to carry any person or SECTION III - LIMITS OF INSURANCE: property for a charge. Subject to 5, above, the Damage To 2, The following is added to Paragraph 4.b., Premises Rented To You Limit is the most we Excess Insurance, of SECTION IV - will pay under Coverage A for damages COMMERCIAL GENERAL LIABILITY because of "property damage" to any one CONDITIONS: premises while rented to you, or temporarily This insurance is excess over any valid and occupied by you with permission of the collectible other insurance, whether primary, owner, caused by fire; explosion; lightning; pis~'' smoke resulting from such fire, explosion, or excess, contingent or on any other basis, that lightning; or water. The Damage To Premises is available to the insured for use of an Rented To You Limit will apply to all damage aircraft that is: proximately caused by the same (a) Chartered with crew to any insured; "occurrence", whether such damage results (b) Not owned by any insured, and from: fire; explosion; lightning; smoke (c) Not being used to carry any person or resulting from such fire. explosion, or property for a charge. lightning; or water; or any combination of any of these. F. DAMAGE TO PREMISES RENTED TO YOU The Damage To Premises Rented To You 1. The following replaces the last paragraph of Limit will be the higher of: Paragraph 2., Exclusions, of SECTION I - a. $1,400,000; or COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE b. The amount shown on the Declarations of LIABILITY in COVERAGES: this Coverage Part for Damage To Exclusions c. through n. do not apply to Premises Rented To You Limit, damage to premises while rented to you, or 3. The following replaces Paragraph a. of the temporarily occupied by you with permission definition of "insured contract" in the of the owner, caused by: DEFINITIONS Section: a. Fire: a. A contract for a lease of premises. b. Explosion; However, that portion of the contract for a c. Lightning; lease of premises that indemnifies any person or organization for damage to d. Smoke resulting from such fire, explosion, premises while rented to you, or or lightning; or temporarily occupied by you with e. Water. permission of the owner, caused by: A separate limit of insurance applies to such (1) Fire; damage to premises as described in (2) Explosion; Paragraph 6. of Section III - Limits Of Insurance. This insurance does not apply to (3) Lightning; damage to premises while rented to you, or (4) Smoke resulting from such fire, temporarily occupied by you with permission explosion, or lightning; or of the owner, caused by: (5) Water, a. Rupture, bursting, or operation of is not an "insured contract"; pressure relief devices; 4. The following replaces Paragraph 4.b.(1)(b) b. Rupture or bursting due to expansion or of SECTION IV - COMMERCIAL GENERAL swelling of the contents of any building or LIABILITY CONDITIONS: structure, caused by or resulting from water; or (b) That is insurance for premises rented to c. Explosion of steam boilers, steam pipes, you, or temporarily occupied by you with the permission of the owner; steam engines, or steam turbines. CG D3 79 01 16 + 2016 The Travelers Inderrrrty Company All rights reserved- Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. MALICIOUS PROSECUTION - EXCEPTION TO insured, but only with respect to liability for "bodily KNOWING VIOLATION OF RIGHTS OF injury", "property damage", "personal injury" or ANOTHER EXCLUSION "advertising injury" that: The following is added to Exclusion a., Knowing a. Is "bodily injury" or "property damage" caused Violation Of Rights Of Another, in Paragraph 2. by an "occurrence" that takes place, or of SECTION I - COVERAGES - COVERAGE B "personal injury" caused by an offense that is PERSONAL AND ADVERTISING INJURY committed, after you have signed that LIABILITY: contract; and This exclusion does not apply to "personal injury" b. Arises out of the ownership, maintenance or caused by malicious prosecution. use of that part of any premises leased to you H. MEDICAL PAYMENTS - INCREASED LIMIT under that written contract. The following replaces Paragraph 7, of SECTION The insurance provided to such premises owner, III - LIMITS OF INSURANCE: manager or lessor is subject to the following 7. Subject to 5. above, the Medical Expense provisions: Limit is the most we will pay under Coverage a. The limits of insurance provided to such C. for all medical expenses because of premises owner, manager or lessor will be "bodily injury" sustained by any one person, the limits which you agreed to provide in the and will be the higher of: written contract. or the limits shown on the (a) $10.000; or Declarations of this Coverage Part, whichever are less. (b) The amount shown on the Declarations of b. The insurance provided to such premises this Coverage Part for Medical Expense Limit. owner, manager or lessor does not apply to: 1. INCREASED SUPPLEMENTARY PAYMENTS (1) "Bodily injury" or "property damage" caused by 1. The following replaces laces Paragraph 1.b. of an "occurrence" that takes 9 p place, or "personal injury" caused by an SUPPLEMENTARY PAYMENTS - offense that is committed, after you COVERAGES A AND B of SECTION I - cease to be a tenant in that premises; or COVERAGES: b. U to $2,500 for cost of bai! bonds (2) Structural alterations, new construction or P demolition operations performed by or on required because of accidents or traffic behalf of such premises owner, manager law violations arising out of the use of any or lessor. vehicle to which the Bodily Injury Liability Coverage applies. We do not have to c. The insurance provided to such premises furnish these bonds, owner, manager or lessor is excess over any 2. The following replaces Paragraph 1.d. of valid and collectible other insurance available SUPPLEMENTARY PAYMENTS _ to such premises owner, manager or lessor, COVERAGES A AND B of SECTION I - unless you have agreed in a written contract COVERAGES: for this insurance to apply on a primary or contributory basis. d. All reasonable expenses incurred by the K. ADDITIONAL INSURED - LESSOR OF LEASED insured at our request to assist us in the investigation or defense of the claim or EQUIPMENT "suit", including actual loss of earnings up The following is added to SECTION II - WHO IS to $500 a day because of time off from AN INSURED: work. Any person or organization that is an equipment J. ADDITIONAL INSURED - OWNER, MANAGER lessor and that you have agreed in a written OR LESSOR OF PREMISES contract to name as an additional insured on this The following is added to SECTION 11 - WHO IS Coverage Part is an insured, but only with respect AN INSURED: to liability for "bodily injury", "property damage", Any person or organization that is a premises "Personal injury" or "advertising injury" that: owner, manager or lessor and that you have a. Is "bodily injury" or "property damage" caused agreed in a written contract to name as an by an "occurrence" that takes place, or additional insured on this Coverage Part is an "personal injury" caused by an offense that is Page 4 of 6 m 2016 The Travelers indemnity Company. All rights reserved. CG D3 79 01 16 COMMERCIAL GENERAL LIABILITY committed, after you have signed that written M. ADDITIONAL INSURED - STATE OR contract; and POLITICAL SUBDIVISIONS - PERMITS b. Is caused, in whole or in part, by acts or RELATING TO OPERATIONS omissions of you or any person or The following is added to Paragraph 2. of organization performing operations on your SECTION li -WHO IS AN INSURED: behalf, in the maintenance, operation or use Any state or political subdivision that has issued a of equipment leased to you by such permit with respect to operations performed by equipment lessor. you or on your behalf is an insured, but only with The insurance provided to such equipment lessor respect to "bodily injury", "property damage", is subject to the following provisions: "personal injury" or "advertising injury" arising out of operations performed by you or on your behalf a. The limits of insurance provided to such for which that state or political subdivision has equipment lessor will be the limits which you issued such permit. However, no such state or agreed to provide in the written contract, or political subdivision is an insured for. the limits shown on the Declarations of this (1) "Bodily injury", "property damage", "personal Coverage Part, whichever are less; and injury" or "advertising injury" arising out of b. The insurance provided to such equipment operations performed for that state or political lessor does not apply: subdivision; or (1) To any "bodily injury" or "property (2) "Bodily injury" or "property damage" included damage" caused by an "occurrence" that within the "products - completed operations takes place, or "personal injury" caused hazard". by an offense that is committed, after the N. WHO IS AN INSURED NEWLY ACQUIRED equipment lease expires; or OR FORMED ORGANIZATIONS (2) If the equipment is leased with an The following replaces Paragraph 4.a. of operator. SECTION 11- WHO IS AN INSURED: c. The insurance provided to such equipment a. Coverage under this provision is afforded lessor is excess over any valid and collectible only:, other insurance available to such equipment (1) Until the 180th day after you acquire or lessor, unless you have agreed in a written form the organization or the end of the contract for this insurance to apply on a policy period, whichever is earlier, if you primary or contributory basis. do not report such organization in writing L. ADDITIONAL INSURED - STATE OR to us within 180 days after you acquire or POLITICAL SUBDIVISIONS - PERMITS forma; or RELATING T O PREMISES (2) Until the end of the policy period, when The following is added to Paragraph 2. of that date is later than 180 days after you SECTION 11- WHO 1S AN INSURED: acquire or form such organizations, if you report such organization in writing to us Any state or political subdivision that has issued a within 180 days after you acquire or form permit in connection with premises owned or it, occupied by, or rented or loaned to, you. is an O, KNOWLEDGE AND NOTICE OF insured, but only with respect to "bodily injury", OCCURRENCE OR OFFENSE "property damage" "personal injury" or "advertising injury" arising out of the existence, The following is added to Paragraph 2., Duties In ownership, use, maintenance, repair, The Event of Occurrence, Offense, Claim Or construction, erection or removal of advertising Suite of SECTION 1V - COMMERCIAL signs, awnings, canopies, cellar entrances. coal GENERAL LIABILITY CONDITIONS: holes, driveways, manholes, marquees, hoist e. The following provisions apply to Paragraph away openings, sidewalk vaults, elevators, street a. above. but only for the purposes of the banners or decorations for which that state or insurance provided under this Coverage Part political subdivision has issued such permit. to you or any insured listed in Paragraph 1. or 2. of Section 11- Who Is An Insured: CG D3 79 01 16 201.6 The Travelers lndemn-ty Company All rghts reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY (1) Notice to us of such "occurrence" or of an health insurer. This applies only if you offense must be given as soon as subsequently give notice to us of the practicable only after the "occurrence" or "occurrence" or offense as soon as offense is known to you (if you are an practicable after any of the persons individual), any of your partners or described in Paragraphs e. (1) or (2) members who is an individual (if you are a above discovers that the "occurrence" or partnership or joint venture), any of your offense may result in sums to which the managers who is an individual (if you are insurance provided under the Coverage a limited liability company), any of your Part may apply. trustees who is an individual (if you are P. UNINTENTIONAL OMISSION a trust), any of your "executive officers" or The following is added to Paragraph 6., directors (if you are an organization other than a partnership, joint venture, limited Representations. of SECTION IV - liability company or trust), or any COMMERCIAL GENERAL LIABILITY "employee" (such as an insurance, loss CONDITIONS: control or risk manager or administrator) The unintentional omission of. or unintentional authorized by you to give notice of an error in, any information provided by you which "occurrence" or offense. we relied upon in issuing this policy will not Knowledge by any other "employee" of an prejudice your rights under this insurance. "occurrence" or offense does not imply However, this provision does not affect our right that you also have such knowledge, to collect additional premium or to exercise our rights of cancellation or nonrenewal in (2) If you are a partnership, joint venture, accordance with applicable insurance laws or limited liability company or trust, and regulations. none of your partners, joint venture members, managers or trustees are Q. WAIVER OF TRANSFER OF RIGHTS OF individuals, notice to us of such RECOVERY AGAINST OTHERS TO US WHEN "occurrence" or offense must be given as REQUIRED BY WRITTEN CONTRACT soon as practicable only after the The following is added to Paragraph 8., Transfer "occurrence" r offense is known by: of Rights of Recovery Against Others to Us, of (a) Any individual who is: SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: (1) A partner or member of any partnership or joint venture; We waive any right of recovery we may have against any person or organization because of (ii) A manager of any limited liability payments we make for injury or damage arising company; out of premises owned or occupied by or rented (ill) A trustee of any trust; or or loaned to you; ongoing operations performed (iv) An executive officer or director of by you or on your behalf, done under a written any other organization; contract with that person or organization; "your work"; or "your products". We waive this right that is our partner, joint venture Y 1 where you have agreed ro do so as art of a member, manager or trustee: or Y p written contract signed by you prior to toss. (b) Any "employee" authorized by such R. AMENDED INSURED CONTRACT DEFINITION partnership, joint venture, limited - RAILROAD EASEMENT liability company, trust or other 1 The following replaces Paragraph c. of the organization to give notice of an definition of "insured contract" in the "occurrence" or offense. DEFINITIONS Section: (3) Notice to us of such "occurrence" or offense will be deemed to be given as c. Any easement or license agreement; soon as practicable if it is given in good 2. Paragraph f.(1) of the definition of "insured faith as soon as practicable to your contract" in the DEFINITIONS Section is workers' compensation, accident, or deleted. Page 6 of 6 &2016 2016 The Trave;ers Indemnity Company: All nghts reserved. CG D3 79 01 16 i I