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HomeMy WebLinkAboutInsurance Certificate - Pacific Electrical Contractors Inc. - I A~oRO® CERTIFICATE OF LIABILITY INSURANCE F DATE (MM/DDYYYV) 6/18/2018 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: Kim SChnetzk Ward Insurance Agency Inc. PHONE FAX PO Box 10167 A/C No E110: 541-687-1117 A/c No): 541-342-8280 Eugene OR 97440 A DRless: kim@wardinsurance.net INSURER(S) AFFORDING COVERAGE NAIC # i INSURER A : Cincinnati Casualty 28665 INSURED PACIELE-01 INSURER B : Columbia Casualty Insurance Company 31127 Pacific Electrical Contractors Inc 920 S. Grape Street INSURER C Medford OR 97501 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 801522771 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD YYYY MM/DD YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY Y Y EPP 0488739 7/1/2018 7/1/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $50" 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 F POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 JECT Fx] OTHER: Limited Pollution $ 1,000,000 A AUTOMOBILE LIABILITY Y Y EBA 0488739 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ x HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR EPP 0488739 7/1/2018 7/1/2019 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below F.L. nISEASE - POLICY LIMIT $ _ A Installation Floater EPP 0488739 7/1/2018 7/1/2019 Limit $500.000 Ded: $1.000 B Professional Liability 02088371577 7/112018 7/1/2019 Limit $2,000,000 Ded: $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Ashland Booster Pump Station Integration Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations and auto liability, including waiver of subrogation as required by written contract per attached endorsements. Subject to policy limits, terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4. Subject to the above limit, deductible, and K. Transportation Expense - Higher Limits 2. SECTION V - DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards excess provisions we will provide cover- by adding the following, but only for the age equal to the broadest coverage appli- SECTION III - PHYSICAL DAMAGE COV- purposes of this Loan or Lease Gap SECTION IV - BUSINESS AUTO CONDI- cable to any covered "auto" you own in- ERAGE, A. Coverage, 4. Coverage Exten- Coveraga TIONS, B. General Conditions, 2. Conceal- sured under this policy. sions is amended by replacing $20 per day ment, Misrepresentation or Fraud is with $50 per day. and $600 maximum with "Total loss" means a "loss" in which the amended by adding the following: Coverage includes loss of use of that hired au- $1,500 maximum in Extension a. Transpor- cost of repairs plus the salvage value ex- to, provided it results from an "accident" for tation Expenses. ceeds the actual cash value. However, if you unintentionally fail to disclose which you are legally liable and as a result of any hazards existing on the effective date of which a monetary loss is sustained by the L. Airbag Coverage N. Glass Repair - Waiver of Deductible this Coverage Form, we will not deny cover- leasing or rental concern. The most we will age under this Coverage Form because of pay for any one "accident" is $3.000. ERAGE, SECTION B. III E-xclusions, 3PHYSICAL.a. is ameDAMAGEnded b by y CO ERAGE, SECTION D. III - Deductible is aPHYSICALmended by DAMAGE COV adding - such failure. If a limit for Hired Auto - Physical Damage is adding the following: the following: Q. Mental Anguish Resulting from Bodily Inju- shown in the Schedule, then that limit re lac- ry p However, the mechanical and electrical No deductible applies to glass damage if the es, and is not added to, the $50,000 limit indi- breakdown portion of this exclusion does not glass is repaired in a manner acceptable to us SECTION V - DEFINITIONS, C. "Bodily inju- cated above. apply to the accidental discharge of an airbag. rather than replaced. ry" is deleted in its entirety and replaced by J. Rental Reimbursement This coverage for airbags is excess over any the following: other collectible insurance or warranty. O. Duties in the Event of an Accident, Claim, SECTION III - PHYSICAL DAMAGE is Suit or Loss - Amended "Bodily injury" means bodily injury, sickness or amended by adding the following: M. Loan or Lease Gap Coverage disease sustained by a person, including men- SECTION IV - BUSINESS AUTO CONDI- tal anguish and death sustained by the same 1. We will pay for rental reimbursement ex- 1. SECTION III - PHYSICAL DAMAGE TIONS, A. Loss Conditions, 2. Duties in the person that results from such bodily injury, penses incurred by you for the rental of COVERAGE, C. Limit of Insurance is Event of Accident, Claim, Suit or Loss, a. is sickness or disease. "Bodily injury" does not an "auto" because of a "loss" to a covered deleted in its entirety and replaced by the amended by adding the foiiowing: include mental anguish or death that does not "auto". Payment applies in addition to the following, but only for private passenger otherwise applicable amount of each cov- type "autos" with an original loan or lease, This condition applies only when the "acci- result from bodily injury, sickness or disease. and only in the event of a "total loss" to dent" or "loss" is known to: R. Coverage for Certain Operations in Con- Con- erage deductible you have applies s t [o a this covered " coverage. auto". No such a private passenger type "auto": 1. You, if you are an individual: nectio nwith Railroads deductible 2. We will pay only for those expenses in- a. The most we will pay for "loss" in any 2. A partner, if you are a partnership; With respect to the use of a covered "auto" in curred during the policy period beginning one "accident" is the greater of: operations for or affecting a railroad: 24 hours after the "loss" and ending, re- 3. An executive officer insurance manag- gardless of the policy's expiration, with (1) The amount due under the terms er, if you are a corporation; or 1. Section V - Definitions, "Insured con- the lesser of the following number of of the lease or loan a which tract", 1.c. is amended to read: your covered private passenger 4. A member or manager, if you area lim- days: type "auto" is subject, but will not ited liability company. c. An easement or license agreement; a. The number of days reasonably re- include: 2. Section V - Definitions, H. "Insured con- quired to repair the covered "auto". If tract". 2.a. is deleted. "loss" is caused by theft, this number (a) Overdue lease or loan pay- y menu; of days is added to the number of days it takes to locate the covered (b) Financial penalties imposed "auto" and return it to you; or under the lease due to high b. 30 days. mileage, excessive use or abnormal wear and tear; 3. Our payment is limited to the lesser of the (c) Security deposits not re- following amounts: funded by the lessor: a. Necessary and actual expenses in- (d) Costs for extended warran- curred; or ties. Credit Life Insurance, b. $50 per day. Health, Accident or Disabil- ity Insurance purchased 4. This coverage does not apply while there with the loan or lease, and are spare or reserve "autos" available to you for your operations. (e) Carry-over balances from previous loans or leases, or 5. We will pay under this coverage only that amount of your rental reimbursement ex- (2) Actual cash value of the stolen penses which is not already provided for or damaged property. under SECTION III - PHYSICAL DAM- b. An adjustment for depreciation and AGE COVERAGE, A. Coverage, 4. physical condition will be made in de- Coverage Extensions. termining actual cash value at the time of "loss". Includes copyrighted material of ISO Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 3 of 4 AA 288 01 16 Properties, Inc., with its permission. Page 4 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. However, any "auto" that is leased, a. Is effective on the date of acquisition hired, rented or borrowed with a driver or formation, and is afforded for 180 is not a covered "auto". days after such date: CinciPlus° E. Audio, Visual and Data Electronic Equip- b. Does not apply to "bodily injury" or BUSINESS AUTO XC+® ment "property damage" resulting from an "accident" that occurred before you EXPANDED COVERAGE PLUS SECTION III - PHYSICAL DAMAGE COV- acquired or formed the organization; ERAGE, C. Limit of insurance is amended ENDORSEMENT by adding the following: Does not apply to any newly acquired 4. The most we will pay for all "loss" to au- or formed organization that is a joint venture or partnership; and dio, visual or data electronic equipment This endorsement modifies insurance provided by the following: and any accessories used with this d. Does not apply to an insured under equipment as a result of any one "acci- any other automobile liability policy, BUSINESS AUTO COVERAGE FORM dent" is the lesser of: or would be an insured under such a a. The actual cash value of the dam- policy but for the termination of such policy or the exhaustion of such poli- With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless aged or stolen property as of the time cy's limits of insurance. of the "accident modified by this endorsement. b. The cost of repairing or replacing the 3. Any of your "employees" while using a - covered auto" in your business or your damaged or stolen property with oth A. Blanket Waiver of Subrogation This provision does not apply unless the valid personal affairs, provided you do not own, er property of like kind and quality: or hire or borrow that "auto". written contract has been: SECTION IV - BUSINESS AUTO CONDI- c. $2,500. TIONS, A. Loss Conditions, 5. Transfer of 1. Executed prior to the accident causing G. Liability Coverage Extensions - Supple- Rights of Recovery Against Others to Us is "bodily injury" or "property damage", and Provided the equipment, at the time of the mentary Payments - Higher Limits amended by the addition of the following: 2. Is still in force at the time of the "accident" "loss" is: SECTION II - LIABILITY COVERAGE, A. We waive any right of recovery we may have causing "bodily injury" or "property dam- a. Permanently installed in or upon the Coverage, 2. Coverage Extensions, a. Sup- against any person or organization because of age". covered "auto" in a housing, opening plementary Payments is amended by: payments we make for "bodily injury" or or other location that is not normally "property damage" arising out of the operation D. Employee Hired Auto used by the "auto" manufacturer for 1. Replacing the 0 Limit of Insurance for bail bonds with th $4,000 in (2): and of a covered "auto" when you have assumed 1. Changes in Liability Coverage the installation of such equipment; liability for such "bodily injury" or "property 2. Replacing the $250 Limit of Insurance for damage" under an "insured contract", rovid- The following is added to the Section II - b. Removable from a permanently in- reasonable expenses with $500 in (4). p g stalled housing unit as described in ed the "bodily injury" or "property damage" oc- Liability Coverage, A. Coverage, 1. 9 u curs subsequent to the execution or the "in- Who is an Insured: Paragraph 2.a. above; or H. Amended Fellow Employee Exclusion sured contract"' An "employee" of yours is an "insured" c. An integral part of such equipment. SECTION II -LIABILITY COVERAGE, B. Ex- B. Noncontributory Insurance while operating an "auto" hired or rented clusions, 5. Fellow Employee is modified as F. Who is an Insured - Amended follows: under a contract or agreement in that SECTION IV - BUSINESS AUTO CONDI- "employee's" name, with your permission. SECTION II - LIABILITY COVERAGE, A. Exclusion S. Fellow Employee is deleted. TIONS, B. General Conditions, 5. Other In- while performing duties related to the Coverage, 1. Who is an Insured is amended surance c. is replaced by the following: conduct of your business. by adding the following: I. Hired Auto - Physical Damage c. Regardless of the provisions of Par- 2, Changes in General Conditions The following are "insureds": If hired "autos" are covered "autos" for Liability agraph a. above, this Coverage Coverage, then Comprehensive and Collision Form's Liability Coverage is primary SECTION IV - BUSINESS AUTO CON- 1. Any subsidiary which is a legally incorpo- Physical Damage Coverages as provided un- and we will not seek contribution DITIONS, B. General Conditions, S. rated entity of which you own a financial der SECTION III - PHYSICAL DAMAGE from any other insurance for any lia- Other Insurance is amended by replac- interest of more than 50% of the voting COVERAGE of this Coverage Part are ex- bility assumed under an "insured ing Paragraph 5.b. with the following: stock on the effective date of this cover- tended to "autos" you hire, subject to the fol- contract" that requires liability to be b. For Hired Auto Physical Damage age form. lowing: assumed on a primary noncontributo- Coverage the following are deemed However, the insurance afforded by this ry basis. to be covered "autos" you own: provision does not apply to any subsidiary hired "auto" The most w is will pay for "loss" to any " is $50,000 or the actual cash C. Additional Insured by Contract that is an "insured" under any other au- value or cost to repair or replace, which- (1) Any covered "auto" you lease, tomobile liability policy, or would be an SECTION II - LIABILITY COVERAGE, A. hire, rent or borrow: and "insured" under such policy but for termi- ever is the least, minus a deductible. Coverage, I. Who is an Insured is amended est to include as an insured any person or organi- (2) Any covered "auto" hired or nation of such slit or the exhaustion of 2. The deductible will bee equal to the largest zation with which you have agreed in a valid rented by your "employee" under such policy's limits of insurance. deductible applicable to u any owned "a a contract in that individual "em for that coverage, or $1,000, whichever is written contract to provide insurance as is af- 2. Any organization that is newly acquired or less. forded by this policy. ployee's" name, with your per- formed by you and over which you main- mission, while performing duties tain majority ownership. The insurance 3. Hired Auto - Physical Damage coverage This provision is limited to the scope of the related to the conduct of your provided by this provision: is excess over any other collectible insur- valid written contract. business. ante. Includes copyrighted material of ISO Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 1 of 4 AA 288 01 16 Properties, Inc., with its permission. Page 2 of 4 graphs 9.a.(3)(a) or 9.b. agreement specifies (2) Deductible Clause a. Nurses, above, or any combina- the Insurance Services lion thereof, shall be in- Office additional in- (a) Our obligation to pay dam- b. Emergency Medical Technicians, or lerpreted as providing sured form number CG ages on your behalf applies the limits or coverage 20 10 but does not only to the amount of dam- c. Paramedics, required by the terms of specify which edition, or ages for each "occurrence" in the jurisdiction where an "occurrence" the written contract or specifies an edition that which are in excess of the or offense to which this insurance applies agreement, but only to does not exist, Para- Deducible amount stated in takes place. the extent that such lim- graphs 9.a.3.b. and Section B. Limits of Insur- its or coverage is in- 9.b. of this endorse- ance, 11. of this endorse- 13. Broadened Notice of Occurrence cluded within the terms ment shall not apply ment. The limits of insur- of the Coverage Part to and Paragraph ance will not be reduced by Paragraph a. of Condition 2. Duties in which this endorsement 9.a.(3)(a) of this en- the application of such De- the Event of Occurrence, Offense, is attached. dorsement shall apply. ductible amount. Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- b. With respect to addi- 10. Broadened Contractual Liability -Work (b) Condition 2. Duties in the TIONS) is hereby deleted and replaced by tional insureds de- Within 50' of Railroad Property Event of Occurrence, Of- the following: scribed in Paragraph fense. Claim or Suit, ap- 9.a.(2)(g) above only: It is hereby agreed that Paragraph f.(1) of plies to each claim or "suit" a. You must see to it that we are notified Definition 12. "Insured contract" (SEC- irrespective of the amount. as soon as practicable of an "occur- If a written contract or TION V - DEFINITIONS) is deleted. rence' or an offense which may result agreement between (c) We may pay any part or all in a claim. To the extent possible, no- you and the additional 11. Property Damage to Borrowed Equip- of the deductible amount to tice should include. insured specifies that ment effect settlement of any coverage for the addi- claim or "suit" and, upon no- (1) How, when and where the "oc- a. The following is hereby added to Ex- tification of the action taken, currence" or offense took place, tional insured: clusion j. Damage to Property of you shall promptly reim- The names and addresses of a. Be provided by the Paragraph 2., Exclusions of SEC- burse us for such part of the (2) Insurance Ser- TION I -COVERAGES, COVERAGE deductible amount as has any injured persons and wit- vices Office addi- A. BODILY INJURY AND PROP- been paid by us. nesses; and tional insured form ERTY DAMAGE LIABILITY (3) The nature and location of any number CG 20 10 12. Employees as Insureds - Specified in damage arising out of Paragraphs (3) and (4) of this a - Health Care Services lurY or g or CG 20 37 sion do not apply to tools or equip- the "occurrence" or offense. (where edition ment loaned to you, provided they are It is hereby agreed that Paragraph specified); or not being used to perform operations 2.a.(1)(d) of SECTION II - WHO IS AN This requirement applies only when at the time of loss. INSURED, does not apply to your "em- the "occurrence" offense is known b. Include coverage to an "authorized representative". for completed op- b. With respect to the insurance pro- care a who provide professional health erations. or vided by this section of the endorse- ae services on your behalf as duly li- ment, the following additional ~ovi- censed: c. Include coverage 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) or 9.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- crrrenoe" 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 malenal of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 15 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 16 of 16 organization with which you (a) Subparagraphs (e), (f) and chitectural or engi- primary to other insurance have agreed per Paragraph (g) do not apply to 'bodily in- neering activities. available to the additional 9.a.(1) above to provide in- jury' or "property damage" insured except surance, but only to the ex- included within the "prod- 3) Professional services tent that the liability is uds-completed operations do not include services 1) As otherwise provided caused by "your world per- hazard", within construction in SECTION IV - formed for that additional in- means, methods, tech- COMMERCIAL GEN- sured and only to the extent (b) Subparagraphs (a), (d), (e) niques, sequences and ERAL LIABILITY that such liability is caused and (g) do not apply to "bod- procedures employed CONDITIONS, S. by your negligence or the ily injury", "property dam- by you in connection Other Insurance, b. negligence of those acting age" or "personal and ad- with construction work Excess Insurance, or on your behalf. A person or vertising injury' arising out you perform. organization's status as an of the sole negligence or 2) For any other valid and insured under this provision willful misconduct of the ad- (d) Subparagraphs (f) and (g) collectible insurance of this endorsement oontin- ditional insured or its "em- do not apply to "bodily in- available to the addi- ues for only the period of ployees"; or jury' or "property damage" tional insured as an ad- required by the written arising out of "your work" for ditional insured by at- time time rd or agreement, but (c) Subparagraph (f) and (g) do which a consolidated (wrap- tachment of an en- not apply to 'bodily injury", up) insurance program has dorsement to another in no event beyond the expi- "property damage" or "per- been provided by the prime insurance policy that is ration date of this Coverage sonal and advertising injury" contractor/ project manager written on an excess Part. If there is no written arising out of: or owner of the construction basis. In such case, the contract or agreement, or if project in which you are in- coverage provided un- no period of time is required 1) The rendering of, or volved. der this endorsement by the written contract or failure to render, any shall also be excess. agreement, a person or or- professional services b. Only with regard W insurance pro- ganization's status as an in- by you or on your be- vided to an additional insured desig- (2) Condition 11. Conformance to sured under this endorse- half, but only with re- nated under Paragraph 9.a.(2) Sub- Specific Written Contract or ment ends when your op- sped to either or both paragraphs (f) and (g) above, SEC- Agreement is hereby added: erations for that insured are of the following opera- TION III - LIMITS OF INSURANCE is completed. bons: amended to include 11. Conformance to Specific Written Contract or (g) For "your work" performed a) Providing engi- The limits applicable to the additional Agreement in the "coverage territory" nearing, architec- insured are those specified in the but not in Oregon, any per- tural or surveying written contract or agreement or in a. With respect to addi- son or organization with services to others, the Declarations of this Coverage tional insureds de- which you have agreed per and Part, whichever are less. If no limits scribed in Paragraph Paragraph 9,a.(1) above to are specified in the written contract or 9.a.(2)(f) above only: provide insurance, but only b) Providing, or hiring agreement, or if there is no written with rasped to liability ans- independent pro- contract or agreement, the limits ap- If a written contract or ing out of "your work" per- fessionals to pro- plicable to the additional insured are agreement between vide, engineering, you and the additional formed for that additional in- those specified in the Dedarations of insured species that sured by you or on your be- architectural or this Coverage Part. The limits of in- coverage for the addi- haft. A person or organiza- surveying services surance are inclusive of and not in tional insured : tion's status as an insured in connection with addition to the limits of insurance under this provision of this construction work shown in the Dedarations. (1) Be provided by the endorsement continues for you perform. only the period of time re- c. SECTION IV - COMMERCIAL GEN- vices Office addi- quired by the written con- 2) Subject to Paragraph 3) ERAL LIABILITY CONDITIONS is tional insured form below, professional hereby amended as follows: tract or agreement, but in no services include: number CG 32 61, event beyond the expiration CG 32 62 or CG date of this Coverage Part. a) Preparing, approv- (1) Condition Other Insurance is 32 63, or If there is no written contract ing, or failing to amended to o include: or agreement, or if no period prepare or ap- (a) Where required by a written (2) Include coverage of time is required by the prove, maps, shop contract or agreement, this for completed op- Written contract or agree- drawings, opin- insurance is primary and/or erations, or ment, a person or organiza- ions, reports, sur- noncontributory as respects (3) Include coverage tiori s status as an insured veys, field orders, any other insurance policy for "your work!', under this endorsement change orders, or issued to the additional in- ends when your operations drawings and sured, and such other in- and where the limits or for that insured are corn- specifications; and surance policy shall be ex- coverage provided to pleted. cess and / or nonoontribut- the additional insured is b) Supervisory or in- ing, whichever applies, with more restrictive than (3) Any insurance provided to an spection activities this insurance. was specifically re- additional insured designated performed as part quired in that written under Paragraph 9.a.(2): of any related ar- (b) Any insurance provided by contract or agreement, this endorsement shall be the terms of Para- Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 13 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 14 of 16 (a) The written or oral contract or use of equipment leased e) Any failure to Part with respect or agreement is: to you by such person(s) or make such inspec- to such products. 1 Currently in effect or organizations(s). However, tans, adjustments, h' this insurance does not ap- tests or servicing (d) Any state or political se becomes effective dud- ply to any "occurrence" as the vendor has vision with which you have ing the policy period; which takes place after the agreed to make or agreed per Paragraph and equipment lease expires. normally under- 9.a. 1 above to provide in- g) Executed prior to an takes to make in surance, subject to the fol- "occurrence" or offense an (c) Any person or organization the usual course of lowing additional provision: (referred to below as ven- business, in con- to which this insurance dor) with whom you have nection with the This insurance applies only would apply, and agreed per Paragraph with respect to the following b They are not 9.a.(1) above to provide in- distribution or sale hazards for which the state ( ) y specifically of the products; or political subdivision has named as an additional in- surance, but only with re- Po sured under any other pro- sped to "bodily injury' or f) Demonstration, in- issued a permit in connec- vision of, or endorsement "property damage" arising stallation, servicing tion with premises you own, added to, this Coverage out of "your products" which or repair opera- rent or control and to which Part. are distributed or sold in the lions, except such this insurance applies: regular course of the ven- operations per- 1) The existence, mainte- (2) Only the following persons or or- does business, subject to formed at the ven- nance, repair, construc- ganizations are additional insur- the following additional ex- dor's premises in tion, erection, or re- eds under this endorsement, and clusions: connection with moval of advertising insurance coverage provided to the sale of the signs, awnings, cano- sudi additional insureds is lion- 1) The insurance afforded the vendor does not product; pies, cellar entrances, ited as provided herein: apply to: g) Products which, coal holes, driveways, (a) The manager or lessor of a after distribution or manholes, marquees, premises leased to you with a) "Bodily injury" or sale by you, have hoist away openings, whom you have agreed per "property damage" been labeled or re- sidewalk vaults, street Paragraph 9.a.(1) above to for which the ven- labeled or used as banners, or decorations provide insurance, but only dor is obligated to a container, part or and similar exposures; with respect to liability aris- pay damages by ingredient of any or ing out of the ownership, reason of the as- other thing or sub- maintenance or use of that sumption of liability stance by or for 2) The construction, erec- part of a premises leased to in a contract or the vendor, or lion, or removal of ele- you, subject to the following agreement. This vators; or additional exclusions: exclusion does not h) "Bodily injury" or apply to liability for "property damage" 3) The ownership, main- This insurance does not ap- damages that the arising out of the tenants, or use any ply to: vendor would have negligence, acts or elevators covered d by in the absence of omissions of the this insurance. 1) Any "occurrence" which the contract or vendor, its em- (e) Any state or political subdi- takes place after you agreement; ployees or anyone vision with which you have cease to be a tenant in else acting on its agreed per Paragraph that premises. b) Any express war- behalf. 9.a.(1) above to provide n- ranty unauthorized 2) Structural alterations, by you, 2) This insurance does not lowiows n subject to the fd- new construction or lowing provisions demolition operations c) Any physical or apply to any insured person or organization: 1) This insurance applies performed by or on be- chemical change only half of such additional in the product a) From whom you with respect to er by insured. made intentionally have acquired you or performed by by the vendor; such products, or you on your behalf (b) Any person or organization for which the state or from which you lease d) Repackaging, ex- any ingredient, political subdivision has equipment with whom you cept when un- part or container, issued a permit. have agreed per Paragraph packed solely for entering into, ac- have above to provide in- the purpose of in- containing companyg such h 2) This insurance does not surance. Such person(s) or spection, demon- apply to "bodily injury", organization(s) are insureds, stration, testing, or products; or "property damage" or but only to the extent that the substitution of b) When liability in- personal and acv of the liability for "bodily injury', parts under in- cluded within the ing injury" arising out t d "property damage" or "per- structions from the "products- operations performed sonal and advertising injury" manufacturer, and completed opera- for the state or political is caused by your negf- then repackaged tions hazard" has subdivision. gence, acts or omissions in in the original con- been excluded un- (f) For "your work" performed the maintenance, operation tainer, der this Coverage in Oregon, any person or Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 11 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 12 of 16 a) Foundations, one "occurrence" to which b. Care, Custody or Control Liability deductible amount as has been walls, floors or this insurance applies. Coverage paid by us. paved surfaces, (3) The amount we will pay is limited SECTION I - COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or b) Basements, as described in Section B. Lim- ERAGE A. BODILY INJURY AND Acquired Organizations whether paved or its of Insurance. 3. Damage to PROPERTY DAMAGE LIABILITY, 2. SECTION II -WHO IS AN INSURED is not, or Premises Rented to You of this Exclusions, j. Damage to Property. Doors, windows or endorsement. apply graphs (3), (4) and (5) do not amended as follows: "property damage" to the C) other openings. 4. Supplementary Payments properly of others described therein. Subparagraph a. of Paragraph 4. is hereby deleted and replaced by the fol- (c) Loss caused by or resulting Under SECTION I - COVERAGE, SUP- With respect to the insurance provided by lowing: from water that leaks or PLEMENTARY PAYMENTS - COVER- this section of the endorsement, the fol- Flows from plumbing, heat- AGES A AND B: lowing additional provisions apply: a. Insurance under this provision is er ing, air conditioning, or fire forded only until the 180th day after protection systems caused a. Paragraph 2. is replaced by the fol- a. The Limits of Insurance shown in the you acquire or form the organization by or resulting from freezing, lowing: Declarations are replaced by the lim- or the end of the policy period, unless: Up to the limit shown in Section B its designated in Section B. Limits of whichever is earlier, B. 1) You did your best to Limits of Insurance, 4.a. Bail Bonds DInsu ama a ea . Calu re, tary Prope t 8. Waiver of Subrogation maintain heat in the of this endorsement for cost id bailents Control Liability Coverage of this SECTION IV -COMMERCIAL GENERAL building or structure: or bonds required because of accid 9 endorsement with respect to cover- LIABILITY CONDITIONS, 9. Transfer of or traffic law violations arising out of age provided by this endorsement. Rights of Recovery Against Others to 2) You drained the equip- the use of any vehicle to which the These limits are inclusive of and not Us is hereby amended by the addition of - ment and shut t off the Bodily Injury Liability Coverage ap water supply if the heat plies. We do not have to furnish in addition to the limits being re- the following: was not maintained. these bonds. placed. The Limits of Insurance shown in Section B. Limits of Insur- We waive any right of recovery we may (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- ante, 6. Voluntary Property Dam- have because of payments we make for lowing: age and Care. Custody or Control injury or damage arising out of your ongo- 1) Plumbing, heating, air Liability Coverage of this endorse- ing operations or "your work" done under conditioning, fire pro- All reasonable expenses incurred by ment fix the most we will pay in any a written contract requiring such waiver tection systems, or the insured at our request to assist us one "occurrence" regardless of the with that person or organization and in- other equipment or ap- in the investigation or defense of the number of eluded in the "products-completed opera- pliances; or claim or "suit", including actual loss of tions hazard". However, our rights may earnings up to the limit shown in Sec- (1) Insureds; only be waived prior to the "occurrence" 2) The interior of any tion B. Limits of Insurance, 4.b. giving rise to the injury or damage for building or structure, or Loss of Earnings of this endorsement (2) Claims made or "suits" brought; which we make payment under this Cov- to personal property in per day because of time off from or erage Part. The insured must do nothing the building or structure work after a loss to impair our rights. At our re- caused by or resulting (3) Persons or organizations making quest, the insured will bring "suit"or trans- from rain, snow, sleet 5. Medical Payments claims or bringing "suit'. fer those rights to us and help us enforce or ice, whether driven b. Deductible Clause those rights. by wind or not. The Medical Expense Limit of Any One Person as stated in the Declarations is (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- e. Limit of Insurance amended to the limit shown in Section B. on your behalf applies only to the Pied Relationships Limits of Insurance, 5. Medical Pay- amount of damages for each The Damage to Premises Rented to ments of this endorsement. a. The following is hereby added to You Limit as shown in the Dedara- "occurrence" which are in excess tions is amended as follows 6. Voluntary Property Damage and Care, of the deductible amount stated SECTION II -WHO IS AN INSURED Custody or Control Liability Coverage in Section B. Limits of Insur- (1) Any person or organization de- (2) Paragraph 6. of SECTION III - ante, 6. Voluntary Property scribed in Paragraph 9.a.(2) be- LIMITS OF INSURANCE is a. Voluntary Property Damage Cov- Damage and Care, Custody or low (hereinafter referred to as hereby deleted and replaced by erage Control Liability Coverage of additional insured) whom you are the following: this endorsement. The limits of required to add as an additional We will pay for "property damage" to insurance will not be reduced by 6. Subject to S. above, the property of others arising out of op- the application of such deducti- insured under this Coverage Part Damage to Premises erations incidental to the insured's ble amount. by reason of Rented to You Limit is the business when (a) A written contract or agree- most we will pay under (2) Condition 2. Duties in the Event ment, or COVERAGE A. BODILY (1) Damage is caused by the in- of Occurrence, Offense, Claim INJURY AND PROPERTY sired; or or Suit, applies to each claim or (b) An oral agreement or con- DAMAGE LIABILITY, for (2) Damage occurs while in the in- "suit" irrespective of the amount. tract where a certificate of damages because of "prop- sured's possession. insurance showing that per- erty damage" to premises (3) We may pay any part or all of the son or organization as an while rented to you or tem- With your consent, we will make deductible amount to effect set- additional insured has been porarily occupied by you these payments regardless of fault. dement of any claim or "suit" issued, with permission of the and, upon notification of the ac- tion taken, you shall promptly re- is an insured, provided: imburse us for such part of the Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 9 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 10 of 16 This insurance shall not providing some or all of the ages are claimed and The exclusions under SECTION cover any loss for following benefits to "em- to which the insured I - COVERAGES, COVERAGE which the insured is en- ployees', whether provided must submit or does A. BODILY INJURY AND titled to recovery under through a "cafeteria plan" or submit with our con- PROPERTY DAMAGE LIABIL- any other insurance in otherwise: sent; ITY, 2. Exclusions, other than i. force previous to the ef- War and the Nuclear Energy fective date of this a. Group life insurance, b. Any other alternative Coverage Part. group accident or dispute resolution pro- and the following are added health insurance ; den- ceeding in which such e. Additional Definitions tal, vision and hearing damages are claimed This insurance does not apply to: plans, and in- As respects Employee Benefit Li- spending accounts' sand u ed it submits with our (a) "Property damage": ability Coverage, SECTION V - provided that no one consent; or 1) Assumed ed in is amended as fol- other than an "em- lows 1) umed any con- : ployee" may subscribe c. An appeal of a civil pro- tract, or (1) The following definitions are to such benefits and ceeding. 2) Los caused by or re- added: such benefits are made 8• "Employee" means a person sulting from any of the generally available to actively employed, formerly following: 1. "Administration" means: those "employees" who employed, on leave of ab- a. Providing information to satisfy the plan's eligi- a) Wear and tear; bility requirements, sonce or disabled, or re- "empbyees', including tired. "Employee" includes a b) Rust, corrosion, their dependents and b. Profit sharing plans, "leased worker". "Employee" fungus, decay, de- beneficiarles, with re- employee savings does not include a "tempo- terioration, hidden sped to eligibility for or plans, employee stock rary worker". or latent defect or scope of "employee ownership plans, pen- 2 any quality in benefit programs", sion plans and stock • arndistentional Failure to Disclose Haz- property that b. Interpreting the "em- subscription plans, pro- causes it to darn- b. vided that no one other SECTION IV -COMMERCIAL GENERAL age or destroy it- ployee benefit pro- than an "employee' LIABILITY CONDITIONS. 7. Represen- self, grams"; ma subscribe to such Y tations is hereby amended by the addi- C) Smog; C. Handling records in benefits and such tion of the following: connection with the benefits are made gen- d) Mechanical break- "employee benefit pro- erally available to all Based on our dependence upon your rep- down inGuding "em loees" who are resertations as to existing hazards, if un- grams"; or p Y rupture or bursting eligible under the plan intentionally you should rail to disclose all caused by cen- d. Effecting, continuing or for such benefits; such hazards at the inception date of your trifugal force; terminating any "em- policy, we will not reject coverage under ployee's" participation c. Unemployment insur- this Coverage Part based solely on such e) Settling, cracking, in any benefit included ance, social security failure. shrinking or ex- in the "employee bene- benefits, workers' com- pansion; or fit program". pensation and disability 3. Damage to Premises Rented to You f) Nesting or char, e benefits; and a• The last Subparagraph of Paragraph lion However, "administration" , or discharge does not include: d. Vacation plans, includ- 2. SECTION I - COVERAGES, or release of waste ing buy and sell pro- COVERAGE A. - BODILY INJURY products or secre- a. Handling payroll deduc- grams; leave of ab- AND PROPERTY DAMAGE, 2. LI- tions, insects, lions; or Bence programs, in- ABILITY Exclusions is hereby de- birds, rodents or b. The failure to effect or cluding military, mater- leted and replaced by the following: other animals. nity, family, and civil Exclusions C. through do not apply maintain any insurance leave, tuition assistance q' (b) Los caused directly or indi- or adequate limits of to damage by fire, explosion, light- plans; transportation redly by any of the follow- coverage of insurance, ning, smoke or soot to premises and health club subsi- while rented to temporarily oc- including but not limited dies. cupied by you w h or permission of the 1) Earthquake, volcanic to unemployment in- ing: suranoe, social security (2) The following definitions are de- owner. eruption, landslide or benefits, workers' com- leted in their entirety and re- any other earth move- b. and disability placed by the following: The insurance provided under SEC- ment; benefits. TION I -COVERAGES, COVERAGE 21. "Suit" means a civil pro- A. BODILY INJURY AND PROP- 2) Water that backs up or 2. "Cafeteria plans" means ceeding in which money ERTY DAMAGE LIABILITY applies overflows from a sewer, plan authorized by applica- damages because of an act, to "property damage" arising out of drain or sump, ble law to allow "employees" error or omission to which water damage to premises that are to elect to pay for certain this insurance applies are both rented to and occupied by you. 3) Water under the ground benefits with pre-tax dollars. alleged. "Suit" includes: surface pressing on, or (1) As respects Water Damage Le- flowing or seeping 3. "Employee benefit pro- a. An arbitration proceed- gal Liability, as provided in Para- through: grams" means a program ing in which such dam- graph 3.b. above: Includes copyrighted material of Insurance Includes copyrighted matetal of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 7 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 8 of 16 (1) The Limits of Insurance shown in amount stated in the Deda- may result in a daim. surance may also Section B. Limits of Insurance, rations as applicable to To the extent possible, apply. 1. Employee Benefit Liability Each Employee. The limits notice should include: Coverage and the rules below of insurance shall not be re- d. No insured will, except fix the most we will pay regard- duced by the amount of this (1) What the act, error at that insured's own less of the number of. deductible. or omission was cost, voluntarily make a and when it oc- payment, assume any (a) Insureds; (b) The deductible amount curred, and obligation, or incur any stated in Claims made or "suits" applies to all damages Declarations (2) The names and expense without our brought; tained by any one "em- addresses of any- ployee", including such one who may suf- (2) Item 5. Other Insurance is de- (C) Persons or organizations "employee's" dependents fer damages as a leted in its entirety and replaced making claims or bringing result of the act, by the following: "suits", and beneficiaries, because of all acts, errors or omis- errororomission. (d) Acts, errors or omissions, or sions to which this insur- 5. Other Insurance b. If a daim is made or ance applies. If other valid and collectible e Benefits included in our "suit" s brought against ( ) your insurance is available to the "employee benefit program". (c) The terms of this insurance, any insured, you must: insured for a loss we cover (2) The Aggregate Limit shown in including those with respect (1) Immediately re- under this Coverage Part, cord the specifics our obligations are limited Section B. Limits of Insurance, 1. Employee Benefit Liability 1) Our right and duty to of the daim or asfdlows: Coverage of this endorsement is defend the insured and the date the most we will pay for all dam- against any "suits" received; and a. Primary Insurance ages because of ads, errors or seeking those dam- (2) Notify us as soon This insurance is pri- omissions negligently committed ages, and as practicable. mary except when c. in the "administration" of your below applies. lfthis in- "employee benefit program". 2) Your duties, and the You must see to it that surance is primary, our duties of any other in- we receive written no- obligations are not af- (3) Subject to the limit described in voNed insured, in the tice of the daim or fected unless any of the (2) above, the Each Employee event of an act, error or "suit" as soon as practi- other insurance is also Limit shown in Section B. Limits omission, or daim, cable. primary. Then, we will of Insurance, 1. Employee apply irrespective of the ap- share with all that other Benefit Liability Coverage of deductible c. You and any other in- insurance by the this endorsement is the most we phption of the voNed insured must: method described in b. will pay for all damages sus- amount. below. tained by any one "employee", (1) Immediately send (d) We may pay any part or all us copies of any including damages sustained by of the deductible amount to b. Method of Sharing am s, notices, such "employee's" dependents effect settlement of any summonses or le- If all of the other insur- and beneficiaries, as a result of claim or "suit" and, upon no- gal papers re- ante permits contribu- (a) An act, error or omission, or tification of the action taken, ceived in conned- lion by equal shares, you shall promptly reim- tion with the claim we will follow this (b) A series of related ads, er- burse us for such part of the or "suit'; method also. Under this rors or omissions, regard- deductible amount as we approach each insurer less of the amount of time have paid. (2) Authorize us to ob- contributes equal that lapses between such tain records and ads, errors or omissions, d. Additional Conditions other information, a until it has paid id its its applicable limit negligently committed in the As respects Employee Benefit Li- (3) Cooperate with us of insurance or none of "administration" of your "em- ability Coverage, SECTION IV - in the investigation the loss remains, ployee benefit program". COMMERCIAL GENERAL LIABIL- or settlement of whichever comes first. ITY CONDITIONS is amended as fit- the claim or de- However, the amount paid under lows: fense against the If any of the other in- this endorsement shall not ex- "suit", and surance does not per- ceed, and will be subject to the (1) Item 2. Duties in the Event of mit contribution by limits and restrictions that apply Occurrence, Offense, Claim or (4) Assist us, upon equal shares, we will Suit is deleted in its entirety and our request, in the contribute by limits. plan the included payment in n the "employee in any plan replaced by the following: enforcement of Under this method, benefit program". 2. Duties in the Event of an any right against each insurer's share is any person or or- based on the ratio of its (4) Deductible Amount Act, Error or Omission, or applicable limit of in- Claim or Suit ganizabon which surance to the total sp- (a) Our obligation to pay dam- may be liable to plicable limits of insur- ages on behalf of the in- a. You must see to it that .he insured be- ance of at insurers. sured applies only to the we are notified as soon cause of an ad, as practicable of an ad, error or omission c. No Coverage cess amount of damages in ex- of the deductible error or omission which to which this in- Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 5 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 6 of 16 knowledge of a 1) Failure of any invest- (3) Coercion, demotion, tors are insureds, but only claim or "suit" ment to perform, evaluation, reassign- with respect to their duties when any "author- ment, discipline, defa- as your officers or directors. ized representa- 2) Errors in providing in- mation, harassment, Your stockholders are also tive'; formation on past per- humiliation, discrimina- insureds, but only with re- formance of investment tion or other employ, sped to their liability as i) Reports all, or vehicles, or ment-related practices, stockholders. any part, of the ad, error or 3) Advice given to any ads or omissions; or with respect to (e) A trust, you are an insured. omission to us person P (4) Consequential liability Your trustees are also in- or any other that person's decision as a result of (1), (2) or sureds, but only with respect insurer, to participate or not to (3) above. to their duties as trustees. participate in any plan ii) Receives a included in the "em- This exclusion applies (2) Each of the following is also an written or ver- ployee benefit pro- wfiether the insured may be insured: bal demand or gram held liable as an employer claim for dam- or in any other capacity and (a) Each of your "employees" ages because (f) Workers' Compensation to any obligation to share who is or was authorized to of the act, error and Similar Laws damages with or repay administer your "employee or omission; Any claim arising out of your someone else who must benefit program". and failure to comply with the pay damages because of (b) Any persons, organizations b) There is no other mandatory provisions of any the injury. or "employees" having applicable insur- workers' compensation, un- (3) Supplementary Payments proper temporary authoriza- ance. employment compensation tion to administer your "em- insurance, social security or SECTION I - COVERAGES, ployee benefit program" if (2) Exclusions disability benefits law or any SUPPLEMENTARY PAY- you die, but only until your similar law. MENTS - COVERAGES A AND legal representative is ap- This insurance does not apply to: (g) ERISA B also apply to this Coverage. pointed. (a) Bodily Injury, Property b. Who is an Insured (c) Your legal representative if Damage or Personal and Damages for which any in- you die, but only with re- Advertising Injury sured is liable because of li- As respects Employee Benefit Liabil- sped to duties as such. ability imposed on a fiduci- ity Coverage, SECTION II - WHO IS That representative will "Bodily injury', "property ary by the Employee Re- AN INSURED is deleted in its entirety damage" or "personal and tirement Income Security and replaced by the following: have all your rights and du- advertising injury'. ties under this Coverage Act of 1974, as now or Part. hereafter amended, or by (1) If you are designated in the Dec- (b) Dishonest, Fraudulent, any similar federal, state or larations as (3) Any organization you newly ac- Criminal or Malicious Act local laws. (s) An individual, you and your quire or form, other than a part- Damages arising out o any nership, joint venture or limited h Available Benefits spouse are insureds, but intentional, dishonest, ( ) only with respell to the con- liability company, and over which fraudulent, criminal or mali- Any claim for benefits to the duct of a business of which you maintain ownership or ma- cious act, error or omission, extent that such benefits are you are the sole owner. jority interest, will qualify as a committed by any insured, available, with reasonable Named Insured if no other simi- including the willful or reck- effort and cooperation of the (b) A partnership or joint ven- lar insurance applies to that or- less violation of any statute. insured, from the applicable ture, you are an insured. ganization. However, coverage C Failure to Perform a Con- funds accrued or other col- Your members, your part- under this provision: ( ) ledible insurance. ners, and their spouses are tract also insureds but only with (a) Is afforded only until the Damages arising out of fail- (i) Taxes, Fines or Penalties respect to the conduct of 180th day after you acquire of performance of con- your business. or form the organization or ure P Taxes, fines or penalties, the end of the policy period, tract by any insurer. including those imposed (c) A limited liability company, whichever is earlier; and (d) Insufficiency of Funds under the Internal Revenue you are an insured. Your Code or any similar state or members are also insureds, (b) Does not apply to any ad, Damages arising out of an local law. but only with respect to the error or omission that was insufficiency of funds to conduct of your business. committed before you ac- meet any obligations under (j) Employment-Related Your managers are insur- quired or formed the organi- any plan included in the Practices eds, but only with respect to zation. "employee benefit program". Any liability arising out of their duties as your manag- c. Limits of Insurance ens. (e) Inadequacy of Perform- any' As respects Employee Benefit Liabil- ance of Investment / Ad- (1) Refusal to employ; (d) An organization other than a ity Coverage, SECTION III - LIMITS vice Given With Respect partnership, joint venture or OF INSURANCE is deleted in its en- to Participation (2) Termination of em- limited liability company, you tirety and replaced by the following: ployment, are an insured. Your "ex- Any claim based upon: ecutive officers" and direc- Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 3 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 4 of 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY Limits of Insurance (Each Occurrence) Coverage a. $1,000 BROADENED ENDORSEMENT Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) This endorsement modifies insurance provided under the following: Coverage a. $250 COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage b. $250 unless otherwise stated $ A. Endorsement - Table of Contents: COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of Coverage: Begins on Page: (b) Payroll (C) Gross Sales $5,000) $5,000) 1. Employee Benefit Liability Coverage ..................................................................................................2 (d) Units 2. Unintentional Failure to Disclose Hazards .........................................................................................8 a Other 3. Damage to Premises Rented to You .................................................................................................8 b. Care, Custody 4. Supplementary Payments .................................................................................................................9 or Control $ 5. Medical Payments ............................................................................................................................10 TOTAL ANNUAL PREMIUM 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) ......................................................................................................10 11. Property Damage to Borrowed Equipment 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 8. Waiver of Subrogation .....................................................................................................................10 Each Occurrence Limit: $ 10,000 9. Automatic Additional Insured - Specified Relationships: Al Deductible: $ 250 x Managers or Lessors of Premises; x Lessor of Leased Equipment; x Vendors; C. Coverages: x State or Political Subdivisions - Permits Relating to Premises; 2) Our right and duty to x State or Political Subdivisions - Permits, and 1. Employee Benefit Liability Coverage defend ends when we x Contractors' Operations have used up the appli- 10. Broadened Contractual Liability -Work Within 50' of Railroad Property ..........................................16 a. The following is added to SECTION I cable limit of insurance 11. Property Damage to Borrowed Equipment ......................................................................................16 - COVERAGES: Employee Benefit in the payment of 12. Employees as Insureds - Specified Health Care Services: 16 Liability Coverage. judgments or settle- x Nurses; (1) Insuring Agreement ments. x Emergency Medical Technicians, and No other obligation or liabil- x Paramedics (a) We will pay those sums that 13. Broadened Notice of Occurrence .....................................................................................................16 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 Limits of Insurance: ror or omission of the in- under Supplementary Pay- B. or of any other per-ments. The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, son for whose acts the in- (b) This insurance applies to except as provided below sured is legally liable, to damages only if the act, er- which this insurance ap- ror or omission, is negli- 1. Employee Benefit Liability Coverage plies. We will have the right gently committed in the Each Employee Limit: $ 1,000,000 and duty to defend the in- 'administration" of your Aggregate Limit: $ 3,000,000 sured against any "suit" .'employee benefit program Deductible: $ 1,000 seeking those damages. and However, we will have no 3. Damage to Premises Rented to You duty to defend against any 1) Occurs during the pol- 'suit" seeking damages to icy period, or The lesser of: which this insurance does not appl a, The Each Occurrence Limit shown in the Declarations; or y. may, at our 2) Occurred prior the discretion, investigate any effective date of f this b. $500,000 unless otherwise stated $ report of an act, error or endorsement provided: omission and settle any a) You did not have 4. Supplementary Payments claim or "suit" that may re- knowledge of a $ 1,000 sult. But: claim or "suit' on a bonds: ds: 1) The amount vve will pay or before the ef- b.. Bail Lossof earnings: $ 350 for damages is limited fective date of this 5. Medical Payments as described in SEC- endorsement. TION III - LIMITS OF You will be Medical Expense Limit: $ 10,000 INSURANCE, and deemed to have Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 1 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 2 of 16