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HomeMy WebLinkAboutInsurance Certificate: Measure - Tech, inc ^ Phone: (541)488-6002 Fax: (541)488-5311 l ® DATE(MMIDDITYYY) ACORD® CERTIFICATE OF LIABILITY INSURANCE . 4....---- 10/1312017 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 NAME:CONTACT Samuel Boatright ALMEA Insurance,Inc. PHONE FAX 201 NE Park Plaza Dr#293 EL' EaH. 360-694.7994 A/c,No): 360.694-8575 Vancouver,WA 98684 ADDRESS: sboatright @almeainsurance.com License#:920891 INSURER(S)AFFORDING COVERAGE NAICa INSURER A: Houston Specialty Insurance Company INSURED , INSURER B: Ohio Security Insurance Company 24082 Measure-Tech,Inc. INSURER C: National Union Fire Insurance Company of Pittsb PO Box 499 .INSURER 0: Ariel,WA 98603 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-2224990 REVISION NUMBER: 93 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 'ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD AND POLICY NUMBER IMMIDDNYYY) (MMIDDWYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY I Y Y TEN-19746 07/29/2017 D7/292018 EACH OCCURRENCE $ 1,000,000 EN I ED CLAIMS-MADE X OCCUR PREASES(aoccurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Ja POLICY JEa n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAS55874962 12/032017 12/03/2018 (CeDaaBcIdeDntSINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS $ X AUTOS ONLY X AUUT05 ONLY (PeOraccl DAMAGE $ C X UMBRELLA LIAB X OCCUR EBU01474400 07/29/2017 07/29/2018 EACH OCCURRENCE S 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _$ 5,000,000 DED I RETENTION$ crisis response $ 250,000 A WORKERS COMPENSATION TEN-19746 07/2912017 0712912018 X STATUTE 0TH' Stop Gap AND EMPLOYERS'LIABILITY ANY PROPRIETOR/EXCLUDED? YI❑N NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NM EL.DISEASE-EA EMPLOYEE $ 1,000,000 Eyes.denote un DESCRIPTION OF dOPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Ashland, Oregon, and its elected officials, officers and employees are named as additional insured for both ongoing CG2010 and completed CG2037 operations when required by written contract. Excess liability is follow form. Coverage is primary and non-contributory per forrm TEN0215.Waiver of Subrogation applies per form CG 2404. Workers Compensation is through the State of Washing, current certificate attached, and WA Stop Gap/Employers Liability is afforded through form CG 0442. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland,Oregon ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland,OR 97520 AUTHORIZED REPRESENTATIVE - I Assafienfry (SHB) ©1988-2015ORD CORPORATION. All rights reserved. • ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SHB on October 13,2017 at 09:18AM POLICY NUMBER: TEN-19746 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Only such Person or Organization where required in a written contract with the Named Insured under this policy, entered into prior to the loss or"occurrence". Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against • the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard".This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ®Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ • • POLICY NUMBER:TEN-19746 COMMERCIAL GENERAL LIABILITY • CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR • CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART • SCHEDULE • Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Only those parties required to be named as an ALL Additional Insured in a written contract with the Named Insured under this policy, entered into prior to loss or"occurrence". • • Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to • include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury'or"property dam- age" caused, in whole or in part, by 'your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". • CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ • POLICY NUMBER:TEN-19746 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE • Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Only those parties required to be named as an Addi- ALL tional Insured in a written contract with the Named Insured under this policy,entered into prior to loss or "occurrence". Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: TEN-19746 COMMERCIAL GENERAL LIABILITY CG 04 4211 03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. STOP GAP - EMPLOYERS LIABILITY COVERAGE ENDORSEMENT - WASHINGTON This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Limits Of Insurance • Bodily Injury By Accident $1,000,000 Each Accident Bodily Injury By Disease $1,000,000 Aggregate Limit Bodily Injury By Disease $1,000,000 Each Employee (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. The following is added to Section I — No other obligation or liability to pay sums Coverages: or perform acts or services is covered COVERAGE—STOP GAP—EMPLOYERS unless explicitly provided for under LIABILITY Supplementary Payments. 1. Insuring Agreement b. This insurance applies to "bodily injury by a. We will pay those sums that the insured fccident" or"bodily injury by disease"only becomes legally obligated by Washington Law to pay as damages because of (1) The: "bodily injury by accident"or "bodily injury (a) "Bodily injury by accident"or"bodily by disease" to your "employee" to which injury by disease"takes place in the this insurance applies. We will have the "coverage territory"; right and duty to defend the insured (b) "Bodily injury by accident"or"bodily against any "suit' seeking those damages. injury by disease"arises out of and However, we will have no duty to defend in the course of the injured the insured against any "suit" seeking "employee's" employment by you; damages to which this insurance does not and apply. We may, at our discretion, investigate any accident and settle any (c) "Employee", at the time of the claim or"suit"that may result. But: injury, was covered under a for damages worker's compensation policy and (1) The amount we will pay foamn ges is limited as described in r d III is subject to a "workers compensation Limits Of Insurance; and law"of Washington;and (2) Our right and duty to defend end when (2) The: we have used up the applicable limit of (a) "Bodily injury by accident" is insurance in the payment of judgments • caused by an accident that occurs or settlements under this coverage. during the policy period; or • CG 0442 11 03 C9 ISO Properties, Inc., 2003 Page 1 of 6 ❑ (b) "Bodily injury by disease" is caused c. Statutory Obligations by or aggravated by conditions of Any obligation of the insured under a employment by you and the injured workers' compensation, disability benefits "employee's" last day of last or unemployment compensation law or exposure to the conditions causing any similar law. or aggravating such "bodily injury by disease" occurs during the d. Contractual Liability policy period. Liability assumed by you under any c. The damages we will pay, where recovery contract or agreement. is permitted by law, include damages: e. Violation Of Law (1) For: "Bodily injury by accident" or "bodily injury (a) Which you are liable to a third party by disease" suffered or caused by any by reason of a claim or "suit' employee while employed in violation of against you by that third party to law with your actual knowledge or the recover the damages claimed actual knowledge of any of your against such third party as.a result "executive officers". of injury to your"employee"; f. Termination, Coercion Or (b) Care and loss of services; and Discrimination (c) Consequential "bodily injury by Damages arising out of coercion, criticism, accident' or "bodily injury by demotion, evaluation, reassignment, disease" to a spouse, child, parent, discipline, defamation, harassment, brother or sister of the injured humiliation, discrimination against or "employee"; termination of any "employee", or arising provided that these damages are the out of other employment or personnel P 9 decisions concerning the insured. direct consequence of"bodily injury by accident" or "bodily injury by disease" g. Failure To Comply With "Workers that arises out of and in the course of Compensation LaW' the injured "employee's" employment "Bodily injury by accident" or "bodily injury. by you; and by disease" to an "employee" when you (2) Because of "bodily injury by accident" . are: or "bodily injury by disease" to your (1) Deprived of common law defenses; or "employee"that arises out of and in the (2) Otherwise subject to penalty; course of employment, claimed against you in a capacity other than as because of your failure to secure your employer. obligations or other failure to comply with 2. Exclusions any"workers compensation law". This insurance does not apply to: h. Violation Of Age Laws Or Employment Of Minors a. Intentional Injury "Bodily injury by accident" or "bodily injury "Bodily injury by accident" or"bodily injury by disease" suffered or caused by any by disease" intentionally caused or person: aggravated by you, or "bodily injury by (1) Knowingly employed by you in violation accident' or "bodily injury by disease" of any law as to age; or resulting from an act which is determined to have been committed by you if it was (2) Under the age of 14 years, regardless reasonable to believe that an injury is of any such law. substantially certain to occur. i. Federal Laws b. Fines Or Penalties Any premium, assessment, penalty, fine, Any assessment, penalty, or fine levied by benefit, liability or other obligation any regulatory inspection agency or imposed by or granted pursuant to: authority. (1) The Federal Employer's Liability Act (45 USC Section 51-60); Page 2 of 6 ©ISO Properties, Inc., 2003 CG 04 42 11 03 ❑ (2) The Non-appropriated Fund Instrumentalities Act (5 USC Sections 8171-8173); CG 04 42 11 03 ©ISO Properties, Inc., 2003 Page 3 of 6 ❑ • (3) The Longshore and Harbor Workers' 4. An organization other than a partnership,joint Compensation Act (33 USC Sections venture or limited liability company, you are 910-950); an insured. Your "executive officers" and (4) The Outer Continental Shelf Lands Act directors are insureds, but only with respect to (43 USC Section 1331-1356); their duties as your officers or directors. Your stockholders are also insureds, but only with (6) The Defense Base Act (42 USC respect to their liability as stockholders. Sections 1651-1654); (6) The Federal Coal Mine Health and Safety Act of 1969 (30 USC Sections 901-942); (7) The Migrant and Seasonal Agricultural Worker Protection Act (29 USC Sections 1801-1872); (8) Any other workers compensation, unemployment compensation or disability laws or any similar law; or (9) Any subsequent amendments to the . laws listed above. • j. Punitive Damages Multiple, exemplary or punitive damages. k. Crew Members "Bodily injury by accident" or "bodily injury by disease"to a master or member of the crew of any vessel or any member of the flying crew of an aircraft. B. The Supplementary Payments provisions apply to Coverage — Stop Gap Employers Liability as well as to Coverages A and B. C. For the purposes of this endorsement, Section II — Who Is An Insured, is replaced by the following: If you are designated in the Declarations as: 1. An individual; you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. 2. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. 3. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your 1 managers. L Page 4 of 6 © ISO Properties, Inc., 2003 CG 04 42 11 03 ❑ • • No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. D. For the purposes of this endorsement, Section III — Limits Of Insurance, is replaced by the following: 1. The Limits of Insurance shown in the Schedule of this endorsement and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The "Bodily Injury By Accident" — Each Accident Limit shown in the Schedule of this endorsement is the most we will pay for all damages covered by this insurance because • of "bodily injury by accident" to one or more "employees"in any one accident. 3. The "Bodily Injury By Disease" — Aggregate Limit shown in the Schedule of this endorsement is the most we will pay for all damages covered by this insurance and arising out of "bodily injury by disease", regardless of the number of"employees"who sustain'bodily injury by disease". 4. Subject to Paragraph D.3. of this endorsement, the"Bodily Injury By Disease"— Each "Employee" Limit shown in the Schedule of this endorsement is the most we will pay for all damages because of "bodily injury by disease"to any one"employee". • The limits of the coverage apply separately to each consecutive annual period and to any • remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the • • additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. • CG 04 42 11 03 © ISO Properties, Inc., 2003 Page 5 of 6 ❑ E. For the purposes of this endorsement, Condition d. No insured will, except at that insured's 2.— Duties In The Event Of Occurrence, Claim own cost, voluntarily make a payment, Or Suit of the Conditions Section IV is deleted assume any obligation, or incur any and replaced by the following: expense, other than for first aid, without 2. Duties In The Event Of Injury, Claim Or our consent. Suit F. For the purposes of this endorsement, Paragraph • a. You must see to it that we or our agent are 4. of the Definitions Section is replaced by the notified as soon as practicable of a "bodily following: injury by accident" or "bodily injury by 4. "Coverage territory" means: disease" which may result in a claim. To a. The United States of America (including its the extent possible, notice should include: territories and possessions), Puerto Rico (1) How, when and where the "bodily and Canada; injury by accident" or "bodily injury by b. International waters or airspace, but only if disease"took place; the injury or damage occurs in the course (2) The names and addresses of any of travel or transportation between any injured persons and witnesses; and places included in a. above; or (3) The nature and location of any injury. c. All other parts of the world if the injury or b. If a claim is made or "suit' is brought damage arises out of the activities of a against any insured, you must: person whose home is in the territory described in a. above, but who is away for (1) Immediately record the specifics of the a short time on your business; claim or "suit" and the date received; and provided the insured's responsibility to pay damages is determined in the United States (2) Notify us as soon as practicable. (including its territories and possessions), You must see to it that we receive written Puerto Rico, or Canada, in a suit on the notice of the claim or "suit' as soon as merits according to the substantive law in practicable. such territory, or in a settlement we agree to. c. You and any other involved insured must: G. The following are added to the Definitions (1) Immediately send us copies of any Section: demands, notices, summonses or legal 1. 'Workers Compensation Law" means the papers received in connection with the Workers Compensation Law and any injury, claim, proceeding or"suit"; Occupational Disease Law of Washington. (2) Authorize us to obtain records and This does not include provisions of any law other information; providing non-occupational disability benefits. (3) Cooperate with us and assist us, as we 2. "Bodily injury by accident' means bodily may request, in the investigation or injury, sickness or disease sustained by a settlement of the claim or defense person, including death, resulting from an against the "suit"; accident. A disease is not "bodily injury by accident' unless it results directly from"bodily (4) Assist us, upon our request, in the injury by accident". enforcement of any right against any 3. "Bodily injury by disease" means a disease person or organization which may be sustained by a person, including death. liable to the insured because of injury "Bodily injury by disease" does not include a to which this insurance may also apply; disease that results directly from an accident. and (5) Do nothing after an injury occurs that H. For the purposes of this endorsement, the would interfere with our right to recover definition of"bodily injury"does not apply. from others. Page 6 of 6 ©ISO Properties, Inc., 2003 CG 04 42 11 03 ❑ POLICY NUMBER:TEN-19746 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEN0215 01 14 PRIMARY AND NON-CONTRIBUTING INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM The following is added to SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4: Section IV: Commercial General Liability Conditions 4. Other Insurance: d. Notwithstanding the provisions of sub-paragraphs a, b, and c of this paragraph 4, with respect to the Third Party as defined below, it is understood and agreed that in the event of a claim or "suit" caused in whole or in part by the Named Insured's negligence, this insurance shall be primary and any other insurance maintained by the additional insured named as the Third Party below shall be excess and non-contributory. The Third Party to whom this endorsement applies is: Absence of a specifically named Third Party above means this endorsement applies only to those third p Y hY parties required to be named as an Additional Insured as Primary and Non-Contributory coverage specified in a written contract with the Named Insured under this policy, entered into prior to the "loss"or "occurrence". All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. TEN0215 01 14 Includes copyright material of Insurance Services Office, Inc. Page 1 of 1 1V11it&JV1\1, 11:.1.11 llv1, r4go 1 V1 1 - x' Department of Labor& Industries Certificate of Workers' Compensation Coverage • July 20, 2017 WA UBI No. 602 178 325 L&I Account ID 2589700 Legal Business Name MEASURE TECH INC Doing Business As MEASURE TECH INC Workers'Comp Premium Status: Account is current Estimated Workers Reported Quarter 1 of Year 2017"1 to 3 • (See Description Below) Workers" Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor? Yes License No. MEASUI*985C5 License Expiration 09/05/2018 What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver,of subrogation (See ROW 51.12.050 and 51.16.190). https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=602178325&LIC=M.. 7/20/2017 BAS55874962 COMMERCIAL AUTO CA 88 10 01 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 - ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 18 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 - BROAD FORM INSURED 1 - BODILY INJURY REDEFINED 21 EMPLOYEES AS INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 22 EXTRA EXPENSE- BROADENED COVERAGE 10 GLASS REPAIR-WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN / LEASE GAP 14 . PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 19 SECTION II -LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II - LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or.a self-insured retention plan available to that organization; @2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 1 of 7 .BAS55874962 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is'amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization' is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident' which takes place after you executed the written contract or agreement, or the permit has been • issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- • graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III -PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 2 of 7 BAS55874962 • b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or . (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $750 per "accident, we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or _ (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V-DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual P P 9 cash value. 7. TOWING AND LABOR SECTION Ill - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck' or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of$1,500 ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 3 of 7 r 3AS55874962 9. RENTAL REIMBURSEMENT SECTION III -PHYSICAL DAMAGE COVERAGE,A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident' or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. • f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE-BROADENED COVERAGE Under SECTION III -PHYSICAL DAMAGE COVERAGE,A. COVERAGE,we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V- DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or • carried by an insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: • ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 4 of 7 • I , 3AS55874962 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a$100 deductible. 14. LOAN / LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V-DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 5 of 7 3AS55874962 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered ."auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile •business. SECTION IV -BUSINESS AUTO CONDITIONS is amended as follows: 17. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 18. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident", claim, "suit' or "loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (1) How, when and where the "accident' or "loss" took place; (2) • The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 19. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident' or "loss", our rights are waived also. ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of InsuranceServices Office Inc.,with its Permission. Page 6 of 7 • BAS55874962 20. HIRED AUTO COVERAGE TERRITORY SECTION IV- BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V-DEFINITIONS is amended as follows: e 21. BODILY INJURY REDEFINED Under SECTION V-DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 22. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- -_ lows: e If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 7 of 7