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HomeMy WebLinkAboutInsurance Certificate: American Industrial Door AMERIND-03 APITTMAN ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/17/2019 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: Medford Office PHONE PayneWest Insurance,Inc. ( c, o,Ext):(541)779-1321 (A/c,No):(541)779-9187 E-MAIL 38 North Central Ave. ADDRESS: Medford,OR 97501 INSURERS)AFFORDING COVERAGE NAIL# INSURERA:Western National Assurance Company 24465 INSURED INSURERB:Western National Mutual Insurance Co 15377 American Industrial Door LLC INSURER C: 5022 Table Rock Rd. INSURER D: Central Point,OR 97502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CPP105950207 6/23/2019 6/23/2020 PREMISES(EaEo TTu encel $ 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 POLICY X 128T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Prop.Damage Ded $ 1,000 B AUTOMOBILE LIABILITY /EOMaBI ED SINGLE LIMIT $ 1,000,000 X ANY AUTO X CPP105847107 6/23/2019 6/23/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE J $ 2,000,000 EXCESS LIAB CLAIMS-MADE UMB100969307 6/23/2019 6/23/2020 AGGREGATE $ 2,000,000 DED X RETENTION$ 1 0,000 $ WORKERS COMPENSATION PER H AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY AFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,OR and its elected officials,officers and employees are additional insureds when required by written contract or agreement as per attached form#WNGL49(07/15). 30 day notice of cancellation per attached form#WNGL69(12/10). Auto form#WNCA27(06116) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. Public Works/Engineering Dept 20 E.Main St. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE qty Pm ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY WN GL 69 12 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following condition is added: If we cancel this policy, for any reason other than nonpayment of premium, we will mail advance notice to the person(s) or organization(s) as shown in the Schedule in accordance with the Cancellation and Nonrenewal conditions of the policy and any applicable endorsements. SCHEDULE Person or Organization (Name and Address) -City of Ashland 20 E. Main St. Ashland, OR 97520 30 day notice WN GL 69 12 10 Pagel of 1 WN CA 27 06 16 � I BUSINESS AUTO ENHANCEMENT ENDORSEMENT The Business Auto Enhancement Endorsement is an optional endorsement that provides coverage enhancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this summary, refer to following endorsement for changes in your policy. SUMMARY OF COVERAGES PAGE Accidental Airbag Deployment Coverage 4 Auto Loan/Lease Gap Coverage 4 Blanket Additional Insured 2 Blanket Waiver of Subrogation 5 Broadened Definition of Insured includes: • Newly Acquired Organizations for up to 180 Days 2 • Employees as Insureds 2 • Subsidiaries in Which You Own 50% or More 2 Deductible Waiver for Glass Repair 3 Employee Hired Auto 2, 5 Fellow Employee Coverage 3 Hired Auto Physical Damage Coverage 4 Knowledge of Accident, Claim, Suit or Loss 5 Loss Of Use Expenses-Amended 3 Personal Effects 3 Rental Reimbursement Coverage 4 Supplementary Payments-Amended: • Bail Bonds up to $5,000 2 • Loss of Earnings up to $500/Day 2 Transportation Expense Limits—Amended 3 Unintentional Failure to Disclose Hazards 5 WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 WN CA 27 06 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BUSINESS AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Business Auto Coverage Form identified in this endorsement will be amended as shown below. SECTION II — COVERED AUTOS LIABILITY g. Any "employee" of yours is an "insured" while COVERAGE AMENDMENTS operating a covered "auto" hired or rented under a contract or agreement in the A. Who Is An Insured "employee's" name, with your permission, SECTION II — COVERED AUTOS LIABILITY while performing duties related to the conduct COVERAGE, A. Coverage, 1. Who Is An Insured of your business. is amended to add: B. Blanket Additional Insured d. Any legally incorporated subsidiary of yours in SECTION II — COVERED AUTOS LIABILITY which you own more than 50% of the voting COVERAGE, A. Coverage, 1. Who Is An stock on the effective date of this coverage Insured, paragraph c. is amended to add the form. following: However, "insured" does not include any Any person or organization who is required under a subsidiary of yours that is an "insured" under written contract or agreement between you and any other automobile liability policy, or would that person or organization, that is signed and be an "insured" under such policy but for executed by you before the "bodily injury" or termination of such policy or the exhaustion on "property damage" occurs and that is in effect such policy's limits of insurance. during the policy period, to be named as an e. Any organization which is newly acquired or additional insured is an "insured" for Liability formed by you and over which you maintain Coverage, but only for damages to which this majority ownership. However, coverage under insurance applies and only to the extent that this provision: persons or organization qualifies as an "insured" under the Who Is An Insured provision contained in (1) is afforded only for the first 180 days after Section II. you acquire or form the organization or until the end of the policy period, C. Liability Coverage Extensions —Supplementary whichever comes first; Payments (2) does not apply to "bodily injury" or SECTION II — COVERED AUTOS LIABILITY "property damage" that results from an COVERAGE, A. Coverage, 2. Coverage "accident" that occurred before you formed Extensions, a. Supplementary Payments is or acquired the organization; amended by replacing subparagraphs (2) and (4) with the following: (3) does not apply to any newly acquired or formed organization that is a joint venture (2) Up to $5,000 for cost of bail bonds (including or partnership; and bonds for related traffic law violations) required because of an"accident" we cover. We do not (4) does not apply to an "insured" under any have to furnish these bonds. other automobile liability policy, or would be an "insured" under such a policy but for (4) All reasonable expenses incurred by the termination of such policy or the "insured" at our request, including actual loss exhaustion of such policy's limits of of earnings up to $500 a day because of time insurance. off from work. f. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 5 D. Fellow Employee Coverage D. Glass Repair—Deductible Waiver SECTION II — COVERED AUTOS LIABILITY SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions, 5. Fellow COVERAGE, A. Coverage, 3. Glass Breakage — Employee, the following is added: Hitting A Bird Or Animal — Falling Objects Or Missiles, is amended by adding the following: Co-Employee Lawsuit Defense Cost Reimbursement No deductible will apply to glass breakage if such glass is repaired, in a manner acceptable to us, If a suit seeking damages for "bodily injury" to any rather than replaced. fellow "employee" of the "insured" arising out of and in the course of the fellow "employee's" E. Hired Auto Physical Damage employment or while performing duties related to the conduct of your business, or a suit seeking SECTION III — PHYSICAL DAMAGE damages brought by the spouse, child, parent, COVERAGE, A. Coverage is amended by adding brother or sister of that fellow "employee", is the following: brought against you, we will reimburse reasonable 5. Hired Auto Physical Damage costs that you incur in the defense of such matters. Any reimbursement made pursuant to If hired "autos" are covered "autos" for Liability this sub-section will be in addition to the limits of Coverage and if Comprehensive, Specified liability set forth in the Declarations. Causes of Loss, or Collision coverages are provided under this coverage form for any SECTION III — PHYSICAL DAMAGE COVERAGE "auto" you own, then the Physical Damage AMENDMENTS Coverages provided are extended to "autos" you hire of like kind and use, subject to the A. Transportation Expense—Limits Amended following: SECTION III — PHYSICAL DAMAGE a. The most we will pay for any one "loss" is COVERAGE, A. Coverage, 4. Coverage $50,000 or the actual cash value or cost to Extensions, a. Transportation Expenses is repair or replace, whichever is less, minus amended by replacing $20 per day/$600 maximum a deductible; limit with $50 per day/$1000 maximum. b. The deductible will be equal to the largest deductible applicable to any owned "auto" B. Hired Auto Physical Damage — Loss Of Use for that coverage. Any Comprehensive Expenses—Limits Amended deductible does not apply to "loss" caused SECTION III — PHYSICAL DAMAGE by fire or lightening; COVERAGE, A. Coverage, 4. Coverage c. Hired Auto Physical Damage coverage is Extensions, b. Loss of Use Expenses is excess over any other collectible amended by replacing the $20 per day/$600 insurance; and maximum limit with $50 per day/$750 maximum limit. d. Subject to the above limit, deductible and excess provisions we will provide C. Personal Effects Coverage coverage equal to the broadest coverage applicable to any covered"auto"you own. SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage If a limit for Hired Auto Physical Damage is Extensions is amended by adding the following: indicated in the Declarations, then that limit replaces, and is not added to, the $50,000 limit c. Personal Effects indicated above. We will pay up to $500 for "loss" to personal effects, which are: (1) Owned by an "insured"; and (2) In or on your covered "auto." This coverage applies only in the event of the total theft of your covered "auto." No deductible applies to this coverage WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 • F. Rental Reimbursement G. Accidental Airbag Deployment Coverage SECTION III — PHYSICAL DAMAGE COVERAGE SECTION III — PHYSICAL DAMAGE A. Coverage, is amended by adding the following: COVERAGE, A. Coverage is amended by adding the following: 6. Rental Reimbursement This coverage applies only to a covered "auto" 7. Accidental Airbag Deployment Coverage of the private passenger or light truck type as We will pay to reset or replace factory installed follows: airbag(s) in any covered "auto" for accidental discharge, other than discharge due to a a. We will pay for rental reimbursement collision loss. expenses incurred by you for the rental of a private passenger or light truck type This coverage is applicable only if "auto" because of "loss" to a covered comprehensive coverage applies to the private passenger or light truck type covered"auto". "auto". Payment applies in addition to the otherwise applicable amount of each This coverage is excess over any other coverage you have on a covered private collectible insurance or reimbursement by passenger or light truck type "auto." No manufacturer's warranty. deductibles apply to this coverage. H. Auto Loan/Lease Gap Coverage b. We will pay only for those expenses incurred during the policy period beginning SECTION III PHYSICAL DAMAGE COVERAGE, 24 hours after the "loss" and ending, Item A., Coverage, is amended by adding the regardless of the policy's expiration, with following: the lesser of the following number of days: 8. Auto Loan/Lease Gap Coverage (1) The number of days reasonably This coverage applies only to a covered "auto" required to repair or replace the described or designated in the Schedule or in covered private passenger or light the Declarations as including physical damage truck type "auto". If "loss" is caused coverage. by theft, this number of days is added to the number of days it takes to In the event of a covered total "loss" to a locate the covered private passenger covered "auto" described or designated in the or light truck type "auto" and return it Schedule or in the Declarations, we will pay to you; or any unpaid amount due on the lease or loan (2) 30 days. for a covered"auto"less: c. Our payment is limited to the lesser of the a. The amount paid under the Physical following amounts: Damage Coverage Section on the policy; and (1) Necessary and actual expenses incurred, or b. Any: (2) $50 per day, up to a maximum of (1) Overdue lease/loan payments at the $1,000. time of the"loss"; d. This coverage does not apply while there (2) Financial penalties imposed under a are spare or reserve private passenger or lease for excessive use, abnormal light truck type "autos" available to you for wear and tear or high mileage; your operations. (3) Security deposits not returned by the e. If "loss" results from the total theft of a lessor; covered "auto" of the private passenger or light truck type, we will pay under this (4) Costs for extended warranties, Credit coverage only that amount of your rental Life Insurance, Health, Accident or reimbursement expenses which is not Disability Insurance purchased with already provided for under SECTION III — the loan or lease; and PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions. (5) Carry-over balances from previous loans or leases. For the purposes of this Rental Reimbursement coverage, light truck is defined as a truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as the maximum loaded weight the auto is designed to carry. WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 5 SECTION IV — BUSINESS AUTO CONDITIONS C. Unintentional Failure to Disclose Hazards AMENDMENTS SECTION IV — BUSINESS AUTO CONDITIONS, A. Duties In The Event Of Accident, Claim, Suit Or B. General Conditions, 2. Concealment, Loss Amended Misrepresentation Or Fraud, is amended by SECTION IV — BUSINESS AUTO CONDITIONS, adding the following paragraph: A. Loss Conditions, 2. Duties In The Event Of If you unintentionally fail to disclose any hazards Accident, Claim, Suit Or Loss, a. is amended by existing at the inception date of the policy, or adding the following: during the policy period in connection with any additional hazards, we will not deny coverage This condition applies only when the "accident" or under this Coverage Part because of such failure. "loss"is known to: (1) You, if you are an individual; D. Employee Hired Auto (2) A partner, if you are a partnership; SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, (3) An executive officer or insurance manager, if paragraph b. is deleted and replace by the you are a corporation; or following: (4) A member or manager, if you are a limited b. For Hired Auto Physical Damage Coverage, liability company. the following are deemed to be a covered "autos"you own: But, this section does not amend the provisions relating to notification of police, protection or (1) Any covered "auto" you lease, hire, rent or examination of the property which was subject to borrow. the"loss". (2) Any covered "auto" hired or rented by your B. Blanket Waiver of Subrogation "employee" under a contract in that individual "employee's" name, with your Section IV — BUSINESS AUTO CONDITIONS, A. permission, while performing duties related Loss Conditions, 5. Transfer of Rights of to the conduct of your business. Recovery Against Others to Us, is amended by adding the following exception: However, any "auto" that is leased, hired, rented or borrowed with a driver is not a However, we waive any right of recovery we may covered "auto". have against any person or organization to the extent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. I WN CA 27 06 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5