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HomeMy WebLinkAboutInsurance Certificate: Vss International , Inc 5/2022 - A o® CERTIFICATE OF LIABILITY' INSURANCE E/2DATE(MMIDD/YYYY) M/DD( 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(les)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; Linda Reynolds Andreini &Company-San Mateo PHONE FAX 220 West 20th Ave (A/O,No.Ext):650-378-4258 (A/C,No):650-378-4361 San Mateo CA 94403 ADDRESS: Ireynolds@andreini.com INSURER(S)AFFORDING COVERAGE NAIC# ' INSURERA:Hartford Fire Insurance Co. 19682 INSURED BASIC-1 INSURERS:National Fire&Marine Ins Co 20079 VSS International, Inc. 3785 Channel Drive INSURER c:Ironshore Specialty Ins.Co. 25445 West Sacramento, CA 95691 INSURER D: INSURER E: • ,-- INSURER F: COVERAGES CERTIFICATE NUMBER:1987437780 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. ILTR TYPE OF INSURANCE "ATM SUBR WVD POUCYNUMBER (MM/DD/YYYY) (MMDDYYVY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 51CSEQU2541 3/1/2022 3/1/2023 EACH OCCURRENCE $2;000,000 CLAIMS-MADE X OCCUR PREMISES(EaEocccurrence) $100,000 MED.EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $4,000,000 POLICY X FEC n LOC PRODUCTS-COMP/OPAGG ,$4,000,000 , OTHER: $ A AUTOMOBILE LIABILITY Y 51CSEQU2542 3/1/2022 3/1/2023 (EaaacidoD1)INGLELIMIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ X OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS y X HIRED y NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ B X UMBRELLA LIAR X OCCUR 42UM010050407 3/1/2022 3/1/2023 EACH OCCURRENCE $2,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$75 jinn $Following Form • WORKERS COMPENSATION PER ERH CA Self Insured TH- AND'EMPLOYERS'LIABILITY " ANYPROPRIETOR/PARTNER/EXECUTIVE Y N N/A E.L.EACH ACCIDENT $Certifcate#2106 OFFICER/MEMBEREXCLUDE07 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ A Owned Auto Physical Damage Dad. 51 CSEQU2542 3/1/2022 3/1/2023 Camp/Coll $5,000 C Pollution ICELLUW00120212 3/1/2022 3/1/2023 Each Loss 2,000,000 Aggregate 4,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required). VSSI Job#19-045:The City of Ashland 2019 Slurry Seal Project No,2018-37 The City of Ashland,its officials,officers,agents, employees and volunteers are included as additional insured on a primary and non-contributory basis with regard to General and Auto Liability per terms of the attached endorsements HG00010916 and HA99160312. 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 AUTHORIZEDREPRESENTATIVE Ashland OR 97520 g GnoLai Re.(01-44...C1-4.) I _ _ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 8 of 13 7806 Policy Number:51 CSEQU2542 COMMERCIAL AUTOMOBILE HA99160312 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE.READ IT CAREFULLY. • COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insuranceprovided under the following: BUSINESS AUTO COVERAGE FORM. To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you OM own, hire or Formed Organizations borrow in your business or your The Named Insured shown in the personal affairs. Declarations is amended to include: C. Lessors as Insureds • (1) Any legal business entity other than, a Paragraph A.1. -WHO. IS AN INSURED -of partnership or joint venture, formed as a Section II - Liability Coverage is amended to subsidiary in which you 'have an add: ownership interest of more than 50% on e. The lessor of a covered "auto"while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an "insured" under any other automobile (1) The agreement requires you to policy or would be an "insured" Under provide direct primary Insurance for such a policy but for its termination or the lessor and the exhaustion of its Limit of Insurance. (2) The"auto"is leased without a driver. (2) Any organization that is acquired or Such a leased "auto" will be considered a formed by you and over which you covered "auto" you own and not a covered maintain majority ownership. However, "auto"you hire. the Named insured does not include any D Adcfttlorial 11iiure if Requlrcdtby C1a9htract� newly formed or acquired organization: (1) Paragraph A.1. -WHO AN INSURE (a) That is a partnership or joint - of Section II - Liability Coverage is venture, amended to add: (b) That is an "insured" under any other V. When you have.agreed, in a written policy,, contract or written•agreement,that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your (d) 180 days or more after its business auto policy, such person or acquisition or formation by you, organization is an"insured", but only unless you have given us :notice of to the extent such person or the acquisition or formation. organization is liable for "bodily Coverage does not apply to "bodily injury" or"property damage" caused injury" or "property damage"thatresults by the conduct of an "insured" under from an "accident"that,occurred before paragraphs a. or b. of Who Is An you formed or acquired the organization. Insured with regard to the B. Employees as Insureds ownership, maintenance or use of a covered auto. Paragraph A'.1. -WHO IS AN INSURED of SECTION II - LIABILITY COVERAGE is amended to add: 2011,The Hartford(Includes copyrighted material Form HA 99 16 0312 of ISO Properties, Inc.,with its permission.) Page 1 of hof 13 7606 The insurance afforded to any such add Non ontrilautory if , additional insured applies only If the ; _Required b Contract "bodily injury" or "property damage" Only with respect to insurance provided to occurs: an additional Insured in 1.0. - Additional (1) During the policy period, and Insured If Required by Contract, the (2) Subsequent to the execution of such following provisions apply: written contract, and (3): Primary Insurance When Required By (3) Prior to the expiration of the period Contract of time that the written contract This Insurance is primary if you have requires such insurance be provided agreed in a written contract or written to the additional insured. agreement that this insurance be (2) How Limits Apply primary. If other insurance Is also If you have agreed in a written contract primary, we will share with all that other insurance by the method described in or written agreement that another Other insurance 5.d. person or organization be added as an . additional insured on your policy, the (4) Primary And Non-Contributory To Other most we will pay on behalf of such Insurance When Required By Contract additional insured is the lesser of: If you have agreed in a written contract (a) The limits of insurance specified: in or written agreement that this insurance the written contract or written is primary and non-contributory with the agreement;or additional Insured's own insurance, this (b) insurance, is primary and we will not The Limits of Insurance shown in the Declarations. seek contribution from that other insurance. Such amount shall be a part of and not Paragraphs (3) and (4)do not apply to other in addition to Limits of Insurance shown insurance to which the additional insured in the Declarations and described in this has been added as an additional insured. Section. (3) Section. Additone! Insureds Other Ihsura)Zce When this insurance is excess, we will have no duly to defend the insured against any "suit" if If we cover a claim or "suit" under this any other insurer has a duty to defend the Coverage Part that may also be covered insured against that "suit". If no other insurer by other insurance available to an defends, we will undertake to do so, but we will additional insured, such additional be entitled to the insureds rights against all insured must submit such claim or "suit" those other Insurers. to the other insurer for defense and When this insurance is excess over other indemnity. insuraice, we will pay only our share of the However, this provision does not apply amount of the loss, if any, that exceeds the sum to the extent that you have agreed In a of; written contract or written agreement (1) The total amount that all such other that this insurance Is primary and non- insurance would pay for the loss in the contributory with the additional insured's absence of this insurance;and own insurance. (2) The total of all deductible and self-insured (4) Duties in The Event Of Accident, Claim, . amounts under all that other insurance. Suit or Loss If you have agreed in a written contract We will share the remaining loss, if any, by the or written agreement that another •method described,In Other Insurance 5.d. person or organization be. added as an 2. AUTOS RENTED BY EMPLOYEES additional insured on your policy, the Any "auto" hired or rented by your "employee" .add'tional insured shall be required to on your behalf and at your direction will be comply with the provisions .in LOSS considered an"auto"you hire. CONDITIONS 2. - DUTIES IN THE The OTHER INSURANCE Condition is amended EVENT OF ACCIDENT, CLAiM , SUIT by adding the following; OR LOSS — OF SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured, 2011,The.Hartford (Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 2 of of 13 7806 If an "employee's" personal insurance also 5. PHYSICAL DAMAGE - ADDITIONAL applies on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE hired or rented by your "employee" on your COVERAGE behalf and at your direction, this insurance will Paragraph A.4.a. of SECTION III - PHYSICAL be primary to the "employee's" personal DAMAGE COVERAGE Is amended to provide a Insurance. limit of $60 per day and a maximum limit of 3. AMENDED FELLOW.EMPLOYEE EXCLUSION $1,000. EXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOAN/LEASE GAP COVERAGE SECTION II - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE apply if you have workers' compensation COVERAGE, in the event of a total "loss" to a insurance in-force covering all of your covered "auto", we will pay your additional legal "employees . obligation for any difference between the actual Coverage is excess over any other collectible cash value of the "auto" at the time of the "loss" insurance, and the"outstanding balance"of the loan/lease. 4. iiiiRED-AUTO-PHYSICACCiMiMIE`CpVERAOE "Outstanding balance" means the amount you ,,.._ If hired "autos" are covered "autos" for Liability owe on the loan/lease at the time of "loss" less Coverage and if Comprehensive, Specified any amounts representing taxes; overdue Causes of Loss, or Collision coverages are payments; penalties, interest or charges provided under this Coverage Form for any resulting from overdue payments; additional "auto" you own, then the Physical Damage mileage charges; excess wear and tear charges; Coverages provided are extended to"autos"you lease termination fees; security deposits not hire or borrow,subject to the following limit returned by the !lessor; costs for extended warranties, credit life Insurance, health,.accident rTiii-iiiiii—iiriiiilTailiiri65itr.V-in7fired 1 or disabilltyinsurance purchased with the loan or 1"aute is: i . lease; and carry-over balances from previous i(1) $100,600;_ , l loans or leases. . ,.e (2) The actual cash value of the damaged or 7. AIRBAG'COVERAGE stolen property at the time of the"loss";or Under Paragraph B. EXCLUSIONS - of (3) The cost of repairing or replacing the SECTION III - PHYSICAL DAMAGE damaged or stolen properly, COVERAGE, the following is added: whichever is smallest, minus a deductible. The The exclusion relating to mechanical breakdown deductible will be equal to the largest deductible does not apply to the accidental discharge of an applicable to any owned "auto" for that • airbag. coverage.No deductible applies to"loss"caused 8. ELECTRONIC EQUIPMENT - BROADENED by fire or lightning. Hired Auto Physical Damage. COVERAGE coverage is excess over any other collectible insurance. Subject to the above limit, deductible a. The exceptions to Paragraphs BA - and excess provisions, we will provide coverage EXCLUSIONS -of SECTION III - PHYSICAL equal to the broadest coverage applicable to any DAMAGE COVERAGE are replaced by the covered"auto"you own. following; We will also cover loss of use of the hired'auto" Exclusions 4.c. and 4.d. do not apply to if it results from an "accident", you are legally equipment designed to be operated solely liable and the lessor incurs an actual Mendel by use of the power from the "auto's" loss, subject to a maximum of $1000 per electrical system that, at the time of"loss", "accident". is: This extension of coverage does not apply to (1) Permanently installed in or upon any "auto" you hire or borrow from any of your the covered"auto"; "employees", partners (if you are a partnership), (2) Removable from a housing unit members (if you are a limited liability company), which :is permanently installed in or members of their households. or upon the covered"auto"; (3) An integral part of the same unit housing any electronic equipment described in Paragraphs(1)and (2)above; or , - Cee 2011,The Hartford(Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc.,with Its permission.) Page 3 of,R of 13 7806 (4) Necessary for the normal If another Hartford Financial. Services Group, operation of the covered"auto"or Inc. company policy or coverage form that is not the monitoring of the covered an automobile policy or coverage form applies to "auto's"operating system. the same"accident",the following applies: b.Section Ill — Version CA 00 01 03 10 of the (1) If the deductible under this Business Auto Business Auto Coverage Form, Physical Coverage Form is the smaller (or smallest) Damage Coverage, Limit of Insurance, deductible, it will be waived; Paragraph C.2 and Version CA 00 01 10 01 of (2) If the deductible under this Business Auto the Business Auto Coverage Form, Physical Coverage Form is not the smaller (or Damage Coverage, Limit of Insurance, smallest) deductible, it will be reduced by Paragraph C are each amended to add the the amount of the smaller (or smallest) following: deductible. $1,500 is the most we will pay for "loss" in 12. AMENDED DUTIES IN THE EVENT OF any one "accident" to all electronic ACCIDENT, CLAIM, SUIT OR LOSS equipment (other than equipment designed The requirement in LOSS CONDITIONS 2.a. - solely for the reproduction of sound, and DUTIES IN THE EVENT OF ACCIDENT,CLAIM, accessories used with such equipment) SUIT OR LOSS of SECTION IV - BUSINESS that reproduces, receives or transmits AUTO CONDITIONS that you must notify us of audio, visual or data signals which, at the time of"loss", is; an "accident" applies only when the "accident"is known to: (1) Permanently Installed in or upon (1) You,if you are an individual; the covered "auto" in a housing, opening or other location that is not (2) A partner, if you are a partnership; normally used by the "auto" (3) A member, if you are a limited liability manufacturer for the installation of company; or such equipment; (4) An executive officer or insurance manager, if (2) Removable from a permanently you are a corporation. installed housing unit as described 13. UNINTENTIONAL FAILURE TO DISCLOSE in Paragraph 2.a. above or is an HAZARDS integral part of that equipment;or (3)An integral part of such equipment. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we c.For each covered "auto", should loss be limited will not deny coverage under this Coverage to electronic equipment only, our obligation to Form because of such failure. pay for, repair, return or replace damaged or 14. HIRED AUTO -COVERAGE TERRITORY stolen electronic equipment will be reduced by the applicable deductible shown in the Paragraph e. of GENERAL CONDITIONS 7. - Declarations, or $250, whichever deductible Is POLICY PERIOD, COVERAGE TERRITORY - less. of SECTION IV - BUSINESS AUTO S. EXTRA EXPENSE - BROADENED CONDITIONS is replaced by the following: COVERAGE e. For short-term hired "autos", the coverage Under Paragraph A. -COVERAGE-of SECTION territory with respect to Liability Coverage is III - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if the pay for the expense of returning a stolen covered "insured's" responsibility to pay damages for "auto"to you. "bodily Injury"' or "property damage" ls. determined in a"suit,"the"suit" is brought in 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE the United States of America, the territories Under Paragraph D.-DEDUCTIBLE-of SECTION and possessions of the United States of III - PHYSICAL DAMAGE COVERAGE, the America, Puerto Rico or Canada or in a following is added: settlement we agree to. No deductible applies to glass damage if the 15. WAIVER OF SUBROGATION glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY 11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - of SECTION IV - Under Paragraph D.-DEDUCTIBLE-of SECTION BUSINESS AUTO CONDITIONS is amended by III - PHYSICAL DAMAGE COVERAGE, the adding the following: following is added: O 2011,The Hartford(Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 4 of of 13 7806 We waive any right of recovery we may have c.Regardless of the number of autos deemed a against any person or organization with whom total loss, the most we will pay under this you have a written contract that requires such Hybrid, Electric, or Natural Gas Vehicle waiver because of payments we make for Payment Coverage provision for any one damages under this Coverage Form. loss"is$10,000. 16. RESULTANT MENTAL ANGUISH COVERAGE For the purposes of the coverage provision, The definition of "bodily injury" in SECTION V- a.A "non-hybrid" auto is defined as an auto that DEFINITIONS Is replaced by the following:, uses only an Internal combustion engine to "Bodily injury" means bodily injury, sickness or move the auto but does not include autos disease sustained by any person, including powered solely by electricity or natural gas. mental anguish or death resulting from any of b.A "hybrid" auto is defined as an auto with an these. internal combustion engine and one or more 17. EXTENDED CANCELLATION CONDITION electric motors; and that uses the internal combustion engine and one or more electric Paragraph 2. of the COMMON POLICY TIS - CANCELLATION - applies motors to move the auto, or the Internal CONDITIONS TIs follows: combustion engine to charge one or more exceptelectric motors,which move the auto. If we cancel for any reason other than 19. VEHICLE WRAP COVERAGE nonpayment of premium, we will mall or deliver to the first Named Insured written notice of In the event of a total loss to an"auto"for which cancellation at least 60 days before the effective Comprehensive, Specified Causes of Loss, or date of cancellation. Collision coverages are provided under this 18. HYBRID,: ELECTRIC, OR NATURAL GAS Coverage Form, then such Physical Damage VEHICLE PAYMENT COVERAGE Coverages are amended to add the following: In the event of a total loss to a "non-hybrid" auto In addition to the actual cash value of the "auto", we will pay up to $1,000 for vinyl vehicle wraps for which Comprehensive, Specified Causes of Loss, which are displayed on the covered"auto" at the or Collision coverages are provided Under this Coverage Form, then such Physical time of total loss. Regardless of the' number of Damage Coverages are amended as follows: autos deemed a total'loss, the most we will pay under this Vehicle Wrap Coverage provision for a.if the auto is•replaced with a "hybrid" auto or any one "loss" is $5,000. For purposes of this an auto powered solely by electricity or natural coverage provision, signs or other graphics gas, we will pay an additional 10%, to a painted or magnetically affixed to the vehicle are maximum of$2,500, of the "non-hybrid"auto's not considered vehicle wraps. actual cash value or replacement cost, whichever is less, b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of"loss;" ©2011,The Hartford(Includes copyrighted material Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) 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