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HomeMy WebLinkAboutInsurance Certificate: Chown, Inc Client#:325772 CHOWNINC ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/01/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NA( ACT Bambi Brown,CIC,CRM USI Insurance Services NW CL1 �aHON o,Ext):503.295.8312 FAX 610.362.8189 825 NE Multnomah,Suite 1500 E-MAIL (A/C,No): Portland,OR 97232 aDDREss: bambi.brown@usi.com INSURER(S)AFFORDING COVERAGE NAIL# 503 224-8390 INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Chown,Inc. P 0 Box 2888 INSURER C: Portland,OR 97208 INSURER D: 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY A0146691003 03/01/2022 03/01/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES RENTED rrrence) $1,000,000 MED EXP(Any one person) $15,000 _ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: WA Stop Gap $Included A AUTOMOBILE LIABILITY A0146691001 03/01/2022 03/01/2023 (E°aBc deDn SINGLE LIMIT $1,000,000 X ANY AUTO BODILYINJURY(Perperson) $ OWNED SCHEDULED — AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X NAI UUTOS ONLY PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB X OCCUR A0146691004 03/01/2022 03/01/2023 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in 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 General Liability and Automobile Liability coverages include additional insured primary non contributory coverage when required under written contract or written agreement as per endorsements CG7021, CG2010,CG2037,CG2001 and CA7601.General Liability and Automobile Liability waiver of subrogation coverage is included per the endorsements CG2404 and CA0444. Umbrella Liability follows form and attaches to Employers Liability,Automobile Liability and General Liability limits.A 30 day notice of cancellation (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Kari Olson ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Avenue Ashland,OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 Of 2 The ACORD name and logo are registered marks of ACORD #S35152145/M35151995 BABJT DESCRIPTIONS (Continued from Page 1). applies(10 days for non-payment of premium)to the first Named Insured only. SAGITTA 25.3(2016/03) 2 of 2 #S35152145/M35151995 Policy Number:A0146691003 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: A0146691001 COMMERCIAL AUTO CA 7601 0615 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Chown Inc Endorsement Effective Date: 03/01/2022 SCHEDULE Name Of Person(s)Or Organization(s): Any person or organization you are required to add as an additional insured under written contract or written agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Each person or organization shown in the B. Primary And Noncontributory Insurance Schedule is an "insured" for Covered Autos This insurance is primary to and will not seek Liability Coverage, but only to the extent that contribution from any other auto insurance issued person or organization qualifies as an 'insured" to the person or organization in the schedule under the Who Is An Insured provision contained under your policy provided that: in: (1) Paragraph A.1. of Section II - Covered Autos (1) The person or organization is a Named Insured Liability Coverage in the Business Auto and under such other insurance; and Motor Carrier Coverage Forms;or (2) Prior to the "accident" you have agreed in (2) Paragraph D.2. of Section I - Covered Autos writing in a contract or agreement that this insurance would be primary and would not Coverages of the Auto Dealers Coverage Form. seek contribution from any other insurance available to the person or organization. CA 76 01 0615 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0146691 with its permission. 02/25/2021 Middlesex 1 00001 0000000000 21056 0 N 70365cc8-95ce-434e-be90-4cfe2db00e4e POLICY NUMBER: A0146691001 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Chown Inc Endorsement Effective Date: 03/01/2022 SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 A0146691 02/27/2020 Middlesex Insurance Company 1 00001 0000000000 20058 0 N bc315041-c2fb-42c9-b005-8c0746a38a48 0027020044354738473597208288888 COMMERCIAL GENERAL LIABILITY CG 70 21 0618 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL BROAD FORM GENERAL LIABILITY ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Coverage D. Employee Benefits Liability 2. Exclusions A. The following is added to Section I - This insurance does not apply to: Coverages a. "Bodily injury" or mental injury to any 1. Insuring Agreement person, "property damage"or"personal a. We will pay those sums that the insured and advertising injury". becomes legally obligated to pay as b. Liability assumed by the insured under "damages" because of an "occurrence" any contract or agreement. to which this insurance applies. We will c. Any claim for have the right and duty to defend the insured against any "suit" seeking (1) Failure of performance of a contract those "damages". However, we will by any insurer or other fiduciary have no duty to defend the insured entrusted with monies intended to against any "suit" seeking "damages" fund "employee benefits"; to which this insurance does not apply. (2) Insufficiency of funds to meet any We may, at our discretion, investigate obligations under any "employee any "occurrence" and settle any claim benefits"; or"suit"that may result. But: (3) Inadequacy of performance of (1) The amount we will pay for investments, errors in providing "damages" is limited as described in information on past performance of paragraph B.of this coverage;and investment vehicles or advice given (2) Our right and duty to defend ends with respect to participation; when we have used up the (4)Your failure to establish any applicable limit of insurance in the "employee benefits" in compliance payment of judgments or with the mandatory provisions of settlements under Coverage D. any law governing workers' No other obligation or liability to pay compensation, unemployment sums or perform acts or services is insurance, social security or covered unless explicitly provided for disability benefits or any similar under Supplementary Payments. state or federal law; b. This insurance applies only to (5) Advice given to any person to "damages" caused by an "occurrence" participate or not to participate in during the policy period. The any"employee benefits"; "occurrence" must take place in the (6)Taxes, fines or penalties, including "coverage territory". those imposed under the Internal c. "Damages" sustained by any one Revenue Code or any similar state "employee", including "damages" or local law; sustained by such "employee's" (7) "Damages" arising out of wrongful dependents and beneficiaries, as a termination of employment, result of a series of related errors or discrimination, or other omissions shall be considered one employment-related practices. "occurrence". CG 70 21 0618 Page 1 of 9 A0146691 02/27/2020 Middlesex Insurance Company 1 00005 0000000000 20058 0 N 6b6a89d3-9593.40bb-9759-bObad7932a3f 0027020044354738479997232259875 d. Liability based on: b. Your duties in the event of an (1) Medical malpractice of any occurrence, claim or"suit" physician or surgeon; apply regardless of the application of the (2) Dishonest, fraudulent, criminal or deductible amount. malicious acts or omissions 4. We may pay any part of all of the committed by any insured; deductible amount to effect settlement of (3) The Employee Retirement Income any claim or"suit" and, upon notification of Security Act of 1974 or any the action taken, you should promptly amendment thereof; or reimburse us for each part of the deductible amount as has been paid by us. (4) Circumstances of which you were D. Coverage D Definitions aware, or should have been aware, at the inception of this insurance. 1. For Coverage D, only, the following 3. The Supplementary Payments provisions definitions replace the corresponding are extended to Coverage D. definitions found in the Commercial B. Limit Of Insurance General Liability Coverage Part: a. "Employee" means a person actively For this additional coverage, Section employed or formerly employed by or III - Limits Of Insurance is amended as on leave of absence, disabled or retired follows: from the named insured. Employee 1. Paragraph 2. is replaced by the following: does not include a "leased worker"or a 2. The General Aggregate Limit is the "temporary worker". most we will pay for the sum of: b. "Occurrence" means an error or a. Medical Expenses under Coverage omission in the "administration" of C; "employee benefits". c. "Suit"means a civil proceeding in which b. Damages under Coverage A., "damages" because of an "occurrence" except damages because of "bodily injury" or "property damage" to which Coverage D. applies are included in the "products- alleged. Suit includes: completed operations hazard"; (1)An arbitration proceeding in which c. Damages under Coverage B; and such "damages" are claimed and to which the insured must submit or d. Damages under Coverage D. does submit with our consent; or 2. Subject to the General Aggregate Limit (2)Any other alternative dispute described in paragraph B.1. above, the resolution proceeding in which Each Employee Limit is the most we will damages are claimed and to which pay under Coverage D. for all "damages" the insured submits with our sustained by any one "employee", consent. including "damages" sustained by such 2. The following definitions are added for "employee's" dependents and Coverage D only: beneficiaries, because of any one "occurrence". a. "Administration" means: C. Deductible (1) Providing information to employees, 1. Our obligation under Coverage D. to pay including their dependents and "damages" on behalf of the insured applies beneficiaries, with respect to only to the amount of"damages" in excess eligibility for or scope of "employee of any Each Employee Deductible amount benefits , shown in the Declarations. (2) Interpreting "employee benefits"; 2. The deductible amount applies to all (3) Handling of records in connection "damages" sustained by any one with the "employee benefits"; or "employee", including such "employee's" (4) Effecting, continuing or terminating dependents and beneficiaries, because of any employee's participation in any any one occurrence. benefit included in "employee 3. The terms of this insurance, including benefits" those with respect to: by you or a person or organization a. Our right and duty to defend the authorized by you to perform such insured against "suits" seeking those acts. "damages"; and However, "administration" does not include handling payroll deductions. Page 2 of 9 CG 70 21 0618 A0146691 02/27/2020 Middlesex Insurance Company b. Damage" means" b. Paragraph 1.d. is amended to pay for loss of (1)Those sums that the insured is earnings up to $750 a day because of time off legally obligated to pay as a result of from work. negligent errors or omissions to 3. Fellow Employee Bodily Injury which this insurance applies. For the Paragraph 2.a.of Section II - Who Is An Insured purpose of this coverage, "dam- is replaced by the following: ages" does not include punitive or exemplary damages, requests for 2. Each of the following is also an insured: restitution, requests for injunctive or a. Your "volunteer workers" only while declarative relief, including performing duties related to the conduct of associated requests for costs or your business, or your "employees", other fees or any other costs, fees or than either your "executive officers" (if you penalties that are not insurable by are an organization other than a law;or partnership, joint venture or limited liability (2) Other costs, fees or penalties company) or your managers (if you are a required to be paid by order of limited liability company), but only for acts enforcement of any federal, state, or within the scope of their employment by local statutes to the extent they are you or while performing duties related to insurable by lawconduct of none ofthese "employees" or "volunteer c. "Employee benefits" means: workers"are insureds for: (1) Insurance programs for: (1) "Personal and advertising injury": (a) Group Life; (a)To you,to your partners or members (b) Group accident and health; (if you are a partnership or joint (c) Dental,vision and hearing plans; venture), to your members (if you are limited liability company), to a (d) Flexible spending accounts; co-"employee" while in the course (e)Workers'compensation; of his or her employment or (f) Unemployment; and performing duties related to the conduct of your business or to your (g)Social security and disability other "volunteer workers" while benefits. performing duties related to the (2) Group Plans for: conduct of your business; (a) Profit Sharing; (b)To the spouse, child, parent, brother (b) Pensions; or sister of that co-"employee" or "volunteer worker" as a (c) Employee stock subscription; consequence of paragraph (1)(a) (d) Employee savings plans; and above or (e) Employee stock ownership (c) For which there is any obligation to plans; share damages with or repay (3) Vacation plans, including buy and someone else who must pay damages because of the injury sell programs; leave of absence programs, including military, described in paragraphs (1)(a) or(b) above. maternity, family, and civil leave; or "personal and(2) "Bodily injury tuition assistance plans; transportation and health club advertising injury" arising out of his or subsidies; and her providing or failing to provide professional health care services. (4) Other similar employee benefits, But this does not apply to "bodily identified by separate endorsement. injury" arising out of nurses, emergenc The above plans must be provided by medical technicians or paramedics you and are applicable to you and your providing or failing to provide employees. professional health care services. 2. Broadened Supplementary Payments (3) "Property damage"to property: Under Section I - Coverages, Supplementary (a) Owned, occupied or used by; Payments-Coverages A And B: a. Paragraph 1.b. is amended to pay up to (b) Rented to, in the care, custody or control of, or over which physical $3,000 for cost of bail bonds;and control is being exercised for any purpose by; CG 70 21 06 18 Page3of9 A0146691 Middlesex Insurance Company 02/27/2020 3 00005 0000000000 20058 0 N 6b6a89d3-9593-40bb-9759-bObad7932a3f 0027020044354738479997232259875 you, any of your "employees", (3)Any of the other insurance, whether "volunteer workers", any .partner or primary, excess, contingent or on member(if you are a partnership or joint any other basis: venture), or any member (if you are a (a) If the insured's liability to pay limited liability company). damages is determined in a 4. World Wide Coverage Territory s "suit" brought outside the United a. Under Section V - Definitions, Paragraph 4. States of America (including its is replaced by the following: territories and possessions), Puerto Rico or Canada;or 4. "Coverage territory" means anywhere in the world. (b)That is coverage required by law, regulation or other governmental b. The following is added to Section IV - authority in a part of the Conditions: "coverage territory" that is Expanded Coverage Territory outside of the United States of (1) If a"suit" to which this insurance applies is America (including its territories brought outside the United States of and possessions), Puerto Rico or America (including its territories and Canada. possessions), Puerto Rico or Canada, we 5. Engine Rebuilding And Overhaul Operations will have the right but not the duty to If this insurance applies to "property damage" defend the insured against such "suit". included within the "products-completed In any such case in which we elect not to operations hazard", the following exception is defend, the insured will at our option and added to exclusion I. under Paragraph 2., under our supervision: Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability: (a) Make or cause to be made such This exclusion does not apply if "property investigation and defense as are damage" arises from "engine rebuilding or reasonably necessary; and overhaul operations" conducted by you or on (b)To the extent possible, effect such your behalf. settlement or settlements as we shall "Engine rebuilding or overhaul operations" means deem proper. repair of internal combustion engines or We will reimburse the insured, under component parts of such engines owned by Supplementary Payments, for the others if the repair involves the complete reasonable cost of such investigation and disassembly and reassembly of the engine or defense and,within the limits of liability, for component part of the engine. the amounts of such authorized This insurance does not apply to "property settlement. damage to engines or component parts of engines which are used in, or while in practice or (2)All payments or reimbursements we make preparation for, any prearranged racing, speed, for damages because of judgments or demolition or stunting activity. settlements will be made in U.S. currency 6. Incidental Medical Malpractice at the prevailing exchange rate at the time the insured became legally obligated to a. Under Section V - Definitions, the definition pay such sums. All payments or of "bodily injury" is amended to include injury reimbursements we make for expenses arising out of the rendering or failure to render under Supplementary Payments will be medical services to persons by any physician, made in U.S. currency at the prevailing dentist, nurse, emergency medical technician exchange rate at the time the expenses or paramedic who is employed by you to were incurred. provide such services. (3)Any disputes between you and us as to b. This insurance does not apply: whether there is coverage under this policy (1) If you are engaged in the business or must be filed in the courts of the United occupation of providing medical services; States of America (including its territories or and possessions), Puerto Rico or Canada. (2) To liability assumed in a contract or c. The following is added to Paragraph 4.b. agreement. under the Conditions section: 4. Other Insurance b. Excess Insurance This insurance is excess over: Page4of9 CG 70 21 06 18 A0146691 02/27/2020 Middlesex Insurance Company 7. Damage To Premises Rented To You We waive the right of recovery we may have a. The final paragraph under Paragraph 2., because of payments we make for "bodily injury" Exclusions of Section I - Coverage A - under Section I - Coverage C - Medical Bodily Injury And Property Damage Liability Payments. is replaced by the following: 11.Aircraft Chartered With A Crew Exclusions c., d., e. and g. through n. do not The following is added to Exclusion g. under apply to damage to premises while rented to Paragraph 2. Exclusions of Section I- Coverage you or temporarily occupied by you with A - Bodily Injury And Property Damage permission of the owner. A separate limit of Liability: insurance applies to this coverage as this exclusion does not apply to an aircraft, not described in Section III - Limits Of owned by any insured, charted with a crew by or Insurance. on behalf of the insured. This insurance does not apply to 'property This insurance is excess over any other valid and damage" (other than damage by fire) to collectible aircraft insurance available to the premises rented to you for a period of 7 or insured, whether such insurance is primary, fewer consecutive days. excess, contingent or on any other basis. b. Except for damage arising out of fire, 12.Extended Property Damage explosion or water discharge, our obligation under this coverage to pay for premises Exclusion a. under Paragraph 2., Exclusions of "property damage" on your behalf applies Section I - Coverage A - Bodily Injury And only to the amount of damages in excess of a Property Damage Liability is replaced by the $5,000 per claim deductible. The deductible following: applies to all damages sustained by any one a. "Bodily injury"or"property damage" expected person or organization because of premises or intended from the standpoint of the insured. "property damage". This exclusion does not apply to "bodily injury" The terms of this insurance, including those or"property damage" resulting from the use of with respect to: reasonable force to protect persons or property. (1)Our right and duty to defend the insured 13.Hostile Fire-Pollution Clean against any "suit" seeking damages to Up which this insurance applies; and The following is added to Paragraph (2) of (2)Your duties in the event of an Exclusion f. under Paragraph 2., Exclusions of "occurrence", claim or"suit" Section I - Coverage A - Bodily Injury And Apply irrespective of the application of the Property Damage Liability: deductible amount. Subparagraphs (2)(a) and (b) do not apply to We may , sohea pay any part of or all of the deductible or lossfumescost or from expense a "hostileariing fireut" of coveredt, under amount to effect settlement of any claim "suit" or paragraph f.(1). above.A separate aggregate limit suit and, upon notification of the action of $25,000 is the most we will pay under this taken, you shall promptly reimburse us for coverage for losses during the policy period. such part of the deductible amount as has been paid by us. The above provision does not apply if a Total 8. Extended Medical Payments Pollution Exclusion endorsement is part of this Coverage Part. Section I - Coverage C - Medical Payments is 14.Newly Acquired Organizations extended to apply to medical expenses incurred and reported to us within three years of the date Paragraph 3.a.of Section II-Who Is An Insured of the accident. is amended, substituting 180th day for 90th day. 9. Extended Non-Owned Watercraft 15.Broad Knowledge Of Occurrence, Claim Or Paragraph (2)(a) of Exclusion g. under Paragraph Suit 2., Exclusions of Section I - Coverage A - Under Section IV - Commercial General Bodily Injury And Property Damage Liability is Liability Conditions, Condition 2. Duties In The amended, substituting 51 feet for 26 feet. Event Of Occurrence, Offense, Claim Or Suit is 10.Medical Payments - Waiver Of Transfer Of amended by the addition of the following: Rights Of Recovery Under Section IV - Commercial General Liability Conditions, Condition 8. Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: CG 70 21 0618 Pae 5 of 9 A0146691 g Middlesex Insurance Company 02/27/2020 5 00005 0000000000 20058 0 N 6b6a89d3-9593-40bb-9759-bObad7932a3f 0027020044354738479997232259875 Knowledge of an "occurrence", offense, claim or 19.Additional Insureds "suit" by an agent or"employee"of any insured or a. The following is added to Section II - Who Is receipt of any demand, notice, summons or other An Insured. legal paper in connection with a claim or"suit" by any agent or "employee" of any insured shall not The following are included as Additional in itself constitute knowledge of the named Insureds when you have agreed to add the insured or receipt of the named insured, unless a person or organization as an Additional partner, member, manager, "executive officer" or Insured on your policy in a written contract, director shall have such knowledge or shall have written agreement or because of a permit received such demand, notice, summons or legal issued by a state or political subdivision; paper. provided the injury or damage occurs subsequent to the execution of the contract 16.SoId Premises Property Damage or agreement or issuance of the permit: Exclusion j.(2) under Paragraph 2., Exclusions of (1) Any Person or Organization you are Section I - Coverage A - Bodily Injury And Performing Work For Property Damage Liability does not apply. 17.Unintentional Failure To Disclose Hazards Any person(s) or organization(s) not an insured under paragraphs 2. through 6. Under Section IV - Commercial General below, but only with respect to liability for Liability Conditions, the following is added to "bodily injury", "property damage" or Condition 6. Representations: "personal and advertising injury"caused, in If in your representations to us you whole or in part, by your acts or omissions unintentionally failed to disclose all hazards and or the acts or omissions of those acting on exposures subject to this insurance, we shall not your behalf; in the performance of your deny all coverage under this policy because of ongoing operations for the Additional such oversight. Insured. 18.Stop Gap Liability A person's or organization's status as an The following exception is added to Exclusion e. Additional Insured under this endorsement under Paragraph 2., Exclusions of Section I - dds when your operations e for that A Coverage A - Bodily Injury And Property Additional Insured are completed. Damage Liability: (2) Lessor of Leased Equipment This exclusion does not apply to "bodily injury" to Any person(s) or organization(s), but only an employee of the insured arising out of the with respect to liability for "bodily injury", course of: "property damage" or "personal and a. Employment by the insured;or advertising injury" caused, in whole or in part, by your maintenance, operations or b. Performing duties related to the conduct of use of equipment leased to you by such the insured's business person(s) or organization(s). provided such employee is reported and declared With respect to the insurance afforded to under the Workers Compensation Fund of the these Additional Insureds, this insurance states of North Dakota, Ohio, Washington or does not apply to any "occurrence"which Wyoming, whichever is applicable as respects takes place after the equipment lease such injured employee. expires. As used herein, employee includes a "leased (3) Lessor of Leased Land worker"or"temporary worker". Any person(s) or organization(s), but only The insurance provided by this coverage with respect to liability arising out of the extension does not apply to: ownership, maintenance or use of that a. Punitive or exemplary damage because of part of the land leased to you by that "bodily injury" to an employee employed in person(s)or organization(s), subject to the violation of law; following additional exclusions: b. "Bodily injury" to an employee while employed This insurance does not apply to: in violation of law with your actual knowledge (a) Any "occurrence" which takes place or the knowledge of any of your "executive after you cease to lease the land; officers";or (b) Structural alterations, new construction c. Damages arising out of the discharge of, or demolition operations performed by coercion of, or discrimination against any or on behalf of the person(s) or employee in violation of law. organization(s) that are Additional Insureds under this provision. Page 6 of 9 CG 70 21 0618 A0146691 02/27/2020 Middlesex Insurance Company (4) Managers or Lessors of Premises This exclusion applies even if the claims Any person(s) or organization(s); but only against any insured allege negligence or with respect to liability arising out of the other wrongdoing in the supervision, ownership, maintenance or use of that part hiring, employment, training or of the premises leased to you by that monitoring of others by that insured if person(s) or organization(s); subject to the the "occurrence" which caused the following additional exclusions: "bodily injury" or "property damage" or This insurance does nota I to: the offense which causes the"personal apply and advertising injury" involved the (a) Any "occurrence" which takes place rendering of or the failure to render any after you cease to be a tenant in that professional architectural, engineering premises. or surveying services. (b)Structural alterations, new construction (b) Bodily injury" or "property damage" or demolition operations performed by occurring after: or on behalf of the person(s) or (i) All work, including materials,parts or organization(s) that are Additional equipment furnished in connection Insureds under this provision. with such work, on the project(other (5) Owners, Lessees or Contractors than service, maintenance or Any person(s) or organization(s), but only repairs) to be performed by or on with respect to liability for "bodily injury", behalf of the Additional Insured(s) at "property damage" or "personal and the location of the covered advertising injury" caused, in whole or in operations has been completed;or part, by: (ii) That portion of "your work" out of (a) Your acts or omissions; or which the injury or damage arises has been put to its intended use by (b)The acts of omissions of those acting any person or organization other on your behalf; than another contractor or In the performance of your ongoing subcontractor engaged in the operations for the Additional Insured(s). performing operations for a principal With respect to the insurance afforded to as a part of the same project. these Additional Insureds, the following (6) State or Political Subdivisions - Permits additional exclusions apply: Or Authorizations Related To Premises This insurance does not apply to: Any state or governmental agency or (a) "Bodily injury", "property damage" or subdivision or political subdivision; but only "personal and advertising injury"arising with respect to the following hazards for out of the rendering of, or the failure to which the state or governmental agency or render any professional, architectural, subdivision has issued a permit or engineering or surveying services, authorization in connection with premises including: you own, rent or control and to which this insurance applies: (i) The preparing, approving, or failing (a)The existence, maintenance, repair, to prepare or approve, maps, shop construction, erection or removal of drawings, opinions, reports, advertising signs, awnings, canopies, surveys, field orders, change orders cellar entrances, coal holes, driveways, or drawings and specifications; or manholes, marquees, hoist away (ii) Supervisory, inspection, openings, sidewalk vaults, street architectural or engineering banners or decorations and similar activities. exposures; or (b)The construction, erection or removal of elevators; or (c) The ownership, maintenance or use of any elevators covered by this insurance. However; (1) The insurance afforded to such Additional Insureds only applies to the extent permitted by law; and CG 70 21 0618 Page 7 of 9 A0146691 02/27/2020 Middlesex Insurance Company 7 00005 0000000000 20058 0 N 6b6a89d3-9593-40bb-9759-b0bad7932a3f 0027020044354738479997232259875 (2)The insurance afforded to such Additional (i) This insurance is primary if you have Insured will not be broader than that which agreed in a written contract or written you are required by the contract or agreement that this insurance be agreement to provide for such Additional primary. If other insurance is also Insureds. primary, we will share with that other A person or organization is an Additional insurance by the method described in Insured under this provision only for the Method of Sharing section below. period of time required by the contract or (ii) If you have agreed in a written contract, agreement. written agreement or permit that this However, no such person or organization is insurance is primary and an insured under this Additional Insured non-contributory with the Additional coverage if included as an insured by an Insured's own insurance,this insurance endorsement issued by us and made a part is primary and we will not seek of this coverage part. contribution from that other insurance. b. The following is added to Section III - Limits Paragraphs(i)and(ii)do not apply to other of Insurance insurance to which the Additional Insured If you have agreed in a written contract or has been specifically named as an written agreement that another person or ditrsem Insured under a separate en organization be added as an Additional endorsement. Insured on your policy, the most we will pay 20.Mental Anguish on behalf of that Additional Insured is the The definition of "bodily injury" under Section V lessor of: - Definitions is replaced by the following: 1. The Limits of Insurance specified in the "Bodily injury" means bodily injury, sickness or written contract or written agreement;or disease sustained by a person, including "mental 2. Available under the applicable Limits of anguish" or death resulting from any of these at Insurance shown in the Declarations. any time. This amount shall be a part of and not in The following definition is added to Section V addition to Limits of Insurance shown in the - Definitions: Declarations and described in Section III. "Mental anguish" means extreme pain or distress c. The following is added to Section IV - inflicted upon an individual's emotional and Commercial General Liability Conditions: intellectual condition with regard to the If we cover a claim or "suit" under this individual's response to the environment. Coverage Part that may also be covered by 21.Non-Employment Related Discrimination other insurance available to an Additional The following is added to the definition of Insured, such Additional Insured must submit "personal and advertising injury"under Section V such claim or "suit" to the other insurer for - Definitions: defense and indemnity. Discrimination against or harassment of a person However, this provision does not apply to the if: extent that you have agreed in a written a. Coverage for such discrimination or contract or written agreement that this harassment is permitted by law; and insurance is primary and non-contributory with the Additional Insured's own insurance. b. The discrimination or harassment is not d. The following is added to Section IV - committed by or at the direction of: Commercial General Liability Conditions (1) You; 4.b.(1)of Excess Insurance: (2) If you are an individual,your spouse; (c)Any other insurance available . to an (3) If you are a partnership, a partner or his or Additional Insured covered by this policy. her spouse; However, the following provisions apply to (4) If you are a joint venture, a member of the other insurance available to any person or joint venture or his or her spouse; organization who is an Additional Insured (5) If you are a limited liability company, any of under this coverage part. your members or managers;or (6) If you are an organization other than' a partnership, joint venture, or limited liability company, any of your "executive officers", directors or stockholders. Page 8 of 9 CG 70 21 0618 A0146691 Middlesex Insurance Company 02/27/2020 This insurance does not apply to "personal and advertising injury" arising out of any insured's failure to comply with any responsibilities or duties required by the Americans With Disabilities Act, any amendments or additions or any similar state or local law. All other terms and provisions of this policy remain unchanged. CG 70 21 06 18 Page9of9 A0146691 02/27/2020 Middlesex Insurance Company 9 00005 0000000000 20058 0 N 6b6a89d3-9593-40bb-9759-bObad7932a3f 0027020044354738479997232259875 POLICY NUMBER: A0146691003 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s) Operations Any person or organization you are required to add as Jobsites and operations as described in written an contracts with the named insured additional insured under a written contract or written agreement in effect prior to any loss or damage 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 is added to organization(s) shown in the Schedule, but only Section III- Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we your work at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown in the Declarations; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured applicable Limits of Insurance shown in the is required by a contract or agreement, the Declarations. insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 1 A0146691 02/27/2020 Middlesex Insurance Company 1 00001 0000000000 20058 0 N 8cc5a063-0866-46af-833f-bbcbf583b6ae 0027020044354738473397208288888 POLICY NUMBER: A0146691003 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Any person or organization you are required to add as Jobsites as described in written contracts with the an named insured additional insured under a written contract or written Description: in effect prior to any loss or damage All operations with written contract with the named insured 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 organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage" occurring after: injury caused, in whole or in part, by: 1. Your acts or omissions;or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured onlyapplies to the extentpermitted byintended use by any person or organization pp other than another contractor or law;and subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal as a part of the same is required by a contract or agreement, the project. insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 A0146691 02/27/2020 Middlesex Insurance Company 1 00001 0000000000 20058 0 N 1c4c682e-64d2-4dbf-a65f-3456c193a013 0027020044354738475497208288888 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III-Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 2010 0413 A0146691 02/27/2020 Middlesex Insurance Company POLICY NUMBER: A0146691003 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: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any lossor damage 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 A0146691 02/27/2020 Middlesex Insurance Company 1 00001 0000000000 20058 0 N a37b73a3-4b2f-46b6-a56c-c3d9832c06a2 0027020044354738475697208288888 USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING PO BOX 629035 EL DORADO HILLS CA 95762-9035 CITY OF ASHLAND ATTN KARI OLSON 90 N MOUNTAIN AVE ASHLAND OR 97520-2014