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HomeMy WebLinkAboutInsurance Certificate: Professional Credit Holdings; Ray Klein, Inc i;! J r_ Y{ 'i f' -;1^, if �fet,f-,, GA\,s 3 T� '' '7 %�r�S�y;,.7� jF� Fw.. -y;Ft%, ''.. ,n. r .,... ,4 r ,.r• P. 4r\-t tj,,-.... ..t': ; _.,': ;1t...W f ':M. 't( f,1.% :.'. F'.. <' 1:Z o l;W�i.Fn,Mti S i',":u�T-L,,L.V�..t„Y't;, '�w ��.,+,qi'M;+.pf.,T7"z"Z7s +T',.;?-}PKi } 'R. �,.S41Wt+,1"(s,MA•„h! ).{ >' ., .s,, r4Yti s `i',.. t,I-' ,?t,'`A't' "" y.G.+:h%? 4r.t;i.4i fxi-t,t 'AC'9Ro : • CERTIFICATE OF LIABILITY.INSURANCE ' DATE(MM:,DDIYYYY) . L.. ' '08/06/2021 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 . - `,.L 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 thiscertificate does not-confer rights to the certificate holder in lieu of such endorsement(s).. . . - 1:7:‘.'.['- :' ' PRODUCER'. CONTACT AnNAME: • gie Diethelm " . + Christensen Group ,, RHONE , (952)653 1000 ,,., 'FAXt '(952)653 1100 f,,•^. - • (AIC No) 9855 West 78th Street Ste 100-- ,..,-4,:f':, i f ADDRESS adiethelm@ch�istensengroupcom" : INSURER(S)AFFORDING COVERAGE e' • NAIC# Eden Prairie -- _ '. -•, ., MN 55344 ' INSURERA Hanover Ins Group.. _ , INSURER e: Evanston Insurance Company • • • Professional Credit Holdings Corporation;Ray Klein,Iric 'INSURER Hudson Excess Insurance Company.: ' ' 400 International Way,Ste 250 INSURER D Travelers Casualty and Surety Co of America ' ' ' INSURER E:. . Springfield OR 97477 INSURER F: LIABILITY 21-22' ' COVERAGES '...• ' .` ,CERTIFICATE NUMBER:,` - • , REVISION NUMBER:-1 - "4 „.o:_ -.,,.. ,,'.THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED-TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD , INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ' ' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED'BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, '':`, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. • INSR - , • ADDLSUBR '• POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD , POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) - LIMITS'- - COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $- , , • ' X 1000 .000 '.. DAMAGE TO RENTED CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $:300,000 • , MED EXP(Any one person)' $ A • Y ZDXH67267900 06/30/2021 06/30/2022 ' PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 .. POLICY n ECn C PRODUCTS-COMP/OFAGG S .2 000,00 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , f — 1' (Ea accident) $ 1,000,000 ANY AUTO - • BODILY INJURY(Per person) $ ; A OWNED SCHEDULED Y ZDXH67267900 06/30/2021 06/30/2022 BODILY INJURY(Per accident)' $ AUTOS ONLY AUTOS HIRED NON-OWNED X AUTOS ONLY X AUTOS ONLYPROPERTY DAMAGE $ (Per accident) • • X UMBRELLA UAB _J OCCUR EACH OCCURRENCE .- ' $ 10,000,000 ' A EXCESS LIAB ' CLAIMS-MADEAGGREGATE UHXH67269600 06/30/2021 .06/30/2022 '$ 10,000,000 ,, • DED X RETENTION$ 10,000 $ • WORKERS COMPENSATION . - - X STATUTE ERH '- AND EMPLOYERS'LIABILITY ' ' ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? n N/A WZXH63911600., 06/30/2021 06/30/2022 (Mandatory In NH) . E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ •• • Cyber Limit , $5,000,000 Cyber Liability B/C Excess Cyber ' MKLV5PCY000044/CXS1002688 06/30 /2021 06/3,0/2022 Excess Cyber Limit $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) " The City of Ashland,its elected officials, officers&employees are included as an Additional Insured under the General Liability on a . Primary/Non-Contributory basis and Auto Liability when required by written contract. , 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 ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street ' AUTHORIZED REPRESENTATIVE ' Ashland OR 97520 . -t I '' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) ' ' The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACCME) ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Christensen Group Professional Credit Holdings Corporation;Ray Klein,Inc POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS • THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes C)Excess Cyber Liability-6/30/21-6/30/22-Policy#CXS-1002688-00-Limit:$5,000,000 D)Professional Liability-6/30/21-6/30/22-Policy#107470356-Limit:$3,000,000 • • • •• • ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LUX H672679 00 2509544 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGES 1. Additional Insured by Contract,Agreement or Permit Included 2. Additional Insured—Primary and Non-Contributory Included 3. Blanket Waiver of Subrogation Included 4. Bodily Injury Redefined Included 5. Broad Form Property Damage—Borrowed Equipment, Customers Goods& Use of Elevators Included 6. Knowledge of Occurrence Included 7. Liberalization Clause Included 8. Medical Payments—Extended Reporting Period Included 9. Newly Acquired or Formed Organizations-Covered until end of policy period -Included • 10. Non-owned Watercraft 51 ft. 11. Supplementary Payments Increased Limits - - Bail Bonds $2,500 - Loss of Earnings $1000 12. Unintentional Failure to Disclose Hazards Included 13. Unintentional Failure to Notify Included This endorsement amends coverages provided under the Commercial General Liability Coverage Part through new coverages, higher limits and broader coverage grants. 1. Additional Insured by Contract, Agreement or (1) "Your work" for the additional insured(s) Permit designated in the contract, agreement or The following is added to SECTION II — WHO IS permit; AN INSURED: (2) Premises you own, rent, lease or occupy; Additional Insured by Contract, Agreement or. or Permit (3) Your maintenance, operation or use of a. Any person or organization with whom you equipment leased to you. agreed in a written contract, written agreement b. The insurance afforded to such additional or permit that such person or organization to insured described above: add an additional insured on your policy is an (1) Only applies to the extent permitted by additional insured only with respect to liability • law; and for "bodily injury", "property damage", or "personal and advertising injury" caused, in (2) Will not be broader than the insurance whole or in part, by your acts or omissions, or which you are required by the 'contract, the acts or omissions of those acting on your agreement or permit to provide for such behalf, but only with respect to: additional insured. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 4 LOX H672679 00 2509544 (3) Applies on a primary basis if that is advertising injury" involved the rendering required by the written contract, written of or failure to render any professional agreement or permit. services by or for you. (4) Will not be broader than coverage ' d. With respect to the insurance afforded to provided to any other insured. these additional insureds, the following is, (5) Does not apply_ if the "bodily injury", added to SECTION III LIMITS OF "property damage" or "personal and INSURANCE: advertising injury" is otherwise excluded. The most we will pay on behalf of the from coverage under this Coverage Part, additional insured for a covered claim is the including any endorsements thereto. lesser of the amount of insurance: c. This provision does not apply: 1. Required by the contract, agreement or (1) Unless the written contract or written permit described in Paragraph a.; or agreement was executed or permit was 2. Available under the applicable Limits of issued prior to the"bodily injury", "property „ Insurance shown in the Declarations. damage"; or "personal injury and This endorsement. shall not increase the advertising injury". applicable Limits of Insurance shown in the (2) To any person or organization included as Declarations. an insured by another endorsement 2. Additional Insured - Primary and Non- issued by us and made part of this Contributory Coverage Part. The following is 'added to SECTION IV — (3) To any lessor of equipment: COMMERCIAL GENERAL LIABILITY (a) After the equipment lease expires; or r CONDITIONS, Paragraph 4.Other insurance: (b) If the "bodily injury", "property Additional Insured ' — Primary and Non- damage", "personal and advertising Contributory. injury" arises out of sole negligence of ' If you agree in a written contract, written the lessor , agreement or permit that the insurance provided to (4). To any: any person or organization included as an (a) Owners or other interests from. whom Additional Insured under SECTION ll — WHO IS land has been leased which takes AN INSURED, is primary and'non-contributory, place after the lease for the land ex- the following applies: pires; or , If other valid and collectible insurance is available (b)' Managers or lessors of premises if: to the Additional Insured for a loss,covered under Coverages A or B of this Coverage Part, our (i) The occurrence takes place after obligations are limited as follows: you cease to be a tenant in that premises; or a. Primary Insurance (ii) The "bodily injury", "property This insurance is primary to other insurance damage", "personal injury" or that is available to the Additional Insured "advertising injury" arises out of which covers the structural alterations, new con- Additional Insured as a NamedInsured. We struction or demolition operations will not seek' contribution from any other performed by or on behalf of the ' 'insurance available'to the Additional Insured manager or lessor. except: (5) To "bodily injury", "property damage" or (1) For the sole negligence of the Additional "personal and advertising injury" arising - Insured; out of the rendering of or the failure to (2) When 'the . Additional Insured is an render any professional services. Additional Insured under another primary This exclusion, applies even if the claims liability policy; or against any insured allege negligence or' ' '(3) when b. below applies. other wrongdoing in the -supervision, hiring, employment,-training or monitoring If this insurance is primary, our obligations are of others by that insured, if the not affected unless any of the other insurance "occurrence" which caused the "bodily is also primary. Then, we will share with all injury" or"property damage" or the offense that other insurance by the method described which caused the "personal and in c. below. 421=2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 4 LUA f1b IA)/y UU LbUy544 r b. Excess Insurance insurer contributes equal amounts until it has (1) This;insurance is excess over any of the .„-''-,-'`- paid its applicable limit of insurance or none of other insurance, whether primary, excess, - the loss remains, whichever comes first. If any contingent or on any other basis: of •the other insurance does not ,permit, contribution by equal shares, we will contribute (a) That is Fire, 'Extended Coverage, by limits. Under this, method, each insurer's Builder's Risk, Installation Risk or share is based on the ratio of its applicable similar coverage for"your work"; limit of insurance to the total applicable limits ' (b) That is Fire insurance for premises of insurance of all insurers " rented to the Additional Insured or 3. Blanket Waiver of Subrogation temporarily occupied by the Additional Insured with permission of the owner; - The following is added to, SECTION .IV' — COMMERCIAL GENERAL LIABILITY (c) That is insurance purchased by the , CONDITIONS, Paragraph 8. Transfer Of'Rights Additional Insured to cover the Of Recovery Against Others To Us: ' Additional Insured's liability as a - tenant for "property damage". to , We waive any right of recovery we may have premises rented to the Additional against any person or organization with whom you Insured or temporarily occupied by the have a written contract that requires such waiver , Additional with permission of the because of payments we make for damage under owner; or this coverage form. The damage must arise out of your activities'under a written contract with that (d) If the loss arises 'out- of ' the person or organization. This waiver applies only to maintenance or use of aircraft, "autos" the extent that subrogation .is waived under a or watercraft to the extent not subject written contract executed prior to the "occurrence" ' to Exclusion g. `'of SECTION I — or offense giving rise to such payments. COVERAGE A — BODILY INURY • AND PROPERTY DAMAGE 4. Bodily Injury Redefined . , ' LIABILITY. SECTION V — DEFINITIONS, Definition 3. "bodily (2) When this insurance is excess, we will injury" is replaced by the following: have no duty under Coverages A or B to • 3.' "Bodily injury" means bodily injury, sickness or defend the insured against any"suit" if any disease sustained by a person including death other-insurer has 'a duty to defend the resulting from any of these at any time. "Bodily insured against that "suit". If no other injury" includes mental anguish or other insurer defends, we will undertake to do " mental injury resulting from "bodily injury". so, but we will be entitled to the insured's 5. Broad Form Property Damage - Borrowed rights against all those insurers. Equipment, Customers Goods, Use of (3) When this insurance is excess over other Elevators, . ' Insurance, we will pay only our share of a. SECTION I—COVERAGES, COVERAGE A— the amount of the loss, if any, that ' BODILIY ' INJURY AND PROPERTY exceeds the sum of: DAMAGE LIABILITY, . Paragraph ' 2. • (a) The total amount that all such other Exclusions subparagraph j. is amended as insurance would pay for the loss in the follows: , absence of this insurance; and Paragraph (4) does' not apply to "property (b) The total of all- deductible_ and self' ,damage" to borrowed equipment. while at a insured amounts under,all that other jobsite , and . not being used to perform insurance. operations. , We will share the remaining loss, if any, - - Paragraphs (3), (4) and (6) do not apply to with any other , insurance that is not "property damage"to "customers goods"while described in this -Excess Insurance , on your premises nor do they apply to the use provision and was not bought specifically , "of elevators at premises you own, rent, lease • to apply in -excess of the Limits of or occupy. ' Insurance shown in the Declarations of b. The following is added to SECTION V — this Coverage Part. DEFINTIONS: c. Method Of Sharing 24. "Customers goods" means property of If all of the ,other insurance permits your customer on your premises for the . contribution by equal shares,we will follow this purpose of being: method also. Under this approach each - 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission.-'• Page 3 of 4 LUX H672679 00 2509544 a. worked on; or 10. Non-Owned Watercraft • b. used in your manufacturing process. SECTION I — COVERAGES, COVERAGE A { c. ' The insurance afforded under this provision is BODILY INJURY AND PROPERTY DAMAGE excess over any other valid and collectible LIABILITY, Paragraph 2. Exclusions, property , insurance (including deductible) subparagraph g.(2) is replaced by the following: available to the insured whether primary, g. Aircraft,Auto Or Watercraft excess, contingent (2) A watercraft you do not own that is: • • 6. Knowledge of Occurrence (a) Less than 51 feet long; and The following is added to SECTION IV — (b) Not being used to carry persons or COMMERCIAL GENERAL LIABILITY property for a charge; CONDITIONS, Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit J This provision applies to any person who, e. Notice of an "occurrence", offense, claim or with your consent, either uses or is responsible for the use of a watercraft. "suit" will be considered knowledge of the insured if reported to an individual named 11. Supplementary Payments Increased Limits insured, partner, executive officer or an SECTION I — SUPPLEMENTARY PAYMENTS "employee" designated by you to give us such COVERAGES A AND B, Paragraphs 1.b. and a notice. 1.d. are replaced by the following: 7. Liberalization Clause 1.b.Up to $2,500 for cost of bail bonds required The following is . added -to SECTION IV — -because of accidents or traffic law violations COMMERCIAL GENERAL LIABILITY arising out of the use of any vehicle to which CONDITIONS: the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Liberalization Clause 1.d.AII reasonable expenses incurred by the If we adopt any revision that would broaden the insured gat our request to assist us in the coverage under this Coverage Form without investigation or defense of the claim or "suit", additional premium, within 45 days prior to or including actual loss of earnings up to$1000 a during the policy period, the broadened coverage day because of time off from work. will immediately apply to this Coverage Part. 12. Unintentional Failure to Disclose Hazards 8. Medical Payments — Extended Reporting Period The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY a. SECTION I—COVERAGES, COVERAGE C— CONDITIONS, Paragraph 6. Representations: MEDICAL PAYMENTS, Paragraph 1. Insuring Agreement, subparagraph a.(3)(b) We will not disclaim coverage under this Coverage is replaced by the following: Part if you fail to disclose all hazards existing as of the inception date of the policy provided such (b) The expenses are incurred and reported failure is not intentional. to us within three years of the date of the - accident; and - 13. Unintentional Failure to Notify b. This coverage does not apply if COVERAGE The following is added to SECTION IV — C — MEDICAL PAYMENTS is excluded either COMMERCIAL GENERAL LIABILITY by the provisions of the Coverage Part or by CONDITIONS, Paragraph 2. Duties in the Event endorsement. of Occurrence, Offense, Claim or Suit: 9. Newly Acquired Or Formed Organizations Your rights afforded under this policy shall not be Prejudiced if you fail to give us notice of an SECTION II —WHO IS AN INSURED, Paragraph "occurrence", offense, claim or"suit", solely due to 3.a. is replaced by the following: your reasonable and documented belief that the a. Coverage under this provision is afforded until "bodily injury" or "property damage" is not covered the end of the policy period. under this policy. - ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. • 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 4