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HomeMy WebLinkAboutInsurance Certificate: Industrial Software Solutions Inc Aco O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) `..----- 09/24)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 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 Nanci Gonzalez NAME: Brown&Brown of Washington,Inc. , PHONE (206)956-1600 FAX (206)956-9600 (AIC.No.EMI: (AIC,No): 800 5th Ave Suite 2400 ADDRESS: ngonzalez@bbseattle.com INSURER(S)AFFORDING COVERAGE NAIC# Seattle WA 98104 INSURER A: Travelers Property Casualty Company of America 25674 INSURED INSURER B: The Travelers Indemnity Company 25658 Industrial Software Solutions,IncINSURER C: Travelers Casualty and Surety Company 19038 INSURER D: 19909 120th Ave NE#101 INSURER E: Bothell WA 98011 INSURER F: COVERAGES CERTIFICATE NUMBER: 21 GL BA UM WC 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 SUER POLICY EFF POLICY EXP LTR _INSD NND POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY). LIMITS X COMMERCIAL GENERALUABILITY EACH OCCURRENCE $ 1,000,000 – AMAGE TREN It.D CLAIMS-MADE N OCCUR PREM SES(Ea occurence) .5 300;000 MED EXP(Any one person) $ 10,000 A ZLP-14T51135 12/01/2021 12/01/2022 ' PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ 2.00 0,000 X POLICY❑.Ea 0 LOC PRODUCTS-COMP/OP AGO $ 2,000.000 — OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000(Eacc )idet _ ANY AUTO BODILY INJURY(Per person). $ g OWNED — SCHEDULED BAIL109801 12/01/2021 12/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS _ xHIRED X NON-OWNED . PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) — $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS UAB H CLAIMS-MADE CUP-2L19643A 12/01/2021 12/01/2022 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION vl PER I 0TH- AND EMPLOYERS'LIABILITY •••••1 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L EACH ACCIDENT $ 1000000 C , , OFFICER/MEMBER EXCLUDED? N/A UB6J004239 10/15/2021 10/15/2022 (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 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) • 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. 90 N.Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland OR 97520 1 ©1988-2015 ACORD CORPORATION. All rights'reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR TECHNOLOGY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Non-Owned Watercraft - 75 Feet Long Or H. Blanket Additional Insured - Controlling Less Interest B. Who Is An Insured - Unnamed I. Blanket Additional Insured - Mortgagees, Subsidiaries Assignees, Successors Or Receivers C. Who Is An Insured - Employees - J. Blanket Additional Insured - Governmental Supervisory Positions Entities - Permits Or Authorizations D. Who Is An Insured - Newly Acquired Or Relating To Premises Formed Limited Liability Companies K. Blanket Additional Insured - Governmental E. Who Is An Insured - Liability For Entities - Permits Or Authorizations Conduct Of Unnamed Partnerships Or Relating To Operations Joint Ventures L. Medical Payments - Increased Limit F. Blanket Additional Insured - Persons Or M. Blanket Waiver Of Subrogation Organizations For Your Ongoing Operations As Required By Written N. Contractual Liability - Railroads Contract Or Agreement 0. Damage To Premises Rented To You G. Blanket Additional Insured - Broad Form Vendors PROVISIONS consent, either uses or is A. NON—OWNED WATERCRAFT — 75 FEET responsible for the use of a LONG OR LESS watercraft that you do not own that is: 1. The following replaces Paragraph (2) (1) 75 feet long or less; and of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of (2) Not being used to carry any SECTION I — COVERAGES — COVERAGE person or property for a charge. A — BODILY INJURY AND PROPERTY B. WHO IS AN INSURED — UNNAMED DAMAGE LIABILITY: SUBSIDIARIES (2) A watercraft you do not own The following is added to SECTION II — that is: WHO IS AN INSURED: (a) 75 feet long or less; and Any of your subsidiaries, other than a (Ib) Not being used to carry any partnership or joint venture, that is not person or property for a shown as a Named Insured in the charge; Declarations is a Named Insured if: 2. The following replaces Paragraph a. You are the sole owner of, or maintain 2.e. of SECTION II — WHO IS AN an ownership interest of more than INSURED: 50% in, such subsidiary on the first day of the policy period; and e. Any person or organization that, with your express or implied CG D4 17 02 19 @ 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office. Inc. with its permission. COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured the policy period, whichever is under similar other insurance. earlier, if you do not report such No such subsidiary is an insured for organization in writing to us within 180 "bodily injury" or "property damage" days after you f that occurred, or "personal and acquire or form it; or advertising injury" caused by an (2) Until the end of the policy offense committed: period, when that date is later • a. Before you maintained an ownership than 180 days after you acquire or form such organization, if interest of more than 50% in such you report such organization in subsidiary; or writing to us within 180 days b. After the date, if any, during the after you acquire or form it; policy period that you no longer b. Coverage A does not apply to maintain an ownership interest of "bodily injury" or "property more than 50% in such subsidiary. damage" that occurred before you For purposes of Paragraph 1. of acquired or formed the organ- Section II - Who Is An Insured, each ization; and such subsidiary will be deemed to be c. Coverage B does not apply to designated in the Declarations as: "personal and advertising injury" a. A limited liability company; arising out of an offense committed before you acquired or formed the b. An organization other than a organization: partnership, joint venture or limited For the purposes of Paragraph 1. of liability company; or Section II - Who Is An Insured, each c. A trust; such organization will be deemed to be as indicated in its name or the designated in the Declarations as: documents that govern its structure. a. A limited liability company; C. WHO IS AN INSURED — EMPLOYEES — b. An organization, other than a SUPERVISORY POSITIONS partnership, joint venture or limited The following is added to Paragraph liability company; or 2.a.(1) of SECTION II — WHO IS AN c. A trust; INSURED: as indicated in its name or the Paragraphs (1)(a), (b) and (c) above do documents that govern its structure. not apply to "bodily injury" to a co- E. WHO IS AN INSURED — LIABILITY FOR "employee" while in the course of the CONDUCT OF UNNAMED PARTNERSHIPS OR co-"employee's" employment by you arising out of work by any of your JOINT VENTURES "employees" who hold a supervisory The following replaces the last paragraph position. of SECTION II - WHO IS AN INSURED: D. WHO IS AN INSURED — NEWLY ACQUIRED No person or organization is an insured OR FORMED LIMITED LIABILITY COMPANIES with respect to the conduct of any current The following replaces Paragraph 3. of or past partnership or joint venture that is SECTION II — WHO IS AN INSURED: not shown as a, Named Insured in the Declarations. This paragraph does not 3. Any organization you newly acquire apply to any such partnership or joint or form, other than a partnership or venture that otherwise qualifies as an joint venture, and of which you are insured under Section II - Who Is An the sole owner or in which you Insured. maintain an ownership interest of F. BLANKET ADDITIONAL INSURED — PERSONS more than 50%, will qualify as a OR ORGANIZATIONS FOR YOUR ONGOING Named Insured if there is no other OPERATIONS AS REQUIRED BY WRITTEN similar insurance available to that CONTRACT OR AGREEMENT organization. However: a. Coverage under this provision is The following is added to SECTION II — afforded only: WHO IS AN INSURED: (1) Until the 180th day after Any person or organization that is not you acquire or form the otherwise an insured under this Coverage organization or the end of " Part and that you have agreed in a written Page 2 of 5 © 2017 The Travelers Indemnity Company. All rights reserved. CG D4 17 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY contract or agreement to include as an manufacturer, and then repackaged in additional insured on this Coverage Part the original container; is an insured, but only with respect to liability for "bodily injury" or "property (4) Any failure to make such damage" that: inspections, adjustments, tests or servicing as vendors agree to a. Occurs subsequent to the signing of perform or normally undertake to that contract or agreement; and perform in the regular course of b. Is caused, in whole or in part, by business, in connection with the your acts or omissions in the prodiucctsts"-on r sale of "your performance of your ongoing prod operations to which that contract or (5) Demonstration, installation, servicing agreement applies or the acts or or repair operations, except such omissions of any person or operations performed at such organization performing such vendor's premises in connection operations on your behalf. with the sale of "your products"; or The limits of insurance provided to (6) "Your products" that, after such insured will be the minimum distribution or sale by you, have limits that you agreed to provide in the been labeled or relabeled or used written contract or agreement, or the as a container, part or ingredient of limits shown in the Declarations, any other thing or substance by or whichever are less. on behalf of such vendor. G. BLANKET ADDITIONAL INSURED — BROAD Coverage under this provision does not FORM VENDORS apply to: The following is added to SECTION II — a. Any person or organization from whom WHO IS AN INSURED: you have acquired "your products", or any ingredient, part or container Any person or organization that is a entering into, accompanying or vendor and that you have agreed in a containing such products; or written contract or agreement to include as an additional insured on this b. Any vendor for which coverage as an Coverage Part is an insured, but only additional insured specifically is with respect to liability for "bodily scheduled by endorsement. injury" or "property damage" that: H. BLANKET ADDITIONAL INSURED — CONTROLLING a. Occurs subsequent to the signing of INTEREST that contract or agreement; and 1. The following is added to SECTION II — b. Arises out of "your products" that WHO IS AN INSURED: are distributed or sold in the regular Anyperson or organization that has course of such vendor's business. financialg control ofyou is an insured The insurance provided to such vendor with respect to liability for "bodily is subject to the following provisions: injury", "property damage" or "personal a. The limits of insurance provided to and advertising injury" that arises out such vendor will be the minimum of: limits that you agreed to provide in a. Such financial control; or the written contract or agreement, or the limits shown in the b. Such person's or organization's Declarations, whichever are less. ownership, maintenance or use of premises leased to or occupied by b. The insurance provided to such you. vendor does not apply to: The insurance provided to such person (1) Any express warranty not or organization does not apply to authorized by you or any structural alterations, new construction distribution or sale for a or demolition operations performed by purpose not authorized by you; or on behalf of such person or (2) Any change in "your products" organization. made by such vendor; 2. The following is added to Paragraph 4. (3) Repackaging, unless unpacked of SECTION II — WHO IS AN INSURED: solely for the purpose of This paragraph does not apply to any inspection, demonstration, testing, premises owner, manager or lessor that or the substitution of parts has financial control of you. under instructions from ' the CG D4 17 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY I. BLANKET ADDITIONAL INSURED — J. BLANKET ADDITIONAL INSURED — GOVERNMENTAL MORTGAGEES, ASSIGNEES, SUCCESSORS OR ENTITIES — PERMITS OR AUTHORIZATIONS RECEIVERS RELATING TO PREMISES The following is added to SECTION II — The following is added to SECTION II — WHO IS AN INSURED: WHO IS AN INSURED: Any person or organization that is a Any governmental entity that has issued a mortgagee, assignee, successor or permit or authorization with respect to receiver and that you have agreed in a premises owned or occupied by, or rented written contract or agreement to or loaned to, you and that you are include as an additional insured on this required by any ordinance, law, building Coverage Part is an insured, but only code or written contract or agreement to with respect to its liability as include as an additional insured on this mortgagee, assignee, successor or Coverage Part is an insured, but only with receiver for "bodily injury", "property respect to liability for "bodily injury", damage" or "personal and advertising "property damage" or "personal and injury" that: advertising injury" arising out of the existence, ownership, use, maintenance, a. Is "bodily injury or "property repair, construction, erection or removal of damage" that occurs, or is "personal and advertising injury" any of the following for which that causedo by offense that is governmental entity has issued such committed, ansubsegfenst to permit or authorization: advertising signs, signing of that contracttother awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, agreement; and hoist away openings, sidewalk vaults, b. Arises out of the ownership, elevators, street banners or decorations. maintenance or use of the premises K. BLANKET ADDITIONAL INSURED — for which that mortgagee, assignee, GOVERNMENTAL ENTITIES — PERMITS OR successor or receiver is required AUTHORIZATIONS RELATING TO OPERATIONS under that contract or agreement to be included as an additional insured The following is added to SECTION II — on this Coverage Part. WHO IS AN INSURED: The insurance provided to such Any governmental entity that has issued a mortgagee, assignee, successor or permit or authorization with respect to receiver is subject to the following operations performed by you or on your provisions: behalf and that you are required by any a. The limits of insurance provided to ordinance, law, building code or written such mortgagee, assignee, successor contract or agreement to include as an or receiver will be the minimum additional insured on this Coverage Part is limits that you agreed to provide in an insured, but only with respect to the written contract or agreement, liability for "bodily injury", "property damage" or "personal and advertising or the limits shown in the injury" arising out of such operations. Declarations, whichever are less. b. The insurance provided to such The insurance provided to such person or organization does not governmental entity does not apply to: apply to: a. Any "bodily injury", "property damage" (1) Any "bodily injury" or "property or "personal and advertising injury" damage" that occurs, or any arising out of operations performed for "personal and advertising injury" the governmental entity; or caused by an offense that is b. Any "bodily injury" or "property committed, after such contract damage" included in the "products- or agreement is no longer in completed operations hazard". effect; or L. MEDICAL PAYMENTS — INCREASED LIMIT (2) Any "bodily injury", "property damage" or "personal and The following replaces Paragraph 7. of advertising injury" arising out of SECTION III — LIMITS OF INSURANCE: any structural alterations, new 7. Subject to Paragraph 5. above, the construction or demolition Medical Expense Limit is the most we operations performed by or on will pay under Coverage C for all behalf of such mortgagee, medical expenses because of "bodily assignee, successor or receiver. injury" sustained by any one person, Page 4 of 5 © 2017 The Travelers Indemnity Company. All rights reserved. CG D4 17 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY and will be the higher of: N. CONTRACTUAL LIABILITY — RAILROADS a. $10,000; or 1. The following replaces Paragraph C. of b. The amount shown in the the definition of "insured contract" in Declarations of this Coverage the DEFINITIONS Section: Part for Medical Expense Limit. c. Any easement or license agreement; M. BLANKET WAIVER OF SUBROGATION 2. Paragraph f.(1) of the definition of The following is added to Paragraph 8., "insured contract" in the DEFINITIONS Transfer Of Rights Of Recovery Against Section is deleted. Others To Us, of SECTION IV — 0. DAMAGE TO PREMISES RENTED TO YOU COMMERCIAL GENERAL LIABILITY CONDITIONS: The following replaces the definition of If the insured has agreed in a contract "premises damage" in the DEFINITIONS or agreement to waive that insured's Section: right of recovery against any person or "Premises damage" means "property organization, we waive our right of recovery against such person or damage" to: organization, but only for payments we a. Any premises while rented to you or make because of: temporarily occupied by you with a. "Bodily injury" or "property permission of the owner; or damage" that occurs; or b. The contents of any premises while b. "Personal and advertising injury" such premises is rented to you, if you caused by an offense that is rent such premises for a period of committed; seven or fewer consecutive days. subsequent to the execution of the contract or agreement. • CG D4 17 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission.