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HomeMy WebLinkAboutInsurance Certificate: Doolittle Construction, LLC �-1 DOOLCON-01 _ LMORELOS ACf�RD' DATE(MM/DDIYYTY) CERTIFICATE OF LIABILITY INSURANCE 2/18/2021 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(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: Hub International Northwest LLC PO Box 3018 MEM,Ext>:(425)4894500 FAX No):(425)485-8489 Bothell,WA 98041 AI altss:now.info@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alaska National Insurance Company 38733 INSURED INSURER B: .Doolittle Construction,LLC INSURER C: 1900 118th Avenue SE INSURER D: Bellevue,WA 98005 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 21 BLS08289 2/18/2021 2/18/2022 METOEEoNDence) $ 500,000 15,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WASHINGTON STOP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X I ANY AUTO X X 21BAS08289 2/18/2021 2/18/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS p BODILY INJURY(Per accident) $ X AUTOS ONLY X AST S ONLY (Pereaccident)SAGE A X UMBRELLALIAB X OCCUR EACH OCCURRENCE _ $ 5,000,000 EXCESS LIAB CLAIMS-MADE 21BLU08289 2/18/2021 2/18/2022 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ A ANDWOREMPLRSOERS'LIABILITY OMPENSATION X STA UTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 21 BWS08289 2/18/2021 2/1812()22 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000000 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) RE:Project#000753,2020 Slurry Seal City of Ashland and its agents,officers and employees are included as Additional Insured,coverage is Primary and Non-Contributory,and Waiver of Subrogation applies per the attached forms/endorsements. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 51 Winburn Way Ashland,OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD '( 4p.J:Alaska National :1k41 Alaska National -'' I;Nsun.AN�CE .C'OMPk'NY' ' - ENSU RA MC Et- CONI 1.AN Y-, Policy#21BL508289 CONTRACTORS'GENERAL LIABILITY ENHANCEMENT ENDORSEMENT The insurance provided to such state e. Owners or Other Interests From or political subdivision does not apply Whom Land Has Been Leased to any °bodily injury", "property damage"or'personal and advertising An owner or other interest from whom THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. injury' arising out of operations land has been leased by you but only performed for that state or political with respect to liability arising out of This endorsement modifies insurance provided under the following: subdivision. the ownership,maintenance or use of that specific part of the land leased to COMMERCIAL GENERAL LIABILITY COVERAGE PART b. Controlling Interest you and subject to the following additional exclusions: Any persons or organizations with a Coverage afforded under this extension of coverage endorsement does not apply to any person or organization controlling interest in you but only This insurance does not apply to: covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. with respect to their liability arising out of: (1)Any 'occurrence" which takes • SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW place after you cease to lease (1)Their financial control of you,or that land;or 1. Miscellaneous Additional Insureds 14.In Rem Actions 8 additional insured extensions. (2) Premises they own, maintain or (2) Structural alterations, new con- 1. MISCELLANEOUS ADDITIONAL INSUREDS control while you lease or occupy struction or demolition operations performed and Noncontributory Insurance these premises. performed by or on behalf of Section II Who Is An Insured is amended to such additional insured. 2. Damage To Premises Rented to You include as an additional Insured any person or This insurance does not apply to Limit increased to$500,000. organization described In Paragraphs 2.a. structural alterations, new perati construc- 1. Co-owner of Insured Premises through 2.h.below whom you are required to add tion and demolition operations 3. Medical Payments as an additional insured on this policy under a performed by or for such additional A co-owner of a premises co-owned Limits increased to$15,000. written contract or written agreement. However, insured. by you and covered under this Reporting period increased to three years from the written contract or written agreement must be: insurance but only with respect to the the date of accident. c. Managers or Lessors of Premises co-owners liability as co-owner of 1. Currently in effect or becoming effective such premises. 4. Non-owned Watercraft during the term of this policy;and A manager or lessor of premises but Increased to 50 feet only with respect to liability arising out g. Lessor of Equipment 2. Executed prior to the "bodily injury', of the ownership,maintenance or use "property 5. Supplementary Payments damage"or'personal injury and of that specific part of the premises Any person or organization from leased toyou and subject to the whom you lease equipment. Such Cost of ball bonds Increased to$10,000. advertising injury",but Daily loss of earnings increased to$500. following additional exclusions: person or organization is an Only the following persons or organizations additional insured only with respect to 6. Newly Formed Or Acquired Organizations are additional insureds under this This Insurance does not apply to: their liability for bodily Injury", Coverage extended to the end of the policy period endorsement and coverage provided to such "property damage"or'personal and provided or the next anniversary of this policy's effective additional insureds is limited as (1)Any "occurrence° which takes Advertising injury"caused, in whole place afteryou cease to be a or in art, date, herein: p by your maintenance,oper- tenant In that premises;or ation or use of equipment leased to 7. Liberalization Clause a. State or Governmental Agency or you by such person or organization. Subdivision or Political Subdivl- (2) Structural alterations, new con- A person's or organization's status as 8. Unintentional Failure To Disclose Hazards sions struction or demolition operations an additional insured under this performed by or on behalf of endorsement ends when their written 9. Notice of Occurrence Any state or governmental agency or such additional insured. contract or written agreement with subdivision or political subdivision you for such leased equipment ends. 10.Broad Knowledge of Occurrence that has issued a permit in d. Mortgagee,Assignee or Receiver connection with operations performed With respect to the insurance 11.Bodily injury-Extension of Coverage by you or on your behalf and that you A mortgagee, assignee or receiver afforded these additional insureds, are required by any ordinance,law or but only with respect to their liability the following additional exclusions 12.Expected Or Intended Injury building code to include as an as mortgagee,assignee,or receiver apply. Reasonable force - bodily injury or property additional insured on this coverage and arising out of the ownership, damage. part is an additional insured,but only maintenance,or use of a premises by This insurance does not apply: with respect to liability for "bodily you. 13.Blanket Waiver of Subrogation injury',"property damage,"personal (1)To any"occurrence"which takes Waiver of subrogation where required by written and advertising Injury'arising out of This insurance does not apply to place after the equipment lease contract or written agreement. such operations. structural alterations, new construes expires;or tion or demolition operations performed by or for such additional Insured. ANIC GL 1187 0716 Page 1 of 6 ANIC GL 1187 0716 Page 2 of 6 I ,F :Alaska•Natlonal rfit fs Alaska National 4.�';_ 1(N s;U•R_4'N E-_-c`O,MP A.N,Y•, J 'r i:)%U R N•CE;'c'O,M'.P A N.Y-, (2)To "bodily injury", "property additional insured. However, This provision shall not increase the applicable 4. NON-OWNED WATERCRAFT damage", or "personal and even if coverage within the Limits of Insurance shown in the Declaration. advertising injury' arising out of "products-completed operations A. If endorsement CG 21 09,CG 21 10,CG 24 the sole negligence of such hazard"is required by the written 2. Damage To Premises Rented to You 50,or CG 24 51 Is attached to the policy, additional insured. contract, such coverage is Paragraph A.2.g.(2)(b)is replaced by the available to the additional insured SECTION III — LIMITS OF INSURANCE, following: h. Owners, Lessees or Contractors only if the "bodily injury" or Paragraph 6.is replaced by the following: "property damage"occurs prior to (b)A watercraft that you do not (1) Such person or organization is an the end of the time period during 6. Subject to Paragraph 5. above, the own that is: additional insured for "bodily which you are required by the Damage to Premises Rented to You Limit injury", "property damage" and written contract to provide such is the most we will pay under Coverage A (I) Less than 50 feet long: "personal and advertising injury' coverage or the expiration date of for damages because of "property and if,and only to the extent that,the the policy,whichever comes first. damage" to any one premises, while injury or damage is caused by (II) Not beingused to negligent acts or omissions of Any insurance provided to an additional rented to you,or in the case of damage carry by fire,while rented to you or temporarily persons or property for a you or your subcontractor in the insured designated under Paragraphs 2.a. occupied by you with permission of the charge. performance of "your work" to through 2.g.above does not apply to°bodily owner. which the written contract injury" .or"property damage"included within B. If Paragraph A.does not apply,Paragraph g. _ applies. This person or organi- the products-completed operations hazard." of 2. EXCLUSION under SECTION I— zation does not qualify as an If a limit Is shown for Damage to Premises (2) additional insured with respect to PrimaryAnd NoncontributoryInsurance Rented to You the most we will pay under COVERAGES, COVERAGE A — BODILY Coverage A for damages because or"property INJURY AND PROPERTY DAMAGE injury or damage caused in whole9 or in part by independentdamage"to any one premises is the Limit shown LIABILITY is replaced by the following: The following Is added to the Other Insurance negligent acts or omissions of Condition and supersedes anyprovision to the in the Declarations or $500,000, whichever is such person or organization. P greater. (2)A watercraft that you do not own contrary: that is: (2) However,this insurance does not 3. MEDICAL PAYMENTS apply to°bodily injury","property This insurance is primary to and will not seek (a) Less than 50 feet long;and dama e" or "ersonal and contribution from any other insurance available to g P an additional insured under your policyprovided A. Section 111—Limits of Insurance,Paragraph advertising injury" arising out of 7.is replaced by the following: (b)Not being used to carry an architect's, engineer's, or thatpersons or property for a surveyor's rendering of or failure 7. Subject to Paragraph 5. above the charge. to render any professional (1) The additional insured is a services including: Named Insured under such other Medical F�tpense Limit Is the most we will 5. SUPPLEMENTARY PAYMENTS insurance;and pay under Coverage C for all medical I. the preparing, or expenses because of "bodily injury" failingetoin prepare approving,approve (2)You have agreed in writing in a sustained by any one person. A. Under Section I-Supplementary Payments pp -.Coverage A and B, Paragraph 1.b., the maps, drawings, opinions, contract or agreement that this If a limit is shown for Medical Expense In limit of$250 shown for the cost of bail bonds reports, surveys, change insurance would be primary and the Declarations the most we will pay is replaced by$10,000; would not seek contribution from orders, design or under Coverage C for all medical any other insurance available toB. In Paragraph 1.d.,the limit of$250 shown for specifications;and the additional insured. expenses because of "bodily injury" sustained by any one person is the Limit - daily loss of earnings is replaced by$500. II. supervisory, inspection, or shown in the Declarations or $15,000, engineering services. Section III-Limits of Insurance,the following is whichever is greater. 6. NEWLY FORMED OR ACQUIRED ded: ORGANIZATIONS (3) The insurance provided to this With respect to the Insurance afforded to the B. This provision 5. (Medical Payments) does ra para h 3.a.of Section II-Who Is An Insured additional insured, does notnot apply if Section I-Coverage C Medical Paragraph additional insureds described in Paragraphs a. Payments is excluded either bythe is deleted and replaced by the following: cover"bodily injury"or"property Ym through h.above,the most we will pay on behalf damage" caused by your provisions of the Coverage Part or by negligent acts and omissions in of such additional insured is the amount of endorsement. Coverage under this provision Is afforded only the performance of"your work" insurance: until the end of the policy period or the next that occurs within the"products- C. Paragraph 1.a.(3)(b)of Section I-Coverage anniversary of this policy's effective date after you completed operations hazard", (1) Required by the contract or C-Medical Payments, is replaced by the acquire or form the organization, whichever is unless the written contract agreement;or following: earlier. contains a specific requirement (2) Available under the applicable that you procure completed if Insurancedrt shown ins the (b)The expenses are Incurred operations coverage or coverageLiand reported to us within within the "products-completed Declarations; three years of the date of the operations hazard" for the accident;and whichever is less. ANIC GL 1187 0716 Page 3 of 6 ANIC GL 1187 0716 Page 4 of 6 �, Aaka National . t ,/ AlaskaNativnal ' ..NauRAN`C ,COM.FANY = i,NSU•R;ANC'E. ,c 0,1M PA.N.Y=, 7. LIBERALIZATION CLAUSE 10.BROAD KNOWLEDGE OF OCCURRENCE 13.BLANKET WAIVER OF SUBROGATION However,this waiver applies only when you have agreed in writing to waive such rights of recovery If we adopt a change in our forms or rules which The following is added to Paragraph 2.of Section The Transfer Of Rights Of Recovery Against in a contract or agreement, and only If the would broaden coverage for contractors under IV-Commercial General Liability Conditions- Others To Us Condition (Section IV - contract or agreement: this endorsement without an additional premium Duties in The Event of Occurrence,Offense, Commercial General Liability Conditions) is charge,your policy will automatically provide the Claim or Suit: amended by the addition of the following: 1. Is in effect or becomes effective during additional coverages as of the date the revision is the term of this policy;and effective in your state. You must give us or our authorized representative We waive any right of recovery we may have notice of an'occurrence",offense,claim,or'suit" against any person or organization because of 2. Was executed prior to loss. 8. UNINTENTIONAL FAILURE TO DISCLOSE only when the "occurrence", offense, claim or payments we make for injury or damage arising HAZARDS °suit'is known to: out of: 14.IN REM ACTIONS SECTION IV — COMMERCIAL GENERAL (1)You,if you are an Individual; 1. Your ongoing operations;or Any action In rem against any vessel owned, LIABILITY CONDITIONS — Paragraph 6. — operated by or for,or chartered by or for you will Representations is replaced by the following: (2) A partner, if you are a 2. 'Your work" included in the "products- be treated in the same manner as though the partnership; completed operations hazard." action were in personam against you. 6. Representations (3) An executive officer or the By accepting this policy,you agree: employee designated by you to give such notice, if you are a a. The statements in the Declarations are corporation;or accurate and complete; (4)A manager, if you area limited b. Those statements are based upon liability company. representations you made to us;and 11.EXPANDED BODILY INJURY c. We have issued this policy in reliance Section V-Definitions,the definition of"bodily upon your representations. injury'is changed to read: The unintentional omission of, or °Bodily injury' means bodily injury, sickness or unintentional error in, any information you disease sustained by a person,including death, , provided to us which we relied upon in humiliation, shock, mental anguish or mental issuing this policy will not prejudice your injury by that person at any time which results as rights under this insurance. However, this a consequence of the bodily injury,sickness or provision does not affect our right to collect disease. additional premium or to exercise our rights of cancellation or nonrenewal in accordance 12.EXPECTED OR INTENDED INJURY with applicable laws and regulations. Exclusion a.of Section I-Coverage A-Bodily 9. NOTICE OF OCCURRENCE injury and Property Damage Liability Is replaced by the following: The following is added to Paragraph 2.of Section IV-Commercial General Liability Conditions- a. "Bodily injury'or"property damage" Duties In The Event of Occurrence, Offense, expected or intended from the Claim or Suit: standpoint of the insured. This exclusion does not apply to "bodily Your rights under this Coverage Part will not be injury"or"property damage"resulting prejudiced if you fail to give us notice of an from the use of reasonable force to "occurrence", offense, claim or "suit" and that protect persons or property. This endorsement changes the policy to which it is attached and,unless otherwise stated,is effective on the date failure is solely due to your reasonable belief that Issued at 12:01 A.M.standard time at your mailing address shown in the policy. The Information below Is the 'bodily injury' or"property damage" is not required only when this endorsement is issued subsequent to commencement of the policy. covered under this Coverage Part. However,you shall give written notice of this "occurrence", Endorsement Effective Policy No. offense,claim or"suit"to us as soon as you are aware that this insurance may apply to such Insured Endorsement No. "occurrence",offense,claim or"suit" Countersigned By Includes copyrighted material of Insurance Services Office,Inc.,with Its permission ANIC GL 1187 0716 Page 5 of 6 ANIC GL 1187 0716 Page 6 of 6 Policy#21BLS08289 Alaska National INSUinANCE :C:OM' PA'NY' DESIGNATED CONSTRUCTION PROJECT(S)GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 7KIs endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All Projects ,QIRUEttion required to complete this Schedule,if not shown above,will be shown in the Declarations. A. For all sums which the insured EHFRIes OHJDOO\ 3. $Q\ pD\ments made under Coverage A fRU obligated to pay as damages caused E\ damages or under Coverage C for PHGLFDO "occurrences" under 6HFWLRQ Coverage A, aQG expenses shall Ulduce the 'HVLJQDWHG for all PHdical expenses caused E\ aFFLGHQWV Construction Project General Aggregate /LPLW under 6HFWLRD— Coverage C, which can EH for that designated construction project. 6XFK attributed only to ongoing operations at a Vt JOH SD\PHnts shall not reduce the *HQHUDO designated construction project shown in WKH Aggregate/LP it shown in the Declarations QRU Schedule above: shall WIQt-I reduce any other 'HVLJQDWHG 1. $ separate Designated Construction 3URMHFW Construction Project General Aggregate /LPLW General Aggregate Limit applies to HDFK for DQ\other designated construction SURMHFW designated construction Slcbject, and that OLEIN shown in the Schedule above. is equal to the DPount of the *HQHUDO 4. 7he OLRb shown in the Declarations for (DFK Aggregate Limit shown in the Declarations. Occurrence, 'DP age To Premises Rented 7R 2. 7he Designated Construction Project *HQHUDO You and Medical Expense continue to apply. Aggregate/LP it is the most we will SD\for WKH However, instead of being subject to WKH VXP of all GDPages under Coverage A, e[FHSW General Aggregate Limit shown in WKH damages because of "bodily LQMXU\RU Declarations, such limits will be subject to WKH "property GDPage" included in the "products- applicable Designated Construction 3URMHFW FRPpleted operations hazard", and for PHGLFDO General Aggregate Limit. expenses under Coverage C regardless of WKH number of: a. ,nsureds; b. &ODL'made or"suits"brought;or c. 3ersons or organizations PDNbg claims RU bringing"suits". CG 25 03 05 09 3age 1 of 2 Alaska Nation al INSUA`ANCE COMPANY' B. )or all sums which the insured EHFRIFs OHJDOO\ C. : hen coverage for liability arising out of WKH obligated to pay as damages caused E\ "products-completed operations hazard" LV "occurrences" under 6HFWLRQ Coverage A, aQG provided, Dry SD\ments for GDPages because RI for all PHdical expenses caused E\ aFFLGHQWV "bodily injury"or"property damage"included in the under 6HFWLRQ- Coverage C, which FDinot EH "products-completed operations hazard" ZLOO attributed only to ongoing operations at a VDJOH reduce WAC Products-completed 2SHUDWLRQV designated construction project shown in WKH Aggregate Limit, and not reduce the *HQHUDO Schedule above: Aggregate /LP it nor the Designated &RQVWUXFWLRQ 1. $Q\ pD\ments made under Coverage A fRU Project General Aggregate Limit. damages or under Coverage C for PHGLFDO D. ,f the applicable designated construction SURMHFW expenses shall reduce the DPount DYDLODEOH has been abandoned, delayed, or abandoned DQG under the General Aggregate /LP it or WKH then restarted, or if the authorized FRQWUDFWLQJ Products-completed Operations $JJUHJDWH parties deviate IUII plans, blueprints, designs, /LP it,whichever is applicable;and specifications or timetables, the project will still EH 2. 6uch SD1PHnts shall not reduce DQ\ deemed to be the same construction project. Designated Construction Project *HQHUDO E. The provisions of Section III—Limits Of,QVXUDQFH Aggregate Limit. not otherwise modified E\ this endorsement VKDOO continue to apply as stipulated. 7KCis HQGRUVIdkt changes the SROjLI€o which it is attached and, unless otherwise stated, LVeffective on the date issued at 12:01 A.M. standard time at \Rur mailing address shown in the SROLF\The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Insured ( ndorsement No. 25 Countersigned By ©Insurance Services Office, Inc.,2008 CG 25 03 05 09 3age 2 of 2 Ad? Alaska National INSURANCE COMPANY Policy#21BAS08289 BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. —Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words "you" and "your" Others to Us refer to the Named Insured shown in the Declarations. The words"we", "us", and "our" refer to This condition does not apply to any the company providing this insurance. person(s) or organization(s)to the extent that subrogation . against that person or Other words and phrases that appear in quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V— or the"loss" under a contract with that person DEFINITIONS in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION II — COVERED AUTO LIABILITY per "accident" and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2)—Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law SECTION II — COVERED ,AUTO LIABILITY violations) required because of an COVERAGE, Paragraph A.1. Who Is An Insured is "accident"we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating SECTION II — COVERED AUTO LIABILITY an "auto" hired or rented under a COVERAGE, Paragraph A.2.a. (4)—Supplementary contract or agreement in an "employee's" Payments is replaced by the following: name, with your permission, while performing duties related to the conduct (4) All reasonable expenses incurred by of your business. the "insured" at our request, including actual loss of earnings up to $500 a e. Any person or organization for whom you day because of time off from work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of"autos"covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. ANIC CA 1150 10 13 Page 1 of 4 aft?' Alaska National INSURANCE COMPANY C. "Loss" caused by falling objects or SECTION II — COVERED AUTO LIABILITY missiles. COVERAGE, Paragraph A.2.c.—Voluntary Property Damage is added as follows: However,you have the option of having glass breakage caused by a covered "auto's" c. Voluntary Property Damage collision or overturn considered a "loss"under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage Glass Repair—Waiver of Deductible caused by an "insured", but without liability to a third party, up to$25,000.We No deductible applies to glass breakage, if will not make a Voluntary Property the glass is repaired rather than replaced. Damage payment to anyone who is an "insured"under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. - Transportation Expenses is SECTION III — PHYSICAL DAMAGE COVERAGE, replaced by the following: Paragraph A.2.—Towing is replaced by the following: a. Transportation Expenses Towing We will pay up to $200 per day to a We will pay up to $500 for towing and labor maximum of $1,500 for temporary costs incurred each time a covered "auto" transportation expense incurred by you that is a: because of the total theft of a covered "auto"that is a: a. Private passenger; (1) Private passenger; b. Truck; (2) Truck; c. Pick-up truck; (3) Pick-up truck; d. Panel ;or (4) Panel; or e. Van (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the type vehicle under 20,000 lbs. of Gross labor must be performed at place of Vehicle Weight. We will pay only for disablement. those covered "autos"for which you carry SECTION III — PHYSICAL DAMAGE COVERAGE, either Comprehensive or Specified Paragraph A.3. — Glass Breakage — Hitting a Bird Causes of Loss Coverage. We will pay for temporary transportation expenses or Animal —Falling Objects or Missiles is replaced by the following: incurred during the period beginning 48 hours after the theft and ending, Glass Breakage—Hitting a Bird or Animal regardless of the policy's, expiration, —Falling Objects or Missiles when the covered "auto"� is returned to use or we pay for its"loss". If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss" caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page2of4 „cfA �' Alaska National `;`��-� INSURANCE COMPANY (2) Specified Causes of Loss only if the SECTION III — PHYSICAL DAMAGE COVERAGE, Declarations indicate that Specified Paragraph A.4.b. — Loss of Use Expenses is Causes of Loss Coverage is provided replaced by the following: for the "auto”withdrawn from service; or b. Loss of Use Expenses—Hired, Rented, (3) Collision only if the Declarations or Borrowed Automobiles indicate that Collision Coverage is provided for the "auto" withdrawn We will pay expenses for which an from service. "insured" becomes legally responsible to pay for loss of use of a vehicle hired, SECTION III — PHYSICAL DAMAGE COVERAGE, rented or borrowed without a driver under Paragraph A.4.d. — Airbag Coverage is added as a written rental contract or agreement. follows: We will pay for loss of use expenses, if caused by: d. Airbag Coverage 11) Other than Collision, only if the We will pay for the cost to repair, replace, Declarations indicate that or reset an airbag that inflates for any Comprehensive Coverage is provided reason other than as a result of a for the vehicle withdrawn from collision, if the Declarations indicate that service. the covered "auto" has Comprehensive Coverage or Specified Causes of Loss (2) Specified Causes of Loss only if the Coverage. Declarations indicate that Specified Causes of Loss Coverage is provided SECTION III — PHYSICAL DAMAGE COVERAGE, for the vehicle withdrawn from Paragraph A.4.e. — Rental Reimbursement service. Coverage is added as follows: (3) Collision only if the Declarations e. Rental Reimbursement Coverage indicate that Collision Coverage is provided for the vehicle withdrawn We will pay up to $75 per day for rental from service. reimbursement expenses incurred by you for the rental of an "auto" because of However, the most we will pay for any `loss"to a covered"auto"that is a: expenses for loss of use is$200 per day,to a maximum of$1,500. (1) Private Passenger; SECTION III — PHYSICAL DAMAGE COVERAGE, (2) Truck; Paragraph A.4.c.—Non Transportation Loss of Use Expenses is added as follows: (3) Pick-up truck; c. Non-Transportation Loss of Use (4) Panel; or Expenses (5) Van We will pay up to $2,000 for non- transportation expense incurred by you, type vehicle under 20,000 lbs. of Gross because of `loss" to a covered "auto", if Vehicle Weight. Payment applies in caused by: addition to the otherwise applicable amount of each coverage you have on a (1) Other than Collision, only if the covered "auto". No deductibles apply to Declarations indicate that this coverage. Comprehensive Coverage is provided for the"auto"withdrawn from service; ANIC CA 1150 10 13 Page 3 of 4 Alaska National INSURANCE COMPANY (1) We will pay only for those expenses SECTION IV — BUSINESS AUTO CONDITIONS — incurred during the policy period Paragraph B.5.b. — Other Insurance is replaced by beginning 24 hours after the "loss" the following: and ending, regardless of the policy's expiration, with the lesser of the b. For Hired Auto Physical Damage following number of days: Coverage, the following are deemed to be covered"autos"you own: (a) The number of days reasonably required to repair or replace the (1) Any covered "auto" you lease, hire, covered"auto". rent, or borrow; and (b) 30 days. (2) Any covered "auto"" hired or rented by your "employee" under a contract (2) This coverage does not apply while in that individual "employee's" name, there are spare or reserve "autos" with your permission, while available to you for your operations. performing duties related to the conduct of your business. (3) The Rental Reimbursement Coverage described above does not However, any"auto"that is leased, hired, apply to a covered "auto" that is rented or borrowed with a driver is not a described or designated as a covered covered"auto". "auto" on Rental Reimbursement Coverage Form CA 99 23. SECTION V — DEFINITIONS — Paragraph C. — SECTION IV — BUSINESS AUTO CONDITIONS — "Bodily injury"is replaced by the following: Paragraph B.2. —Concealment, Misrepresentation Or Fraud is amended by adding Unintentional Failure C. "Bodily injury" means bodily injury,' sickness or to Disclose Hazards at the end of Paragraph B.2. as disease sustained by a person including death or follows: mental anguish resulting from any of these. Mental anguish means any type of mental or Unintentional Failure to Disclose Hazards emotional illness or disease If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Countersigned By ©Insurance Services Office, Inc., 2009 ANIC CA 1150 10 13 Page4of4 USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING PO BOX 629035la EL DORADO HILLS CA 95762-9035 CITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1850