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HomeMy WebLinkAboutInsurance Certificate: Noble Coffee Roasting LLC ACCORD CERTIFICATE OF LIABILITY INSURANCE °ATE'MM/°°'YY,") 02/08/2021 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 Hart Insurance Agency - Medford PHONE Michelle Ely FAX PO Box 1240 (A/C,No.Extl: (541) 779-4232 (A/C,No): E-MAIL Grants Pass OR 97528 ADDRESS: mely@hartinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Allmerica Financial Benefit In 41840 INSURED (541) 326-1383 INSURER B:Hanover American Insurance Co 36064 Noble Coffee Roasting LLC INSURER C: 281 4th St. INSURERD: Ashland OR 97520 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 18408 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 LTR TYPE OF INSURANCE ADDL WVD POLICY NUMBER /YR POLICY EFF POLICY EXP LIMITS (MMIDDYYY) (MMIDD/YYYYI B x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 AMAGE TO RENTED CLAIMS-MADE X OCCUR Y OZ2D204742 04/13/2021 04/13/2022 PREMSES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY _$ 1,000,000_ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 PRO- JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO AW2D20476901 04/13/2021 04/13/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? L NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is additional insured per attached 391-1006 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 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract,Agreement or Permit - Included 1 2. Additional Insured—Broad Form Vendors Included 2 3. Alienated Premises Included - 3 4. Broad Form Property Damage—Borrowed Equipment, Customers Included 3 Goods and Use of Elevators 5. Incidental Malpractice(Employed Nurses, EMT's and Paramedics) Included 3 6. Personal and Advertising Injury—Broad Form Included 4 7. Product Recall Expense Included 4 Product Recall Expense Each Occurrence Limit $25,000 Occurrence 5 Product Recall Expense Aggregate Limit $50,000 Aggregate 5 Product Recall Deductible $500 5 8. Unintentional Failure to Disclose Hazards Included 6 9. Unintentional Failure to Notify Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II — (2) Premises you own, rent, lease or occupy; LIABILITY: or 1. Additional Insured by Contract, Agreement or (3).Your maintenance, operation or use of Permit equipment leased to you. The following is added to SECTION II — b. The insurance afforded to such additional LIABILITY,C.Who Is An Insured: insured described above: Additional Insured by Contract, Agreement or (1) Only applies to the extent permitted by Permit law; and a. Any person or organization with whom you (2) Will not be broader than the insurance agreed in a written contract,written agreement which you are required by the contract, or permit to add such person or organization agreement or permit to provide for such as an additional insured on your policy is an additional insured. additional insured only with respect to liability (3) Applies on a primary basis if that is for "bodily injury", "property damage", or required by the written contract, written "personal and advertising injury" caused, in agreement or permit. whole or in part, by your acts or omissions, or the acts or omissions of those acting on your (4) Will not be broader than coverage behalf, but only with respect to: provided to any other insured. (1) "Your work" for the additional insured(s) (5) Does not apply if the "bodily injury", designated in the contract, agreement or "property damage" or "personal and permit advertising injury" is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 1 of 6 � f c. This provision does not apply: The most we will pay on behalf of the (1) Unless the written contract or written additional insured for a covered claim is the agreement was executed or permit was lesser of the amount of insurance: issued prior to the"bodily injury", "property 1. Required by the_contract, agreement or damage", or "personal injury and permit described in Paragraph a.; or advertising injury". 2. Available under the applicable Limits of (2) To any person or organization included as Insurance shown in the Declarations. an insured by another endorsement This endorsement shall not increase the issued by us and made part of this applicable Limits of Insurance shown in the Coverage Part. Declarations (3) To any lessor of equipment: e. All other insuring agreements, exclusions, and (a) After the equipment lease expires; or conditions of the policy apply. (b) If the "bodily injury", "property 2. Additional Insured—Broad Form Vendors damage"; "personal-. and advertising The following is added to SECTION U — injury" arises out of sole negligence of LIABILITY,C.Who Is An Insured: the lessor (4) To any: Additional Insured—Broad Form Vendors (a) Owners or other interests from whom a. Any person or organization that is a vendor land has been leased if the with whom you agreed in a written contract or written agreement to include as an additional "occurrence" takes place or the insured under this Coverage Part is an offense is committed after the lease insured, but only with respect to liability for for the land expires; or "bodily injury" or"property damage" arising out (b) Managers or lessors of premises if: of"your products"which are distributed or sold (i) The "occurrence" takes place or in the regular course of the vendor's business. the offense is committed after you b. The insurance afforded to such vendor cease to be a tenant in that described above: premises; or (1) Only applies to the extent permitted by (ii) The "bodily injury", "property law; damage", "personal injury" ' or (2) Will not be broader than the insurance "advertising injury" arises out of which you are required by the contract or structural alterations, new con- agreement to provide for such vendor; struction or demolition operations performed by or on behalf of the (3) Will not be broader than coverage manager or lessor. provided to any other insured; and (5) To "bodily injury", "property damage" or (4) Does not apply if the "bodily injury", • - -_ "personal and -advertising injury" arising property =damage -or "personal and out of the rendering of or the failure to advertising injury" is otherwise excluded render any professional services. from coverage under this Coverage Part, This exclusion applies even if the claims including any endorsements thereto against any insured•allege negligence or c. With respect to insurance afforded to such other wrongdoing in the supervision, vendors, the following additional exclusions hiring, employment, training or monitoring apply: of others by that insured, if the The insurance afforded to the vendor does not "occurrence" which caused the "bodily apply to: injury" or"property damage" or the offense ' (1) "Bodily injury" or "property damage" for which caused the "personal and which the vendor is obligated to pay advertising injury" involved the rendering damages by reasons of the assumption of of or failure to render any professional liability.in a contract or agreement. This services by or for you. exclusion does not apply to liability for d. With respect to the insurance afforded to damages that the insured would have in these additional insureds, the following is ` the absence of the contract or agreement; added to SECTION II — LIABILITY, D. (2) Any express warranty unauthorized by Liability and Medical Expense Limits of Insurance: you; 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 2 of 6 y (3) Any physical or chemical change in the The most we will pay on behalf of the vendor product made intentionally by the vendor; for a covered claim is the lesser of the amount (4) Repackaging, unless unpacked solely for of insurance: the purpose of inspection, demonstration, 1. Required by the contract or agreement testing, or the substitution of parts under described in Paragraph a.; or instruction from the manufacturer, and 2. Available under the applicable Limits of then repackaged in the original container; Insurance shown in the Declarations; (5) Any failure to make such inspection, This endorsement shall not increase the adjustments, tests or servicing as the applicable Limits of Insurance shown in the vendor has agreed to make or normally Declarations. undertakes to make in the usual course of business in connection with the sale of the 3. Alienated Premises product; SECTION II — LIABILITY, B. Exclusions, 1. (6) Demonstration, installation, servicing or _ Applicable To Business Liability Coverage k. repair operations, except such operations - -Damage'to Property, paragraph (2) is replaced performed at the vendor's premises in by the following: connection with the sale of the product; (2) Premises you sell, give away or abandon, if (7) Products which, after distribution or sale the"property damage" arises out of any part of by you, have been labeled or relabeled or those;premises and occurred from hazards used as a container, part or ingredient of that were known by you, or should have any other thing or substance by or for the reasonably been known by you,at the time the vendor; property was transferred or abandoned. (8) "Bodily injury" or "property damage" 4. Broad Form Property Damage — Borrowed arising out of the sole negligence of the Equipment, Customers Goods, Use of vendor for its own acts or omissions or Elevators those of its employees or anyone else a. The following is added to SECTION II — acting on its behalf. However, this LIABILITY, B. Exclusions, 1. Applicable To exclusion does not apply to: Business Liability Coverage, k. Damage to (a) The exceptions contained within the Property: exclusion in subparagraphs (4) or (6) Paragraph (4) does not apply to "property above; or damage" to borrowed equipment while at a (b) Such inspections, adjustments, tests jobsite and not being used to perform or servicing as the vendor has agreed operations. to make or normally undertakes to Paragraph (3), (4) and (6) do not apply to make in the usual course of business, - "property damage"to "customers goods" while in connection with the distribution or on your premises nor to the use of elevators. sale of,the•products: - - -- --For the-purposes'_.of_-this--endorsement, the (9) "Bodily injury" or "property damage" following definition is added to SECTION II — arising out of an "occurrence" that took LIABILITY, F. Liability and Medical place before you have signed the contract Expenses Definitions: or agreement with the vendor. 1. "Customers goods" means property of (10)To any person or organization included as your customer on your premises for the an insured by another endorsement purpose of being: issued by us and made part of this a. Worked on; or Coverage Part. (11)Any insured person or organization, from b. Used in your manufacturing process. whom you have acquired such products, c. The insurance afforded under this provision is or any ingredient, part or container, excess over any other valid and collectible entering into, accompanying or containing property insurance (including deductible) - such products. available to the insured whether primary, d. With' respect to the .insurance afforded to excess, contingent or on any other basis. these vendors, the following is added to 5. Incidental Malpractice — Employed Nurses, SECTION II — LIABILITY, D. Liability and EMT's and Paramedics Medical Expense Limits of Insurance: SECTION II—LIABILITY, C. Who Is An Insured, paragraph 2.a.(1)(d) does not apply to a nurse, 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 3 of 6 emergency medical technician or paramedic o. Recall of Products, Work or Impaired employed by you if you are not engaged in the Property is replaced by the following: business or occupation of providing medical, o. Recall of Products, Work or Impaired paramedical, surgical, dental, x-ray or nursing Property services. Damages claimed for any loss, cost or 6. Personal Injury—Broad Form expense incurred by you or others for the a. SECTION II — LIABILITY, B. Exclusions, 2. loss of use, withdrawal, recall, inspection, Additional Exclusions Applicable only to repair, replacement, adjustment, removal "Personal and Advertising Injury", or disposal of: paragraph e. is deleted. (1) "Your product"; b. SECTION II — LIABILITY, F. Liability and (2) "Your work"; or Medical Expenses Definitions, 14. "Personal and advertising injury", paragraph b. is (3) "Impaired property"; replaced by the following: If such product, work or property is b. Malicious prosecution or abuse of A' withdrawn or recalled from the market or process. from use by any person or organization c. The following is added to SECTION 11 — because of a known or suspected defect, deficiency, inadequacy or dangerous LIABILITY, F. Liability and Medical condition in it, but this exclusion does not Expenses Definitions, Definition 14. apply to"product recall expenses"that you "Personal and advertising injury": incur for the "covered recall" of "your "Discrimination" (unless insurance thereof is product". prohibited by law) that results in injury to the However, the exception to the exclusion feelings or reputation of a natural person, but does not apply to "product recall only if such"discrimination" is: expenses" resulting from: (1) Not done intentionally by or at the (4) Failure of any products to accomplish direction of: their intended purpose; (a) The insured; (5) Breach of warranties of fitness, (b) Any officer of the corporation, director, quality, durability or performance; stockholder, partner or member of the (6) Loss of customer approval, or any insured; and cost incurred to regain customer (2) Not directly or indirectly related to an approval; "employee", not to the employment, (7) Redistribution or replacement of"your prospective employment or termination of product" which has been recalled by any person pr persons by an insured. like products or substitutes; d. For purposes of this endorsement, the , (8) Caprice or,whim of the insured; following definition is added to SECTION II — . LIABILITY, F. Liability and' Medical (9) A condition likely to cause loss of Expenses Definitions: which any insured knew or had reason 1. "Discrimination" means the unlawful to know at the inception of this insurance; treatment of individuals based upon race, color, ethnic origin, gender, religion, age, (10)Asbestos, including loss, damage or or sexual preference. "Discrimination" clean up resulting from asbestos or does not include the unlawful treatment of asbestos containing materials;or individuals ' based upon developmental, (11)Recall of"your products" that have no physical, cognitive, mental, sensory or known or suspected defect solely emotional impairment or any combination because a known or suspected defect of these. in another of"your products" has been e. This coverage does not apply if liability found. coverage for "personal and advertising injury" b. The following is added to SECTION II — is excluded either by the provisions of the LIABILITY, C.Who Is An Insured, paragraph Coverage Form or any endorsement thereto. 3.b.: 7. Product Recall Expense "Product recall expense" arising out of any a. SECTION II — LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you Applicable To Business Liability Coverage, acquired or formed the organization. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 4 of 6 c. The following is added to SECTION II — a deductible amount, you shall promptly LIABILITY, D. Liability and Medical reimburse us for the part of the deductible Expenses Limits of Insurance: amount we paid. Product Recall Expense Limits of The Product Recall Expense Limits of Insurance Insurance apply separately to each a. The Limits of Insurance shown in the consecutive annual period and to any SUMMARY OF COVERAGES of this remaining period of less than 12 months, endorsement and the rules stated below starting with the beginning of the policy period fix the most that we will pay under this shown in the Declarations, unless the policy Product Recall Expense Coverage period is extended after issuance for an regardless of the number of: additional period of less than 12 months. In that case, the additional period will be deemed (1) Insureds; part of the last preceding period for the (2) "Covered Recalls initiated; or purposes of determining the Limits of (3) Number of"your products"withdrawn. Insurance. b. The Product Recall Expense Aggregate d. The following is added to SECTION II — Limit is the most that we will reimburse LIABILITY, E. Liability and Medical you for the sum of all "product recall Expense General Conditions, 2. Duties in expenses" incurred for all"covered recalls" the Event of Occurrence, Offense, Claim or initiated during the policy period. Suit: c. The Product Recall Each Occurrence Limit You must see to it that the following are done is the most we will pay in connection with in the event_ of an actual or anticipated any one defect or deficiency. "covered recall" that may result in "product d. All"product recall expenses" in connection recall expense": with substantially the same general (1) Give us prompt notice of any discovery or harmful condition will be deemed to arise notification that "your product" must be out of the same defect or deficiency and withdrawn or recalled:' Include a considered one"occurrence". • description of '""your product" and the reason for the withdrawal or recall; e. Any amount reimbursed for"product recall expenses" in connection with any one (2) Cease any further release, shipment, "occurrence"will reduce the amount of the consignment or any other method of Product Recall Expense Aggregate Limit distribution of like or similar products until available for reimbursement of "product it. has been determined that all such recall expenses" in connection with any products are free from defects that could other defect or deficiency. be a cause of loss under this insurance. f. If the Product Recall Expense Aggregate e. For the purposs of this endorsement, the Limit has been reduced by reimbursement definitionsfollowing_ are.added.to SECTION II of"product recall expenses" to an amount - LIABILITY, . F: Liability and Medical that is less than the Product Recall Expenses Definitions: Expense Each Occurrence Limit, the 1. "Covered recall" means a recall made remaining Aggregate Limit is the most that necessary because you or a government will be available for reimbursement of body has determined that a known or "product recall expenses" in connection suspected defect, deficiency, inadequacy, with any other defect or deficiency. or dangerous condition in "your product" g. Product Recall Deductible has resulted or will result in "bodily injury" or"property damage". We will only pay for the amount of 2. "Product recall expense(s)"means: "product recall expenses" which are in excess of the '$500 Product Recall a. Necessary and reasonable expenses Deductible. The Product Recall Deductible for: applies separately to each . "covered (1) Communications, including radio recall". The limits of insurance will not be or television announcements or reduced by the amount of this deductible. printed advertisements including We may, or will if required bylaw, pay all stationary, envelopes and or any part of any deductible amount, if postage; applicable. Upon notice of our payment of 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 5 of 6 (2) Shipping the recalled products (1) If the "products — completed operations from any purchaser, distributor or hazard" is excluded from coverage under user to the place or places this Coverage Part including any designated by you; endorsement thereto; or (3) Remuneration paid to your regular (2) To "product recall expense" arising out of "employees" for necessary any of "your products" that are otherwise overtime; excluded from coverage under this (4) Hiring additional persons, other Coverage Part including endorsements than your regular"employees"; thereto. (5) Expenses incurred by 8. Unintentional Failure to Disclose Hazards "employees" including The following is added to SECTION II — transportation and LIABILITY, E. Liability and Medical Expenses accommodations; General Conditions: (6) Expenses to rent additional Representations warehouse or storage space; We will not disclaim coverage under this Coverage (7) Disposal of "your product", but Part if you fail to disclose all hazards existing as of only to the extent that specific the inception date of the policy provided such methods of destruction other than failure is not intentional. those employed for trash 9. Unintentional Failure to Notify discarding or disposal are required to avoid "bodily injury" or The following is added to SECTION II — "property damage" as a result of LIABILITY, E. Liability and Medical Expenses such disposal, General Conditions, 2. Duties in the Event of Occurrence, Offense,Claim or Suit: you incur exclusively for the purpose of recalling"your product"; and Your rights afforded under this Coverage Part shall not be prejudiced if you fail to give us notice b. Your lost profit resulting from such of an "occurrence", offense, claim or "suit", solely covered recall". due to your reasonable and documented belief f. This Product Recall Expense Coverage does that the "bodily injury", "property damage" or not apply: "personal and advertising injury" is not covered under this Policy. ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. • • 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 6 of 6