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HomeMy WebLinkAboutInsurance Certificate: Kelley Connect Co. • ACORD., CERTIFICATE OF LIABILITY INSURANCE - DATE(MM/DD/YYYY) 7/29/2022 7/28/2021' 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 poiicy(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 Lockton Companies • `NAMEACT 8110 E Union Avenue (PHONE NcC,No,Ext): FAX No): Suite 100 E-MAIL Denver CO 80237 ADDRESS: (303)414-6000 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: The Hanover Insurance Company 22292 INSURED Kelley Connect Co. INSURER B: Allmerica Financial Benefit Insurance Co 41840 1493848 22710 72nd Avenue South INSURER C: Navigators Specialty Insurance Company 36056 Kent,WA 98032 INSURER D: ' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 17719652 REVISION NUMBER: XXXXXXX 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 EXP - TYPE OF INSURANCE . ADDL SUBR POLICY NUMBER • IMM/DD//YY Y Y)(MM/DD/ ) LIMITS A x COMMERCIAL GENERAL LIABILITY Y N ZH2 D996899 02 7/29/2021 7/29/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 17.0CCUR PREMISES(Ea occurs occurrence) $ 100,000 • X Deductible:$0 - MED EXP(Any one person) $ 10,000 • .. - _ PERSONAL&ADV INJURY. $ 1,0007000 ' GEN'L AGGREGATE LIMIT APPLIES PER: - - - - GENERAL AGGREGATE $ 2,000,000 • InPOLICY --, n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 PECO OTHER: A AUTOMOBILE LIABILITY Y N AH2-H329469-0I ' 7/29/2021 7/29/2022 COMBINED SINGLE LIMIT B — AW2-D984632-02 7/29/2021 7/29/2022 (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX — AUTOS ONLY _SCHEDULED BODILY INJURY(Per accident $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY _AUTOS ONLY (Per accident) I $ XXXXXXX • X UMBRELLA LIABX OCCUR Y N EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB — CLAIMS-MADE UH2 D996900 03 7/29/2021 7/29/2022 AGGREGATE $ 10,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION PER OTH- rl'A AND-EMPLOYERS'LIABILITYN WM2 D997140-02 7/29/2021 7/29/2022 STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE n N/A W22-D982583-02 7/29/2021 7/29/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? _ ..(Mandatory in NHt. - _ -. - .. _ _ _ ,_E.L.DISEASE-EAEMPLOYEE $ 1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability N N NY2IPTLZOISXZIC 7/29/2021 7/29/2022 $1,000,000 A Management Liability LH4-D998692-02 7/29/2021 7/29/2022 $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS•/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon its officers,agents and employees are included as Additional Insured as respects General,Auto,and Umbrella Liability if required by written contract.General Liability is Primary and Non-Contributory. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 17719652 AUTHORIZED REPRESENTATIVE City of Ashland 20 East Main Street Ashland,OR 97520 ___ ACORD 25(2016/03) ©1988-21 .6 ACORI CORP RATION.All rights reserved The ACORD name and logo are registered marks of ACORD Attachment Code : D592629 Master ID: 1493848,Certificate ID: 17719652 ZH2 D996899 01 090112 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. 3lanket Waiver of Subrogation Included 4. 3odily Injury Redefined Included 5. 3road Form Property Damage—Borrowed Equipment, Customers Goods& Use of Elevators Included 6. <nowledge of Occurrence Included 7. _iberalization Clause Included 8. Vledical Payments—Extended'Reporting Period - Included 9. ewly Acquired or Formed Organizations-Covered until end of policy period Included 10. Von-owned Watercraft 51 ft. 11. supplementary Payments Increased Limits - Bail Bonds $2,500 - Loss of Earnings $1000 12. Jnintentional Failure to Disclose Hazards Included �13. Jnintentional Failure to Notify r Included This endorsement amends coverages provided under the Commercial General Liability Coverage Part through 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 Attachment Code: D592629 Master ID: 1493848,Certificate ID: 17719652 ZH2 D996899 01 090112 (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 added to SECTION III — LIMITS OF (5) Does not apply if the "bodily injury", ry ' INSURANCE: "property damage"or"personal and 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. (3)To any lessor of equipment: The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY (a)After the equipment lease expires; or 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 II—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 (i) The occurrence takes place after Coverages A or B of this Coverage Part, our you cease to be a tenant in that obligations are limited as follows: 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 Named Insured. 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 other wrongdoing in the supervision, (3)when b. below applies. 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 Attachment Code : D592629 Master ID: 1493848,Certificate ID: 17719652 ZH2 D996899 01 090112 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 by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers 3. Blanket Waiver of Subrogation The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against any person or organization with whom you have a written contract that requires such waiver because of payments we make for damage under this coverage form. The damage must arise out of your activities under a written contract with that person or organization. This waiver applies only to the extent that subrogation is waived under a written contract executed prior to the"occurrence" or offense giving rise to such payments. 4. Bodily Injury Redefined SECTION V—DEFINITIONS, Definition 3. "bodily injury" is replaced by the following: 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person including death resulting from any of these at any time. "Bodily injury" includes mental anguish or other mental injury resulting from "bodily injury". • 5. Broad Form Property Damage — Borrowed Equipment, Customers Goods, Use of Elevators a. SECTION I—COVERAGES, COVERAGE A— BODILIY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions subparagraph j. is amended as follows: Paragraph (4) does not apply to"property damage"to borrowed equipment while at a jobsite and not being used to perform operations. Paragraphs(3), (4) and (6) do not apply to "property damage"to"customers goods"while on your premises nor do they apply to the use of elevators at premises you own, rent, lease • or occupy. b. The following is added to SECTION V— DEFINTIONS: 24. "Customers goods" means property of your customer on your premises for the method also. Under this approach each purpose of being: 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 4 Attachment Code : D592629 Master ID: 1493848,Certificate ID: 17719652 ZH2 D996899 01 090112 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: This provision applies to any person who, with your consent, either uses or is e. Notice of an"occurrence", offense, claim or 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 the Bodily Injury Liability Coverage applies. CONDITIONS: We do not have to furnish these bonds. Liberalization Clause 1.d.All reasonable expenses incurred by the If we adopt any revision that would broaden the insured at 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 t 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 SECTION II—WHO IS AN INSURED, Paragraph prejudiced if you fail to give us notice of an 3.a. is replaced by the following: "occurrence", offense, claim or"suit", solely due to 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