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HomeMy WebLinkAboutInsurance Certificate: Lyft, Inc. AC ® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/02/2019 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 MARSH RISK&INSURANCE SERVICES NAME: PHE FAX 345 CALIFORNIA STREET,SUITE 1300 (A/CNNo.Ext): (A/C.No): CALIFORNIA LICENSE NO.0437153 E-MAIL SAN FRANCISCO,CA 94104 ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC# CN109337515-AOSWC-PGLDW-19- A INSURER A:Lexington Insurance Company 19437 INSURED INSURER B:Indian Harbor Insurance Co. 36940 Lyft,Inc. 185 Berry St.,Suite 5000 INSURER C:N/A N/A San Francisco,CA 94107 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-003605524-64 REVISION NUMBER: 6 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 LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 065463589 05/01/2019 05/01/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PRS TED PREMISES lEaa occurrence) $ 100,000 { MED EXP(Any one person) $ EXCLUDED X Self Insured Retention$500,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ B AUTOMOBILELIABILITY RAD500056201 10/01/2019 10/01/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO UM/UIM$1,000,000 CSL BODILY INJURY(Per person) $ g OWNED SCHEDULED RAD500054901 10/01/2019 10/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED UM/UIM$1,000,000 CSL PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) X Symbo110 X Primary UM/UIM $ 1,000,000 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? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B PRIMARY PERIOD 1 AUTO(SYM 10) RAD500053401 10/01/2019 10/01/2020 BODILY INJURY PER PERSON 50,000 UM/UIM$50,000/$100,000 Prop Damage-Per Accident:$25,000 BI PER ACCIDENT 100,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Proof of insurance for Lyft,Inc.re:VEHICLE FOR HIRE AGENCY in the City of Ashland The City of Ashland,its officers,agents,and employees are included as Additional Insureds on the General Liability and Automobile Liability policies where required by written contract but only with respect to liability arising out of the Name Insured's Operations. Please see the attached notice of cancellation endorsement. Personal Injury Protection is included for all Automobile policies evidenced above. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1155 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland,OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services Jenna Boyce 4.e.A-4",-.6;& ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RAD500053401 COMMERCIAL AUTO CA 20 48 1013. THIS. ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED. AUTOS LIABILITY -COVERAGE This endorsement modifies'insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO. COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions Of the Coverage Form:apply'unless:modified by this endorsement. This endorsement identifies-person(s) or organization(s)Who are"insureds"for CoVered.A0toS cON'ierage Under the Who Is.An Insured provision of the Coverage Form:. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective son the inception date of the policy unless another date is Indicated- beloW. Named Insured: LYFT, INC.. Endorsement Effective:.Date: October 1, 2019 SCHEDULE Heine Of Person(s)Or Organization(s): Any person or organization where required by regulation,statute,ordinande,or-to the extent required by contract or agreement Information required to cdriPPlete this Schedule, if not showhabovei'will be shown in the:Declarations Each person or organization shown in the Schedule is Autos :Liability Coverage in the Business Auto .and: an "insured" for Covered Autos Liability Coverage, but Motor Carrier Coverage Forms and Paragraph D 2 of only to the extent that person or organization qualifies Section I — Covered Autos Coverages of the Auto as an "insured" under the Who Is An Insured provision Dealers Coverage Form: contained in Paragraph A.J. of Section II — Covered CA 20 48 10 13 0 Insurance Services Office, Inc., 20.11 Page 1 of 1 POLICY NUMBER: RAD500054:90.1 COMMERCIAL AUTO CA 20:481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ.IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS'. LIABILITY COVERAGE This endorsement modifies insurance provided under the.following: AUTO DEALERS COVERAGE FORM BUSINESS,AUTO-COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the:provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are"insureds"'for°Covered Autos:Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the.Coverage Farm. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated'below. Named Insured: :LYFT, INC. Endorsement Effective Date: October 1, 2019 SCHEDULE Name Of.Person(s)Or Organization(s) Any person or organization where required by regulation,stetute,ordinance,or to,the:extent required by contract or agreement Information required to:complete this Schedule,.if not ShoWn above, will be shown.in the Declarations.. 'Each person' or organization shown in the Schedule is Autos Liability Coverage in the Business Auto and Motor an "'insured" for Covered Autos Liability Coverage; but Carrier,Coverage Forms.and Paragraph 0:2:of`Section.I only to the extent that person or organization qualifies -- Covered . Autos Coverages of the Auto Dealers as an "insured" under the Who Is An Insured provision Coverage Form. contained in Paragraph A,1. of Section II — Covered CA 20 481013 © Insurance Services Office, Inc.., 2011 Page 1 of 1 POLICY NUMBER: RAD500056201 COMMERCIAL AUTO CA.20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED' INSURED FOR COVERED:AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO.COVERAGE FORM MOTOR CARRIERCOVERAGE FORM With respect tocoverage provided by this endorsement, the proviSionS of the Coverage Form apply unless modified by this endorsement. This endorsement identifies.person(s) or organizatiOn(s)Who are"insureds"for Covered Autos,Liability Coverage-under the Who Is.An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the.policy'unless another date is indicated. below. Named Insured: LYFT, INC. Endorsement Effective Date: October 1, 2019. SCHEDULE Name Of Person(t)Or OrganizatiOn(s): Any person or organization where required by regulation, statute,ordinance, or to the extent required by contract or agreement. Information required to complete this Schedule; if not shown above,will be shown in the DeclaratiOns.. Each person or organization shown in the Schedule is Autos .Liability Coverage in the Business Auto and an "insured" for Covered Autos Liability Coverage, but Motor Carrier Coverage Forms and Paragraph D 2 of only to the extent that person or organization qualifies Section I — Covered Autos Coverages of the Auto as an "insured" under the Who Is An insured provision Dealers Coverage Form. contained in ParagraPh A.1. of Section II — Covered' CA 20 481013 ©insurance Services Office, Inc.,,20.11 Pagel of ENDORSEMENT#008 This endorsement, effective 12:01 a.m., October 1, 2019, forms:a.part of Policy No. RAD500053401 issued to LYFT; INC. by Indian Harbor Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ.IT CAREFULLY. NOTIFICATION TO OTHERS OF CANCELLATION, NON-RENEWAL OR REDUCTION IN LIMITS This:endorsement modifies insurance provided under the: COMMON POLICY CONDITIONS The Cancellation Section of the Common Policy Conditions is amended to include the following: A. If we cancel or non-renew this Coverage Form by written notice to the first Named Insured for any reason other than nonpayment of°premium, we will mail or deliver a:copy of such written notice of cancellation or non-renewal:: 1. Tothe name and address corresponding to each person or organization shown in the Schedule below; and. 2: At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, .or the longer number of days' notice if indicatedin the Schedule below. B. If we cancel this Coverage Form by written notice to the first Name.d Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown inthe•Schedule below at least 10 days prior to the effective date of such.cancellation. C. If the Limits of Liability afforded by this Coverage Form are reduced, except for reduction of limits due to payment of claims, we will mailor deliver notice of such reduction:or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and. 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days'notice if indicated in the Schedule below: D. If notice as described in Paragraphs A., B.or C.of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. MANUS. Page.1 of 2 ©2019 X.L. America, Inc. All Rights Reserved. May not be copied.without permission. SCHEDULE Name and Address of Other Person(S)I Organization(s): Numberof Days'Notice: ANY PERSON OR ORGANIZATION.WHERE REQUIRED BY.REGULATION, 30 STATUTE, ORDINANCE OR BY CONTRACT. All other termsand Conditions of this policy remain unchanged MANUS Page 2 of 2: ©2019 XL. America, Inc. All Rights Reserved. May not be Copied without perrhi$siOn. ENDORSENIENT:#f008 This endorsement, effective 12:01 a.m., October 1, 2019,forms:a part of Policy No. RAD500054.901 issued to. LYFT; INC. by Indian Harbor Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTIFICATION TO OTHERS OF CANCELLATION, NON-RENEWAL OR REDUCTION IN LIMITS This endorsement modifies insurance prOided under the: COMMON POLICY CONDITIONS The Cancellation Section of the Common Policy Conditions is amended toinclude the following: A. If we cancel or non-renew this Coverage Form by written notice..to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal.: 1. Tothe name and address corresponding to each person or organization shown in the Schedule below; and 2: At least 10 days prior to theeffective date ofthe cancellation or non-renewal, as advised in our notice to thefirst Named Insured, or thelonger number of days' notice if indicated in the Schedule below. B. If we cancel:this Coverage Form by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of silch writtennotice of cancellation to the name and address corresponding to each person or organization shown inthe:Schedule below at least 10 days prior to the effective date of such cancellation. C If the Limits of Liability.afforded by this Coverage Form are reduced, except for reduction of limits due to payment:of claims, we will mail or deiver notice of such reduction:or restriction: 1. To the name and address corresponding to each person or organization shown in.the Schedule below; and, 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of :days'notice if.indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C.of this endorsement is mailed, proof of mailing will be sufficient proof of'such notice. MANUS. Page 1 of 2 2019 X.L. America, Inc. All Rights Reserved. May not be copied without permission. SCHEDULE Name and Address of Other Person(S)/Organization(s); Number of Days'Notice:: ANY PERSON OR ORGANIZATION:WHERE REQUIRED BY REGULATION, 30 STATUTE, ORDINANCE OR BY CONTRACT All other terms and Conditions of this policy remain unchanged. .0,53dokviz, Authorized Representative FRAD5000,54901 MANUS P.age2 bf 2 ©2019 XL. America; Inc: All Rights Reserved. May not be copied without permiSsion. ENDORSEMENT##008 This endorsement, effective.f2:01 a.m., October 1, 2019, forms a part of Policy No. RAD500056201 issued to LYFT, INC.. by Indian Harbor Insurance Company THIS ENDORSEMENT CHANGES.THE,POLICY.. PLEASE READ IT CAREFULLY. NOTIFICATION TO OTHERS OF CANCELLATION, NON-RENEWAL OR REDUCTION IN LIMITS This endorsement modifies insurance provided.underthe: COMMON POLICY CONDITIONS: The:Cancellation:Section.of the Comrnon Policy Conditions is,:amended to include the following: A. If we cancel or non-renew this Coverage:Form by written notice to the first Named Insured for any reason other than:nonpayment of`;premium, we will mail or deliver a:copy of such written notice of cancellation or non-renewal.: 1: Tothe name and address corresponding to each person or organization shown in the Schedule below; and. 2: At least 10 days prior to the effective date of:the cancellation or non-renewal, as advised in our notice:to the first Named Insured, orthe:longer number of days' notice if:indicated in the Schedule below. B. If we cancel this Coverage Form by written notice to thefirst Named for nonpayment of premium, we will mail or delivera Copy of Such writtennotice of cancellation to the name and address. corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If the Limits of Liability.afforded by this Coverage Form are,reduced, except for reduction of limits due to payment of claims, we will mail or deliver notice of such reduction or,restriction: 1. To.•the,hatrie and address corresponding to each person or organization shown in the Schedule: below and: 2. At least 10 days prior to the effective date ofthe reduction or,restriction, or the longer number:of days'notice:if:indicated in the Schedule below. D. If notice:as described'in ParagraphsA., B.'or C.of this endorsement is mailed, proof of Mailing will be sufficient proof of such notice. MANUS ©2019 XL. America, Inc. All Rights Reserved. Page 1 of 2 May not:be copied:withoutpermission. Policy Number RAD500056201 SCHEDULE Name and Address of.Other Person(S)/Organization(S): NuMber of DaysNotice:; ANY PERSON OR ORGANIZATtON VVHERE RFQUIRED:BY REGULATION, 30 STATUTE, OFRDINANCE,OR BY CONTRACT All other terms and Conditions of this policy remain unchanged. f•Wthori2ed Representative MANUS 6 2019 XL.America, Inc. All Rights Reserved., RAD500056201 May not be:Capied.without permission. Page 2 of 2 ENDORSEMENT This endorsement, effective 12:01 AM 05/01/2019 Forms a part of policy no.: 065463589 Issued to: LYFT, INC. By: LEXINGTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO INCLUDE AS AN ADDITIONAL INSURED BY A WRITTEN CONTRACT A. Section II - Who Is An Insured is amended required by the written contract or to include the person or'organization shown written agreement. This endorsement in the Schedule above that you are required shall not increase the Limits of to include as an additional insured on this Insurance stated in the Declarations. policy by a written contract or written under Item 3. Limits of Insurance agreement in effect during this policy period pertaining to the coverage provided and executed prior to the "occurrence" of the herein. "bodily injury" or "property damage." 4. The insurance provided to such an B. The insurance provided to the above additional insured does not apply to described additional insured under this "bodily injury" or "property damage" endorsement is limited as follows: arising out of an architect's, engineer's 1. COVERAGE A. BODILY INJURY AND or 1. surveyor's rendering of or failure PROPERTY DAMAGE (Section I - to render any professional services Coverages) only. including: 2. The :person or organization is only an i The preparing, approving or failing to additional insured with respect to liability prepare or approve maps, shop arising out of "your work" or "your drawings, opinions, reports, surveys, product" for that additional insured. field orders, change orders, or 3. In the event that the Limits of Insurance drawings and specifications; and provided by this policy exceed the Limits ii Supervisory, inspection, architectural of Insurance required by the written or engineering activities. contract or written agreement, the 5. This insurance does not apply to "bodily insurance provided by this endorsement injury" or "property damage" arising out shall be limited to the Limits. of Insurance of "your work" or "your product' LX4285 (02/14) included in the "products-completed BODILY INJURY AND PROPERTY operations hazard" unless you are DAMAGE LIABILITY (Section I Coverages) required to provide such coverage by does not apply to you if the "bodilyinjury" or written contract or written agreement and "property damage" arises out of "your then only for theperiod of time required work" or "your product" performed on by the written contract or ,written premises 'Mich are owned or rented by the agreement and in no event beyond the additional insured at the time "your Work" or expiration date of the policy. "your product" is performed: 6. Any coverage provided by this D. In accordance with the termsand>conditions endorsement 'to an additional insured of the policy and as more fully explained in shall be'excess over any other valid and the policy, as soon as practicable, each collectible insurance available to the additional insured must give us prompt additional insured whether primary; notice of any"occurrence" which may result excess, contingent or on any other basis in a claim, forward all legal papers to us, unless 'a written contract or written cooperate in the defense of any actions, and. agreement specifically requires that this otherwise comply with all of the policy's insurance apply on a primary and terms and conditions. non-contributory. basis. C. Subparagraph (1)(a) of the Pollution exclusion' paragraph 2:f., Exclusions of COVERAGE A. LX4285 (0214) Includes copyrighted information of the Insurance Services Offices,Inc., with its permission. All rights reserved. ENDORSEMENT # 026 This endorsement, effective 12:01..AM 05/01/2019 Forms a part of policy no.: 065463589 Issued to: LYFT, INC. By:LEXINGTON INSURANCE COMPANY ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED ENDORSEMENT This endorsement modifies insurance providedby the policy: SCHEDULE Name of Certificate Holder(s) and Address: 1. As per the list on file with the company 2. If the Insurer cancels this policy for any reason other than cancellation for non-payment of premium, notice of cancellation shall be given in accordance V+ath the terms and Conditions of the policy to the Certificate Holder(s) shown in.the above Schedule: Other than the right to receive notice of cancellation as set forth herein, this endorsement confers no rights under this policy to the 'Certificate Holder(s) including,but not limited to, additional insured. status or additional Named Insured status. As used herein, Insurer.rrieans the insurance company shown in the header on the Declarations Page. of this policy. All other terms andconditions of the policy remain the same. ‘211/17 Authorized Representative LX8959(05/13) Page.1 of.1