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HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Goodwill Industries �CI.JRO® CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 07/09/2025 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 NAME: - Misty D Whorle PO Box 1240 A/C No, (541) 779-4232 AIC No:(541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: mwhorley@hartinsurance.com INSURERS AFFORDING COVERAGE NAIC/ __ __ _ INSURERA:SAIF Corporation 36196 INSURED INSURER B:Cincinnati Insurance Company 10677 Southern Oregon Goodwill Industries INSURER C:Cincinnati Casualty Company 28665 11 W Jackson Street INSURER D Medford OR 97501 INSURERE: (541) 772-3300 INSURER F COVERAGES MW CERTIFICATE NUMBER:Cert ID 32464 (45) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICYNUMBER MM/DD MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR Y ETD0542657 07/01/202507/01/2028 DAMAGE TO RENTEDPREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ 1,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 F1POLICY1:1 JECT X]LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: Professional Liab Is 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 8 X ANY AUTO ETA0542657 07/01/2025 07/01/202 BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ C I X I UMBRELLA LIAB I X OCCUR ETDO542657 07/01/2025I07/01/2028 EACH OCCURRENCE $ 5,000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION PER OTH- A AND EMPLOYERS'LIABILITY YIN 940598 04/01/2025�04/01/2026 X STATUTE ER ANYPROPRIETOR/PARTNERlEXECUTNE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? El N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 $ $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Policy includes automatic additional insured where required by written contract per attached GA262. 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 Street AUTHORIZED REPRESENTATIVE F Ashland OR 97520 (" —� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 (1) Paragraph 6.of Section III -Lim- a. Any Insured its Of Insurance is replaced by the following: To any insured, except: 6. Subject to Paragraph 5. (1) A"volunteer worker"; or above, the Damage To (2) A student in training, medical di- Premises Rented To You rector or administrator who is Limit is the most we will pay providing services on your be- under Coverage A - Bodily half. Injury And Property Dam- age Liability for damages 6. 180 Day Coverage For Newly Formed because of "property dam- Or Acquired Organizations age"to any one premises: Section II - Who Is An Insured is a. While rented to you, or amended as follows: temporarily occupied by you with permission of Subparagraph a. of Paragraph 3. is re- the owner; placed by the following: b. In the case of damage a. Coverage under this provision is af- by fire, explosion, light- forded only until the 180th day after ning, smoke or soot, you acquire or form the organization while rented to you;or or the end of the policy period, whichever is earlier; c. In the case of damage by water, while rented 7. Waiver Of Subrogation to and occupied by you. Section IV - Commercial General Lia- (2) The most we will pay is limited bility Conditions, 8. Transfer Of Rights as described in Section B. Limits Of Recovery Against Others To Us is Of Insurance, 3. Damage To amended by the addition of the following: Premises Rented To You of this We waive any right of recovery against endorsement. any additional insured under this en- 4. Supplementary Payments dorsement, because of any payment we make under this endorsement, to whom Under Section I - Supplementary Pay- the insured has waived its right of recov- ments -Coverages A and B: ery in a written contract, written agree- a. Paragraph 1.b. is replaced by the fol- ment, written permit or written authoriza- tion. Such waiver by us applies only to lowing: the extent that the insured has waived its Up to the limit shown in Section B. right of recovery against such additional Limits Of Insurance, 4.a. Bail Bonds insured prior to loss. of this endorsement for cost of bail 8, Automatic Additional Insured - Speci- bonds required because of accidents fied Relationships or traffic law violations arising out of the use of any vehicle to which the a. The following is added to Section 11 - Bodily Injury Liability Coverage ap- Who Is An Insured: plies. We do not have to furnish these bonds. (1) Any person(s) or organization(s) described in Paragraph 8.a.(2) b. Paragraph 1.d. is replaced by the fol- of this endorsement (hereinafter lowing: referred to as additional insured) All reasonable expenses incurred b whom you are required to add y as an additional insured under the insured at our request to assist this Coverage Part by reason of us in the investigation or defense of a written contract, written the daim or "suit', including actual agreement, written permit or loss of earnings up to the limit shown written authorization or, only with in Section B. Limits Of Insurance, respect to Paragraph 8.a.(2)(i)of 4.b. Loss Of Earnings of this en- this endorsement, an oral dorsement per day because of time agreement or contract. off from work. 5. Medical Payments (2) Only the following persons or Y organizations are additional in- Section I - Coverage C - Medical Pay- sureds under this endorsement, ments, 2. Exclusions, a.Any Insured is and insurance coverage provid- replaced by the following: Includes copyrighted material of Insurance GA 262 OR 09 20 Services Office, Inc., with its permission. Page 10 of 22 ed to such additional insureds is after the equipment lease limited as provided herein: expires. (a) Managers Or Lessors Of (c) Vendors Premises Any person or organization The manager or lessor of a (referred to below as ven- premises leased to you you dor) you are required per are required per Paragraph Paragraph 8.a.(1) of this 8.a.(1) of this endorsement endorsement to provide in- to provide insurance, but surance, but only with re- only with respect to liability spect to liability for "bodily for "bodily injury", "property injury' or"property damage" damage" or "personal and arising out of 'your prod- advertising injury" caused, ucts" which are distributed in whole or in part, by you or or sold in the regular course those acting on your behalf of the vendor's business, in connection with the own- subject to the following ad- ership, maintenance or use ditional exclusions: of that part of the premises leased to you, subject to the (i) The insurance afforded following additional exclu- the vendor does not apply to: sions: This insurance does not ap- 1) "Bodily injury" or ply to: "property damage" for which the ven- (i) Any"occurrence"which dor is obligated to takes place after you pay damages by cease to be a tenant in reason of the as- that premises; sumption of liabil- ity in a contract or (ii) Structural alterations, agreement. This new construction or exclusion does not demolition operations apply to liability for performed by or on be- damages that the half of such additional vendor would have insured. in the absence of (b) Lessor Of Leased Equip- the contract or ment agreement; Any person(s) or organiza- 2) Any express war- tion(s)from whom you lease ranty unauthorized equipment you are required by you; per Paragraph 8.a.(1) of this 3) Any physical or endorsement to provide in- chemical change surance. Such person(s) or in the product organization(s) are insureds made intentionally only with respect to liability by the vendor; for "bodily injury", "property damage" or "personal and 4) Repackaging, ex- advertising injury' caused, cept when un- in whole or in part, by your packed solely for maintenance, operation or the purpose of in- use of equipment leased to spection, demon- you by such person(s) or stration, testing, or organization(s). A person's the substitution of or organization's status as parts under in- an additional insured under structions from the this endorsement ends manufacturer, and when their contract or then repackaged agreement with you for such in the original con- leased equipment ends. tainer; However, this insurance does not apply to any "oe, 5) Any failure to currence"which takes place make such inspec- tions, adjustments, Includes copyrighted material of Insurance GA 262 OR 09 20 Services Office, Inc.,with its permission. Page 11 of 22 tests or servicing business, in as the vendor has connection agreed to make or with the distri- normally under- bution or sale takes to make in of the prod- the usual course ucts. of business, in connection with (ii) This insurance does the distribution or not apply to any in- sale of the prod- sured person or organi- ucts; zation: 6) Demonstration, in- 1) From whom you stallation, servic- have acquired ing or repair oper- such products, or ations, except any ingredient, such operations part or container, performed at the entering into, ac- vendor's premises companying or in connection with containing such the sale of the products; or product; 2) When liability in- 7) Products which, cluded within the after distribution or "products- sale by you, have completed opera- been labeled or re- tions hazard" has labeled or used as been excluded a container, part or under this Cover- ingredient of any age Part with re- other thing or sub- spect to such stance by or for products. the vendor; or (d) State Or Governmental 8) "Bodily injury" or Agency Or Subdivision Or "property damage" Political Subdivision - arising out of the Permits Or Authorizations sole negligence of Any state or governmental the vendor for its agency or subdivision or po- own acts or omis- litical subdivision you are sions or those of required per Paragraph its employees or 8.a.(1) of this endorsement anyone else acting to provide insurance, sub- on its behalf. ject to the following addi- However, this ex- tional provision: clusion does not apply to: This insurance applies only: a) The excep- (i) With respect to the fol- tions con- lowing hazards for tained in Par- which the state or gov- agraphs ernmental agency or (c)(i)4)or 6)of subdivision or political this endorse- subdivision has issued ment-, or a permit or authoriza- tion in connection with b) Such inspec- premises you own, rent tions, adjust- or control and to which ments,tests or this insurance applies: servicing as the vendor 1) The existence, has agreed to maintenance, re- make or nor- pair, construction, mally under- erection or remov- takes to make al of advertising in the usual signs, awnings, course of canopies, cellar Includes copyrighted material of Insurance GA 262 OR 09 20 Services Office, Inc.,with its permission. Page 12 of 22 entrances, coal alterations, new construe- holes, driveways, tion and demolition opera- manholes, mar- tions performed by or for quees, hoist away that person or organization. openings, side- walk vaults, street (f) Grantor Of Franchise banners or deco- Any person or organization rations and similar you are required per Para- exposures; graph 8.a.(1) of this en- 2) The construction, dorsement to provide insur- erection or remov- ance, but only with respect al of elevators; or to their liability as the gran- tor of a franchise to you. 3) The ownership, maintenance or (g) Owners, Lessees Or Con- use of any eleva- tractors tors covered by this insurance. Any person or organization you are required per Para- (ii) With respect to opera- graph 8.a.(1) of this en- tons performed by you dorsement to provide insur- or on your behalf for ance, but only with respect which the state or gov- to liability for "bodily injury," ernmental agency or "property damage" or " per- subdivision or political sonal and advertising injury" subdivision issued, in caused, in whole or in part, writing, a contract, by: agreement, permit or i) Your acts or omissions; authorization. or However, with regard to ii) The acts or omissions (d)(ii) above, this in- of those acting on your surance does not apply behalf; to: 1) "Bodily injury", in the performance of your "property damage" ongoing operations for the or "personal and additional insured when re- advertising injury" quired by a written contract. arising out of op- With respect to the insur- erations performed ance afforded to these addi- for the federal tional insureds, the following government, state exclusions apply: or municipality; or This insurance does not ap- 2) "Bodily injury" or ply to "bodily injury" or "property damage" "property damage" occur- included within the ring after: "products- completed opera- 1) All work, including ora- tions hazard". terials, parts or equip- ment furnished in con- (e) Mortgagee, Assignee Or nection with such work, Receiver on the project (other than service, mainte- Any person or organization nance ora repairs) to be you are required per Para- rah 8.a. o this performed by or on be- graph 1( ) fhi en- half of the additional in- dorsement to provide insur- sured(s) at the location ante, but only with respect of the covered opera- to their liability as mortga- tions has been com- gee, assignee or receiver pleted; or and arising out of the own- ership, maintenance or use 2) That portion of 'your of the premises by you. work" out of which the However, this insurance injury or damage arises does not apply to structural has been put to its in- Includes copyrighted material of Insurance GA 262 OR 09 20 Services Office, Inc.,with its permission. Page 13 of 22 tended use by any per- the written contract, written son or organization agreement, written permit or other than another con- written authorization to pro- tractor or subcontractor vide for such additional in- engaged in performing sured; and operations for a princi- pal as a part of the (c) Does not apply to any per- same project. son, organization, vendor, state, governmental agency (h) Controlling Interest or subdivision or political person or organization subdivision, specifically Any p g named as an additional in- you are required per Para- sured under any other pro- graph 8.a.(1) of this en- vision of, or endorsement dorsement to provide insur- added to, this Coverage ance, but only with respect Part, provided such other to their liability arising out provision or endorsement of: covers the injury or damage (i) Their financial control for which this insurance ap- of you;or plies. (ii) Premises they own b. With respect to the insurance afford- maintain or control ed to the additional insureds de- while you lease or oc- scribed in Paragraph 8.a.(1) of this cupy these premises. endorsement, the following is added to Section III- Limits Of Insurance: This insurance does not ap- ply to structural alterations, The most we will pay on behalf of the new construction and demo- additional insured is the amount of lition operations performed insurance: by or for that person or or- (1) Required by the written contract, ganization. written agreement,written permit (i) Benefactors Or Grantors or written authorization de- scribed in Paragraph 8.a.(1) of Any person or organization this endorsement. For the pur- you are required per Para- pose of determining the required graph 8.a.(1) above to pro- amount of insurance only, we vide insurance, but only with will include the minimum amount respect to "bodily injury', of any Umbrella liability or Ex- "property damage" or "per- cess Liability coverage required sonal and advertising injury" for that additional insured in that arising out of: written contract, written agree- ment,providing written permit or written ( ) p 9 authorization; or ing or funding to you; or ii Premises the own, (2) Available under the applicable ( ) Y limits of insurance; maintain or control while you lease or oc- whichever is less. cupy these premises. This endorsement shall not increase This insurance does not ap- the applicable limits of insurance. ply to structural alterations, new construction and demo- C. Section IV - Commercial General lition operations performed Liability Conditions is amended to by or for that person or or- include the following: ganization. Automatic Additional Insured Pro- (3) The insurance afforded to addi- vision tional insureds described in Par- This insurance applies only if the agraph 8.a.(1) of this endorse- "bodily injury" or "property damage" ment: occurs, or the"personal and advertis- (a) Only applies to the extent ing injury'offense is committed: permitted by law; (1) During the policy period; and (b) Will not be broader than that (2) Subsequent to your execution of which you are required by the written contract or written Includes copyrighted material of Insurance GA 262 OR 09 20 Services Office, Inc.,with its permission. Page 14 of 22 agreement, or the issuance of a pay in any one "occurrence" re' written permit or written authori- gardless of the number of: zation, described in Paragraph 8.a.(1). (a) Insureds; d. Section IV - Commercial General (b) Claims made or "suits" Liability Conditions is amended as brought;or follows: (c) Persons or organizations Condition 4. Other Insurance is making claims or bringing amended to include: "suits". Primary And Noncontributory In- (2) Deductible Clause surance (a) Our obligation to pay dam- This insurance is primary to and will ages on your behalf applies not seek contribution from any other only to the amount of dam- insurance available to an additional ages for each "occurrence" insured per Paragraph 8.a.(1) of this which are in excess of the endorsement provided that: Deductible Amount shown in Section B. Limits Of In- (1) The additional insured is a surance, 9. Property Dam- Named Insured under such oth- age To Borrowed Equip- er insurance; and ment of this endorsement. The limits of insurance will (2) You have agreed in writing in a not be reduced by the appli- contract, agreement, permit or cation of such Deductible authorization described in 8.a.(2) Amount. of this endorsement that this in- surance would be primary and (b) Section IV - Commercial would not seek contribution from General Liability Conditions, any other insurance available to 2. Duties In The Event Of the additional insured. Occurrence, Offense, Claim Property Damage To Borrowed claim Suit, applies to each 9. Pro p y g claim or"suit' irrespective of Equipment the amount. a. The following is added to Exclusion (c) We may pay any part or all 2J. Damage To Property under Sec- of the deductible amount to tion I - Coverage A - Bodily Injury effect settlement of any And Property Damage Liability: claim or"suit'and, upon no- tification of the action taken, Paragraphs (3) and (4) of this exclu- you shall promptly reim- sion do not apply to tools or equip- ment loaned to you, provided they burse us for such part of the are not being used to perform opera- deductible amount as has tions at the time of loss. been paid by us. b. With respect to the insurance provid- 10. Employees As Insureds - Specified ed by this section of the endorse- Health Care Services ment, the following additional provi- Paragraph 2.a.(1)(d) under Section II - sions apply: Who Is An Insured does not apply to: (1) The Limits of Insurance shown Your "employees" who provide profes- in the Declarations are replaced sional health care services on your behalf by the limits shown in Section B. as a duly licensed nurse, emergency Limits Of Insurance, 9. Property medical technician or paramedic in the ju- Damage To Borrowed Equip- risdiction where an "occurrence" or of- ment of this endorsement with fense to which this insurance applies respect to coverage provided by takes place. this endorsement. These limits are inclusive of and not in addi- 11. Broadened Notice Of Occurrence tion to the limits being replaced. The Limits of Insurance shown Paragraph a. of Condition 2. Duties In in Section B. Limits Of Insur- The Event Of Occurrence, Offense, ance, 9. Property Damage To Claim Or Suit under Section IV - Com- Borrowed Equipment of this en- mercial General Liability Conditions is dorsement fix the most we will replaced by the following: Includes copyrighted material of Insurance GA 262 OR 09 20 Services Office, Inc.,with its permission. Page 15 of 22