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HomeMy WebLinkAboutInsurance Certificate: Don's Lock LLC ' DATE(MM/DDIYYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 01/22/2026 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 NAME: Julie Ma het Hart Insurance Agency PHONE FAX PO Box 1244 AC No E t: {541} 479-5521 AC ryo;{541} 474-1890 E-MAIL ma het@hartirisurarice.COm Grants Pass OR 97528 A DDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INsuRERA:Ohio Security Insurance Co 24082 INSURED INSURER B:SAIF Corporation 36196 Don's Lock LLC INSURER c:General Insurance CO of Americ 24732 2940 N Pacific Hwy INSURER D: Medford OR 97501 INSURERE: (541) 776-2154 1 INSURER F: COVERAGES IF CERTIFICATE NUMBER:Cert ID 34139 (3) 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR SD POLICY NUMBER MM/DD MMIDD/YYYY A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR Y Y BZS67341663 02/28/2026 02/28/2027 PREMISES Ea occurrence is 2,000,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADVINJURY $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY❑ PRO ❑ $ 4,000,000 LOG PRODUCTS X JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 C X ANY AUTO Y Y AZG67341663 02/28/2026 02/28/2027 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE is 1 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ I$ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS'I.IABILITY Y/N 100064791 02/01/2026 02/01/2027 X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT ($ 500,000 OFFICER/MEMBER EXCLUDED? N/A El in NH) E.L.DISEASE-EA EMPLOYEE:$. 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT li $ - 500,000 I $ I is DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Blanket Additional Insured for General Liability when required by written contract or agreement per the attached BP7996 09/16. Blanket Additional Insured for Commercial Auto when required by written contract or agreement (Primary/Non-Contributory and Waiver of Subrogation included) per the attached AC0033 10/21. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 *_c7�_ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page : of 1 ' POLICY NUMBER: COMMERCIAL AUTO AC8O33032O THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��� 0������� AUTO POLICY BASE �������D���� ����nm���� ^�� m "� m "��u�� m �^��� EXTENSION �n��n'�m� This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With oeap=d to coverage afforded by this endomament, the provisions of the policy apply unless modified by endorsement. SECTION IU—COVEREDAUTOS LIABILITY COVERAGE is amended as follows: 1' Newly Formed Qr Acquired Subsidiaries The following ia added to SECTION U1—COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1.Who Ia An Insured: d. Any legally incorporated subsidiary nf which you own more than 50 percent interest during the policy period ohuvvn on the Declarations. Coverage shall apply for the first ninety (OO) days after your acquisition or the formation of such subsidiary, including the date of acquisition or formation. If you wish to add or continue coverage you must ask us to insure the subsidiary within ninety (90) days after you acquire or form the subsidiary. However, ^ineur*d''does not include any subsidiary that: (1) Is o partnership or joint venture; or (2) Is an "insured"under any other automobile policy except a policy written specifically to apply in excess of any coverage provided by this policy; or (3) Has exhausted its Limit of Insurance for any policy with effective dates overlapping the date of acquisition or formation; or (4) Following the entity's acquisition or formation by you, has had any other automobile policy cancelled or non-renewed. Coverage under this provision d. does not apply to "bodily injury" or "property damage" caused by an accident that occurred before you acquired or formed the subsidiary. 2. Employee Hired Auto The following is added to SECTION 11—COVERED AUTOS LIABILITY COVERAGE, Paragraph A.I.Who Is An Insured: e- An "employee" of yours is an "insured" while operating on "auto" hired or rented under o oonhaoi or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. Paragraph 5.1b.of the Other Insurance Condition in the Business Auto and Auto Dealers Coverage Forms and Paragraph 5.f. of the Other Insurance ~Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos"you own: 1. Any covered "uuto"you lease, hire, rent or borrow; and ACO033832O dX2020 Liberty Mutual Insurance Page 1of4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 07/03/2024 66015260 candidate Process xc Insured Copy 2. Any covered "auto"hired or rented by your"employee"under a contract in an"employee's"name,with your permission, while performing duties related to the conduct of your business. However, any"auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". 3. Employees As Insureds The following is added to the SECTION 11—COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1.Who Is An Insured: f. Any"employee"of yours is an "insured"while using a covered "auto"you don't own, hire or borrow in your business or your personal affairs. 4. Additional Insured By Contract,Agreement Or Permit The following is added to SECTION 11—COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1.Who Is An Insured: g. Any person, organization or governmental or public authority with respect to the operation, maintenance or use of a covered "auto", provided that you and such person, organization, or governmental or public authority have agreed in a written contract, written agreement, or permit, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person, organization or governmental or public authority is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you exhausted the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit.- The"insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to be primary and noncontributory per provision 13. of this endorsement, this policy is excess over any other collectible insurance. 5. Supplementary Payments SECTION 11 — COVERED AUTOS LIABILITY COVERAGE, 2. Coverage Extensions, a. Supplementary Payments, Paragraph (4) is replaced by the following: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 per day because of time off from work. SECTION III—PHYSICAL DAMAGE COVERAGE is amended as follows: 6. Physical Damage—Additional Transportation Expense Coverage Paragraph AA.a.Coverage, Coverage Extensions,Transportation Expenses of SECTION III—PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of$50 per day and a maximum limit of$1,500 per day. 7. Extra Expense—Broadened Coverage The following is added to SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions: c. We will pay up to$1,000 for costs incurred to return a stolen auto to you. Page 2 of 4 @ 2020 Liberty Mutual Insurance AC 00 33 03 20 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 07/03/2024 66015260 candidateProcess HC Insured Copy ` � 8. Accidental Airbag Deployment SECTION III—PHYSICAL DAMAGE COVERAGE, B'Exclusions Paragraph 3'a.ie replaced by the following: a' Wear and tear, freezing, mechanical or electrical breakdown. However, this exclusion does not apply Vw the accidental discharge of an airbag if Comprehensive or Collisi6n Coverage is shown in the Declarations. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. Hmwmver, we agree to pay any deductible applicable to the other insurance or warranty. 8- Glass Repair—Waiver 8f Deductible(Coverage Not Applicable|nFL) SECTION III—PHYSICAL DAMAGE COVERAGE, D. Deductible ia amended by the addition of the following: No deductible will apply to covered glass damage if the glass is repaired rather than replaced. SECTION IV—BUSINESS AUTO CONDITIONS ia amended aofollows: 10. Amended Duties In The Event OfAccident, Claim, Suit, Or Loss SECTION IV—BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the following: o. In the event of"accident", claim, "suit"or"loss", you must promptly notify us when it is known to: (1) You, if you are anindividual; (3) A partner, if you are upartnership; (3) Member, if you are u limited liability company; W0 An executive officer or the"employee"designated by the Named Insured to give such notice, if you are aoorponebun. To the extent possible, notice tmue should include: (o) How,when and where the^acoidenY`or^|ooa"took place; (b) The "insured's" name and address; and (o) The names and addresses of any injured persons and witnesses. 11' Waiver Of Transfer Of Rights Of Recovery Against Others ToUs SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph A'5'. Transfer of Rights of Recovery Against Others to Us, ie amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or"loss", our rights are waived also. 12. Hired Auto Coverage Territory SECTION IV—BUSINESS AUTO CONDITIONS, Paragraph B.General Conditions, Item 7.b.(5), Policy Period, Coverage Territory, is replaced with the following: Anywhere in the world,for covered "autos" hired for thirty(30)days or less. This extension of coverage does not apply to an "auto" hired, |eaoed, rented or borrowed with a driver. ACUO33O32O @2O2O Liberty Mutual Insurance Page 3of4 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 07m3o024 osmousn oanomatepm^*xn xo Insured Copy 13. Primary And Non-Contributory If Required By Written Contract Or Written Agreement The following is added to SECTION IV— BUSINESS AUTO CONDITIONS, B. GENERAL CONDITIONS, 5. Other Insurance and supersedes any provision to the contrary: e. Subject to the applicable limits of liability,this Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: (1) Such "insured" is a Named Insured under such other insurance; and (2) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance collectible to such "insured". SECTION V—DEFINITIONS is amended as follows: 14. Bodily Injury Redefined Under SECTION V—DEFINITIONS, Paragraph C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. Page 4 of 4 O 2020 Liberty Mutual Insurance AC 00 33 03 20 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 07/03/2024 66015260 candidateProcess HC Insured Copy ' BDSINESSOVVNERS 8P7896U916 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUS|NESSOVVNERS COVERAGE FORM Below is a summarization of the coverages provided by this endorsement. No coverages are given by this summary. Actual coverage descriptions are within this endorsement. SECTION SUBJECT A. Supplementary Payments Bail Bonds Loss Of Earnings B. Broadened Coverage For Damage To Premises Rented To You C. Incidental Medical Malpractice Injury D. Mobile Equipment E. Blanket Additional Insured (Owners, Contractors Or Lessors) F. Newly Formed OrAcquired Organizations G. Aggregate Limits H. Duties In The Event Of Occurrence, Ofenaa, Claim Or Suit i Liability And Medical Expenses Definitions Bodily Injury Insured Contract Personal And Advertising Injury � Section U -Liabi|ity is amended as follows: A. Supplementary Payments Section A.1. Business Liability is modified as follows: � 1. The $250 limit shown in Paragraph A.11(11)(b) Coverage Extension -8upp|ementary Payments for the cost of bail bonds is replaced by a$3.000 limit. 3. The $250 limit shown in Paragraph A.1.[(1)(d) Coverage Extension ' Supp!omnentory Payments for reasonable expenses and |oaa of earnings is replaced by a$50O limit. B. Broadened Coverage For Damage To Premises Rented To You 1. The |eot paragraph of Section B.1. Exclusions ' App|icob|e To Business Liability Coverage is replaced by the following: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sion of the mwner. Exclusions o.' d.' e.' Q, h.' k, L m.' n. and o. do not apply to "property damage". � 2O10Ubeny Mutual Insurance BP79 96 09 16 Includes copyrighted material of Insurance Services Office,|nc.with its permission. Page 1 of 2. Paragraph D.2. Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under this endorsement for the sum of all damages because of all "property damage" to premises while rented to you or temporarily occupied by you with the permission of the owner is the Limit of Insurance shown in the Declarations. 3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance does not apply. C. Incidental Medical Malpractice Injury 1. Paragraph (4) under Paragraph B.1.j. Exclusions -Applicable To Business Liability Coverage - Profes- sional Services does not apply to "Incidental Medical Malpractice Injury" coverage. 2. With respect to this endorsement, the following is added to Section F. Liability And Medical Expenses Definitions: a. "Incidental Medical Malpractice Injury" means bodily injury arising out of the rendering of or failure to render, during the policy period, the following services: (1) Medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or beverages in connection therewith; or (2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. b. This coverage does not apply to: (1) Expenses incurred by the insured for first-aid to others at the time of an accident and the Duties in the Event of Occurrence, Offense, Claim or Suit Condition is amended accordingly. (2) Any insured engaged in the business or occupation of providing any of the services described under a. above. (3) Injury caused by any indemnitee if such indemnitee is engaged in the business or occupation of providing any of the services described under a. above. D. Mobile Equipment Section C. Who Is An Insured is amended to include any person driving "mobile equipment" with your permission. E. Blanket Additional Insured (Owners, Contractors Or Lessors) 1. Section C. Who Is An Insured is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy under a written contract or written agreement. The written contract or agreement must be: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury", "property damage", or "personal and advertising injury". 2. The insurance afforded to the additional insured is limited as follows: a. The person or organization is only an additional insured with respect to liability arising out of: (1) Real property, as described in a written contract or written agreement, you own, rent, lease, maintain or occupy; and (2) Caused in whole or in part by your ongoing operations performed for that insured. b. The Limit of Insurance applicable to the additional insured are those specified in the written contract or written agreement or the limits available under this policy, as stated in the Declara- tions, whichever are less. These limits are inclusive of and not in addition to the Limit of Insurance available under this policy. c. The insurance afforded to the additional insured does not apply to: (1) Liability arising out of the sole negligence of the additional insured; (2) "Bodily injury", "property damage", "personal and advertising injury", or defense coverage under the Supplementary Payments section of the policy arising out of an architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: O 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 4 - , - . . (a) The preparing or approving of mepa, shop drowingn, opinions, repodo, ouneyo, field nrdem, change ordero, or drawings and specifications; and (b) Supemioory, inopechon, architectural or engineering activities. (3) Any "occurrence" that takes place after you cease to be utenont in the premises described in the Declarations; or NQ Structural o|h*rationo, new construction or demolition operations performed by or for the person or organization designated in the Declarations. 3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail- able to the additional insured whether phmary, exoeao, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on aprimury basis. F. Newly FonnedOrAcquinad Organizations The following is added to Section C.Who |sAnInsured: Any business entity acquired by you or incorporated or organized by you under the |owe of any individual state of the United States of America over which you maintain majority ownership interest exceeding fifty percent, Such acquired or newly formed organization will qualify as a Named Insured if there is no similar insurance available to that entity. However: i. Coverage under this provision is afforded only until the 180th day after the entity was acquired or incorporated or organized by you or the end of the policy period, whichever is earlier; 2. Section A.I. Business Liability does not apply to: a. "Bodily injury" or "property damage" that occurred before the entity was acquired or incorporated or organized by you; and b. "Personal and advertising injury" arising out of an offense committed before the entity was ac- quired or incorporated or organized by you. 3. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization in an insured with respect to the conduct of any current or past podnemhip, joint venture or limited liability company that is not shown aaaNamed Insured in the Declarations. G. A00vagobe Limits The following is added to Paragraph D.4. Aggregate Limits Liability and Medical Expenses Limits Of Insurance: 1. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or temporarily occupied by you with the permission nf the owner. � 2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or � rented to you For the purpose of this endorsement only, "location" means premises involving the same or connect- ing |oto, or premises whose connection is interrupted only by a otreet, madwoy, waterway or right- of-way ofarailroad. H. Duties In The Event Of Occurrence, Offense, Claim Or Suit 1. Paragraph E.2.u. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses General Condition applies only when the "occurrence" is known to any insured listed in Paragraph C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of on "ocourrence" or claim. %. Paragraph E,2.b. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses 6enon*| Condition will not be considered breached unless the breach occurs after such claim or "suit" is known to any insured listed under Paragraph CA. Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, � 20161-ibexy Mutual Insurance BP78SG081G Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3of4 � i Section F. Liability And Medical Expenses Definitions is modified as follows: 1. Paragraph F.3. iereplaced by the following: 3. "Bodily Injury" means bodily injury, oickneas, diueaae, or incidental medical malpractice injury sustained by operuon. and includes mental anguish resulting from any of these" and including death resulting from any of these at any time. 2. Paragraph F.B. is replaced by the following: 9. "Insured contract" means: a. Auontract for o |eoee of premises. However, that portion of the contract for aleaoe of prem- ises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; m ==== o. 'Any easement or license agreement, except in connection with construction or demolition operations on or within 50��t of n�kood�. . d. An obligation, as required by ordinance, to indemnify a municipa|ity, except in connection with work for a municipality; e. An elevator maintenance agreement f. That part of any other contract or agreement pertaining to your business (including anindem' indem- nification of o municipality in connection with work performed for emunioipo|ih/) under which you assume the hod liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is cauoed, in whole or in part, by you or by those acting on your behalf, However, such pad of � contract or agreement shall only be considered an "insured contract'' to the extent your assumption of the tort liability in permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. , Paragraph [ doea not include that port of any contract or agreement: (1) That indemnifies arai|ruad for "bodily injury" or "property dumoge" arising out ofnon- otruution or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tnaoko, med'bedo, hunne|, underpass or crossing; (2) That indemnifies an arohitect, engineer or surveyor for injury or damage arising out of: (a) Prepering, oppmving, or failing to prepare or approve, mopa, shop drevvings, opin- ions, reports, oumeya. field o/dena, change orders or drawings and specifications; or (b) Giving directions or inetruotiona, or failing to give them, if that is the primary cause of � the injury or damage-, or a (3) Under which the inaured, if an arohiteot, engineer or surveyor, assumes liability for an injury or damage arising out of the inuured'o rendering or failure to render professional oemiceo, including those listed in (2) above and aupemioury, inopection, architectural or � engineering activities. 2. Paragraph F.14.b. Personal And Advertising Injury is nap|oued by the following: b. Malicious prosecution or abuse of process; (D 20101-ibnUy Mutual Insurance BP78 96 09 16 Includes copyrighted material of Insurance Services Office,|nc.with its permission. Page 4of4