HomeMy WebLinkAboutInsurance Certificate: Day Wireless Systems
ACORDTM CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
6/25/2008
PRODUCER (503)241-9221 FAX: (503)542-0621 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Durham and Bates Agencies Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
720 SW Washington ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 250
Portland OR 97205-3554 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: OneBeacon America Ins. Co
Day Management Corporation, INSURER B: Naviga tors Insurance
DBA: Day Wireless Systems INSURER C:
4700 SE International Way INSURER D:
Milwaukie OR 97222 INSURER E:
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 OTH~R 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.
A~l~RI=~ATE LIMITS ~H()WN MAY HAVE BEEN D~nllf"E:n BY PAID CLAIMS
I~~~ ~~~~ ~!~~._-_. P~A~i~:~~68tW~ POLICY EXPIRATION LIMITS
POLICY NUMBER DATE (MM/DDIYY)
GENERAL LIABILITY EACH OC':C':IIRRFNC':F $ 1,000,000
- ~~~~~J9F~~~~~nce\
X COMMERCIAL GENERAL LIABILITY $ 1,000,000
A X I CLAIMS MADE W OCCUR 7110099180001 7/1/2008 7/1/2009 MED EXP (Anv one oerson\ $ 10,000
X $lMM Umbrella PER!=:ONAI & Anv INIIIRY $ 1,000,000
-
- . GENERAL AGGREGATE $ 2,000,000
-il'L AGGREnE LIMIT AAES PER: PRODLJCT~ - COMP/OP Ar,r, $ 2,000,000
X POLICY ~~RT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- $
~ ANY AUTO (Ea accident)
A ALL OWNED AUTOS 7110099180001 7/1/2008 7/1/2009 BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LIABILITY SF08EXC161165NV 7/1/2008 7/1/2009 EACH $ 8,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $ 8,000,000
$
~ DEDUCTIBLE $
! ~!=TENTfON 't. 1$
A WORKERS COMPENSATION AND 7110099180001 7/1/2008 7/1/2009 I T~$T~J,~~ T X I OJ~-
EMPLOYERS' LIABILITY 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE WASHINGTON STOP GAP E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EMPLOYERS LIABILITY E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under 500,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
A OTHER GARAGEKEEPERS 7110099180001 7/1/2008 7/1/2009 COMPREHENSIVE &
COLLISION LIMIT $250,000
DEDUCTIBLE $ 500
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE NAMED AS ADD I TONAL INSUREDS ON THE
GENERAL LIABILITY INSURANCE PER FORM VCG205 02 OS ATTACHED, BUT ONLY WITH RESPECT TO CONTRACTORS SERVICES TO BE
PROVIDE UNDER THIS CONTRACT, SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS *EXCEPT 10 DAYS NOTICE OF
CANCELLATION FOR NON-PAYMENT OF PREMIUM
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLAND
20 EAST MAIN STREET
ASHLAND, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Joanna Brown/MJK
ACORD 25 (2001/08)
INS025 (0108).08a
@ ACORD CORPORATION 1988
Page 1 of 2
III
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
INS025 (0108).OSa
Page 2 of 2
lnsu red: Day Wireless Systems
Policy: 71100918-0001
THIS ENDORSEMENT OIANGES THE POLleY. PLEASE READ IT CAREFULLY.
@VANTAGE FOR GENERAL LIABILITY
ThIs eooorsement rnodi'Iec InsuI'ln08 proWjed ~w .. foIJO't1IinQ:
COMMERCIAL GENERAL. LlA8lL.fTY COVERAGE FORM
The fOllowing schedule IisllIhe cow,. extBttliion& prO\'ided by this 8~cnement ReIer to the IndMduill prOYf-
sIons to determine the extent of your coverage.
SCHI!DULE OF COVERAGE EXTENStONa
1. Additional Insured - Broad Form Vende,.. I. Broadened Pl'Qpartr Damage Ren1ed Preml8.
2. MdtIionallnsured - by Con~r Agreement or 9. eoverBge TerrIlxy - Wol1dwitSw
Permit felating to: 10. DuIos In Event or O~.-.c., Clalm or Sui
o Work ptrformed by you 11. I!ICpected or IntencHd Injury (PO)
o pretlliR:;)IOtI own. tent.a~ Dr occupy , 2. Incidental Medic81 Mllpnldlee
D Equipment you 1181e 1 J. MIdbII ~
3. Aggregate Umlt P"loC4tion 14. Mobif. Equfpment Red.finoa
4. Blanket WaJver of SubrPga1iPn 1$. NIWIy Acqulrld or Formed organiZatiDns
5. BodJy lfaJury Red"flned. Mental Anguish 1 G. Non-OMlld AIrc:nIft
G. Broadened Nlrned lnsIUed 17. Non-Owned Watercraft
7. BroadeMd property Darn80e 1.. Pelwnellllld....rtiA1g lnjUJy
o BoffiJWBd Eq&,jpment 1 ,. ProcMt RICIII Ekpen&e
o Cu5'IDmers' GOGd~ 20. StlppIomontaly Payments fnoreased Urnits
o lJH of EtavatoJ$
i
1. ADDITJONAL INSURED. BROAD fORM VENDORS
Sactlon 1- Who .. AIIID5u...d . am.nded to hcIucIe I' an addllonallnlurad any P'faOl1(S) Of orglnlzatJen(s)
(1&forred to belcw - vsndor) Will whom you agreed in 8 wrIten oontrac:I or IIgrter'ntnt to provide lnsuranc.,
but ordy wib rG5p8Gt tD "bodily bjulf or -property demag.- .riIing out 0( ~ produQs- which ara cistribute.d
or &old klUlI rtgular couru at.... vendor's butiinMis. subild m 11\. folloWIng IdcIIIonal .=UIiona:
a, This prlMliun 1. doos not.ppay 1b:
(1) "BlXdy IhJUJt' or -prapert)' dlm.ge" for which the vendor is oblptwc:l1O p~ damages by telson or tn.
MMlmptlon 0' "1iI1y In I oanhut<< agreemlnl Thtl exduslon doea not epply to labilly lor GIITliIgIJ&
hat the vetldor WDUJd h-"'t lit h ....noe or the connct Of ~.mont;
(2) Any exprftl WIIITIII1ty un8U01orked by YOUj
(3) Any ~~I Of c:hemal ~ In the prcduc:t made tnIen&on.., by the vendor;
(4) Repaokaglngr I_pi whln unplCbd IOI.Jy for 1h. PUI'pOH or lnapec;tion. d9m~nstndDn, ttslilg Of 1ht
substituIItwl of parb lmd.r nstruGtions from the manufaGtwlt, and thu repBck8gDd in the Dri,ginal
contlliner,
(5) Arry '''we fa fllIIkl such InipIdJune, adjustments, tIStI or I8fV1Qng as tho v.ndor hn agreed to make
c)f nonnllly unde.... 10 rnakt In the UJUIl ~ of buIIneIi$. In c;onmdon WIIh the dbtrfbulion or
sate of the produ.:
(I) O~DnstnItion, 1nmI115on! ..flidn.u or r.p.r OperlUona, ~pllUCh operalttJtts perform&d at tha
vendol"s premiHaln oonnec;lon WIth the ule of the prad~ct;
rn Products which. after dIatJfbutbn or A'. by YOU. h.~ been l&beaM or relabeled or used IS . contai1er.
part or Ingr-.1lent of any other Iq or sub5tanoe by or 'CK th. wndor; or
(I) .Sodlty inJcry'" or "prop<<tr d8mlg.- arillng out of the 10" nDgligenoe -of 111. wndor tor lis own lIB or
ClIrM110rw or UlOM of It ,rnpkJyots 01 anyone elM Ic;ting on r.. ~h.Jf. However. thfa exctUllon OON
not apply to:
t.J Tho .xetptionl ;ont*1d In avbpa~nlpha.. or I.: or
(b) SUoh Inipec;aa"" ~jUAn"'. ten or serW*lg ..She nndor hat wglftd to make or norm~ un-
denakes 10 make n .. usuar cosne of busines5. In CGMIdIon wII't It. dis1rbution or RIe of hi prod-
lJC5.
vcc2Oloa M
~ Co..r7a\J.t..:I.... I(Inanrg I<<w. Of'b. hi.
eq,dJ;t ZOI. lit urn mruun!lnlll UI1fPUllflUhlUII1II
GOGeCtClClOOGOH....COQ
PIlgt, d7
(9) Any person or o'l1ankation )f the "prockldS~compfeted oporation$ haz.Rr is excluded either by the pro-
visions 01 fila Coverage Form or by endotaemant.
b. TbJs InSURllnca dc>es not apply to any imurod perKIn or Qrganlution, from woom you have acqweo such
pradudl. or any ingredient. part or container, .nterins lnlo. acc:ompanying or ~Jning .such products.
2.. ADDmONAl.N5URED - CONTRACT, AGREEMENT Oft PERMIT
a. s.ction.. Who Is An lnsurad It atn.ndcd to InelUde as .PI IdciloneJ lnswed art'! Pftreon(s) Dr grganlza..
~n(s) Ydth whom you agreed ... . \\'I1loR contract, written I;reemm Dr perml10 prcrlllde Insurance such
115 $ tlffcwded undear 1tUs ~~e PM. but only with respect to u.bIIty rar 1xdy inJurY', Ilproporty dam-
age4\ or -pel$O/t8I and adverlli1g inJuf)'" caused, 111 wholo or in part. by)'OUlllCtl or ornlssiofla or the ac;1& or
omissions of those dog on your behalf:
1. ," tho parformance of '"yDut wort" for ltw adclfional insurad(s) It the locattondBlligna\ed In \he contract,
agrorJment or permir; or
2. In 1tJ, maintenance. OpelBdon or &n;O o. equipment lailSld to you I:1f sud1 person(s) or Drganllatlon(s).
;)r
3. In c:ol1n~n WIth premlsec,ou own, rent.. lease or 0CC\fP'1.
Tl-blnsurance applies on II prfmlty or prtml'Y end non-contrbJtol} bInI$ it that. requhd in writing b)' the
col'ltr8ct. IOrtemont or permit.
b. Thct Insurance provkted tQ the addllonaf insured her.in Is fimled, This rnsun.nce don not aPPlY:
, , Unl.s
ta) th. wrmel') eontnld, ,greetn*nt or permit is ~umrl\tty in .rr~ 0( beoorne. efJec6ve durinr1 the 1e!rm
~f ChIs policy; an~
(b) the contract or aQreemlnt was 8xt'CUted or perrnit issued prior to Itle ~ inJury". 'property dam-
&gc-, Of -pel'lCnalllnd 8dYertillinp injury";
2. To ar;y penon or orvanlzation bGlul1ed.. ./\ !nsured UfIder the Additionaf Insured. Broad Form Ven-
dors provlslDrt 0' this sndoraement: .
3. To arry pIfIOn or organizalop Cm;Iudad _ an kl5UteCI by an en<lonJemeli ilsuad by us and made pan
of Ihis Covwage Part;
.. To an)' ptJf'aOO or organization if the "bod')' injur(", "property dlmlge", or Rp8l1iCHlal and advertbJng lr.-
J\JfY" arises out of tt.. r~ of or Wute to rtnder any profnsiooall1rchftecturlll. engJneering or
sulW)'irlg seNicea by or for yoll mcludi1g:
(a) Thl prep.~.1IppRMng1 or faIIng m preP'Ue or .ppfCVe, mllpJ. shop dl1lM1gs. OpnlOf1li, reports,
suwe)'S. field ord...., crhange _.1lI or drl'Mrl8s ~ speGificefions; ()f'
tb) SupeNllsoTY, Inspec:ton, aldlftecturB' or engineeling .cMles.
5. To .ny:
(..) Lessor gf Iqulpmunt after the eq~Dnt I... expirtllli or
(b) ownn or other interests rram whcxn land has wen 1HRd; or
(e) Mlnagers or 18&1i015 Df premlles It:
(1) Tha .oocurronceR tlkes place eft. you DNA 10 be . I.....nt In th.t premises; or
(l} 1h! "bodltyinJury'", -prDpertJ dl..nllge", -personal ilnd .~ i1jury-ltktt. out of sirudural
a1te~tiOns, new construc:Ion PI' c>>moIIIIon operatlol1$ petformed by or on behiltf of the m1In.
sa" or ...or,
5. To "oodiIy injury. or -property damlg.. occurring after.
(a) AI ~rk on Ih. proJ-c;t (other thBn service, malnllnante or ropeR) to be performed by Of em tKt..
naif of ht additicx1., ~ It Ute . of the OOVDI'ed operafJonI h. been c;ompfoted; or
(b) "T'N' por1Ion Of "your work- out af ~ tn. Injury Of dmnag. ilriMt "., been put to Is lotend~
U&eby ant.person m~nOlh9rlhlnang~ CMtfII.r or subeon\JtdDJ. eJl9ased In p.r.
forming .rallons 'or . pctndp81 as pert of 1#1, Arne ptOjecL
c. Umita of Insurance applicable 10 iha addtion.. IPlurtd If. those speciDed In.,. connct. .gr..m.nt Qf'
perml'. Of in the Declarat\ons ofthil poley, ~ewr 18 lea, and III lb. mast WI wft1 PFrt regal'Clless of the
number of:
1. Insur"ds;
"%017
~.".,., nllllllOIIraIwQ ....... 0Ib, Inr:.
~~ rttQIISHlltmnt~mm1ln"'lttmmmmu
yea 20J ltZ"
2. Claims made or "suits" brought; Of
3. P'rson$ 01 otganiz:a&ons mtJclng clalma or bringing -sulls-.
These Urn",oI Jnsurant:e are ncluslve of and not In addi1Ion to the Umts 0' Insurance shown in lhe Decla-
rations.
I. AGGREGATE UMrT PER LOCATION
a. Under Section . - Limits of mSUraRG8, the General AQgr.glte Umft applies aeparalBf)r to each of your
'"Ioc8tkma- owned by or rented or Iened to you. .
b. Under Section V - Definitions, the follDWing definJffon Is added:
""Loc8tion- means premises kwohllng the same or connecting lots, or premises whose connection Is in-
terrupted only ~ . &trMt. FoaMY, wa"lWI)' or righl-okvay of a raIroad.
4. BLANKET WAIVER OF SUBROGAnoN
Sediall '" . Transfer 01 Rights of RKovery Against Others to Us CondJlon is amended to add the toUcwMg:
We will WIWe any raht of recovery w. may have agllnst any pelSOh or organization because of payments we
mab for inJuty or damage arising out 01 )'OUr ongoing operation. dane under . wrJtten comract or IIgreement
with that S*SOA or Drganlzation and Included In -you,. WDIk" or the -producD..completed operaflons hazard-.
Thls waiver applies only to peBOn5 or org.ni~1fons with wbom you have . wrilttn contract, executed prior to
the wbodily Injury" or -property damage-,that reqtDs you to waive your rights Of recovery.
S. BODfL Y INJURY REDeFINED - MENTAL ANGUISH
UncIer SectIon V the definillon of "'boc:IIy Injury" Is replaced by 1M folJowIng:
"8odIIy Injury- mea. bodIfy injury. 1IcIcnea, or di..... sustained by I pctniOf1, including mental anguish or
dea1h redng from any 01 these 8t any 1tme.
6. BROADENED NAMED lNSURED
Sec;tlon . · Who Is An Insured Is emended to incfude n an mured the following:
Any organaWon which is . legally incorporated entlly In which you own a financial Jnterest of MDre than 50
penoent of ". voting s10ck on the tftee1H. date of tis endorlerneni wBI be , Named IIwJrad un1l the 1BO- day
or the end of the poIk;y period, wtichever com.. list. prcMded there . nD other limier Jnsurance 8Y8itab1e to
that org8nization.
The Inannce afforded herein does net apply to 8ny entity which II 8110 an Insured under another parleY or
wouJd ba an Insured under such policy but for HI tannlnatlon or Itw exhaustion of.. limits of Insurance.
T. BROADENED PROPERTY DAMAGE - BORROWED EQUIPENT, CUSTOMERS' GOODS AND USE OF
ELEVATORS
The Insurance for -property dlmage.1IabIUly Is subject to the foIICNItng:
a. The Damage To Property exclusion under SecUoa , Ccwel1lge A Is amanded .a follows:
1. The exclusion for perwonal property 1ft the cer., CUIIody or ~ of the insured does not apply to
"property danmge- to equipment you borrow wtte lit I Job'" and provfded It Is not being used by
anyone to perfonn opend0n8 at 1\1 tlm. of loa.
2. The exclusions for
(a) "PlopedyJaaned.to l'J)UZ-.._..~,.____ __
(b) Person" propIIty in the care. CU5tDdy or control of !he Insured: and
(e) That particular part of any property lhet mUllt be restored . rapaJred or replaced beCaU$O )'our
woftl' wulncorreclly perfonned on I
do not apply 10 -property damage- tD "customeri' goods- whh on your premises nor do they appty to
.property damiig.- .risIng from the UN of elevators lit premIMs you own, r:ent. Ie.. or occupy.
Sub}ed to the Each OcGumInce Urn" the moll we wi! ~ for -property damage- to "Cummers'
Good.-. 525,000 per .occurr.noe".
b. Under Section V - DeflnItioM. the follOwing detlnlllon II added:
.Cus1om.,,,' Goods" mearw goods 0' \'OUr custrxner on ~r prenisn for 1he puJpOM of be1ng:
1. Repand; Of'
2. Used in )'Our manutar;1uring process.
c:-. Tn. insurance afforded by this prcMIIon Is ~e.. over any other valid and col1ecttbJe property Insurance
(II'\Clucfmg any deducible) awllable to I\a InsuM whethar such lRSUf'8l\Ca 18 primacy, exceu, contingent or
YCG - CI2 DI ~~ InItIfWcI..... 1lMa0ftl:& ~ PIIQe 3ol1
~ ZD4. IU m mrulflll III IlUIIIIII IItrlllttrlUlJ Inri