HomeMy WebLinkAboutInsurance Certificate: Day Mgmt Corp
A CORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY)
7/1/2009
PRODUCER (503)241-9221 FAX: (503) 542-0621 THIS CERTIFICATE IS ISSUED AS A MA TIER 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: Naviaa tors Insurance
DBA: Day Wireless Systems INSURER c:
4700 SE International Way INSURER D:
Milwaukie OR 97222 I~SURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT'NITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VV1TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
~~E ~~~URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
A R ATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
11!'l!>!l ~~~!:- TYPE OF INSURANCE POLICY NUMBER P.3'l-+~~J~~~g,wlE Pg~lf.rI~~b~J.gN LIMITS
~NERAL LIABILITY EACH OCCURR"N"" , 1.,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~J9E~~6~Wence' , 1,000,000
A I CLAIMS MADE ~ OCCUR 71100991.80002 7/1/2009 10/1/2009 MED EXP IAflv one "erson\ $ 10,000
0.- $1MM Umbrella PERSONAL & ADV INJURY $ 1,000,000
f- GENERAL AGGREGATE , 2,000,000
n'L AGG~EnE LIMIT A~ES PER: PRODI rr-TC:: _ rnMP/np AGG , 2,000,000
POLlCY ~r-gT X LOC
~TDMOBILE LIABILITY COMBINED SINGLE LIMIT , 1,000,000
~ ANY AUTO (Eaaccidenl)
A - ALL OVv'NED AUTOS 7110099180002 7/1/2009 10/1/2009 BODJL Y INJURY
(per person) ,
I- SCHEDULED AUTOS
I- HIRED AUTOS BODILY INJURY
$
NON-DINNED AUTOS (?eraccidenl)
!--
'- PROPERTY DAMAGE ,
(Peraccidentj
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT ,
ANY AUTO OTHER THAN EAA"" $
AUTO ONLY: AGG ,
B ffiESSJUMBRELLA LIABILITY SF09EXC161165NV 7/1/2009 10/1/2010 EArH , a,ooo,OOO
X OCCUR 0 CLAIMS MADE AGGREGATE , 8,000,000
~ DEDUCTIBLE ,
,
RETENTION $ $
A WORKERS COMPENSATION AND 7110099180002 7/1/2009 10/1/2009 I rc STArU-~ I X OJbl-
EMPLOYERS' LIABILITY 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE WASHINGTON STOP GAP E.L. EACH ACCIDENT ,
OFFICERlMEMBER EXCLUDED? EMPLOYERS LIABILITY E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under 500,000
SPECIAL PROVISIONS below E.L. DISEASE - POLlCY UMIT ,
A OTHER GARAGEKEEPERS 7110099180002 7/1/2009 10/1/2009 COMPREHENSIVE &
COLLISION LIMIT $250,000
DEDUCTIBLE $ 500
DESCRIPTION OF OPERATlONSfLOCATIONSNEH1ClESIEXCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS
The City Of Ashland, Oregon, And Its Elected Officials, Officers and Employees are Additional Insured per attached VCG
205 02 05 when required by written contract. These provisions are with respect to General Liability only and are
subject to the terms, conditions, limitations and exclusions of the policy. *Except 10 days notice for non-payment of
premium.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF ASHLAND EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
20 EAST MAIN STREET 30. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
ASHLAND, OR 97520 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 (010B).08a
@ ACORD CORPORATION 1988
Page 1 of2
Policy #711009918-0002
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFUllY.
@VANTAGE FOR GENERAL. LIABILITY
This endorsement modifies illSlJrance provided under the following:
COMMERCIAl GENERAL LIABIUTY COVERAGE FORM
The fOllowing schedule lists the coverage extensions provided by this endorsement Refer to the individual provi-
sions to determine the extent of your coverage.
SCHEDULE OF COVERAGE EXTENSIONS
1. AddlUonallnsured - Broad Form Vendors 8. Broadened Property Damage Rented Premises
2. AddiUonallnsured - by Contract, Agreement or 9. Coverage Territory - Worldwide
Permit relating to: 10. Duties In Event of Occurrence, Claim or Suit
o Work perlorrned by you 11. Expected or Intended Injury (PO)
o Premises you own, rent,lease.or occupy 12. Incidental Medical Melpractlce '.
o Equipment you lease 13. Medical Payments
3. Aggregate Limit Per Location 14. Mobile Equipment Redefined
4, Blanket Waiver of Subrogation 15. Newly Acquired or Formed Organizations
5. Bodily injury Redefined- Mental Anguish 16, Non-Owned Aircraft
6. Broadened Named Insured 17, Non-owned Watercraft
7. Broadened Property Damage' 18. Personal and Advertising Injury
o Borrowed Equipment 19. Product Recall Expense
o Customers' Goods 20, Supplementary Payments Increased Limits
o Use of Elevators
1. ADDITIONAL INSURED - BROAD FORM VENDORS
Section 11- Who Is An Insured is amended to Include as an addillonallnsured any person(s) or organlzatlon(s)
(referred to below as vendor) with whom you agreed in a written contract or agreement to provide insurance,
but only with respect to "bodily Injury" or 'property damage" arising out of "your products" which are disbibuted
or sold In the regular course of the vendor's business, subject to the follOwing additional exclusions:
8. ThIs provision 1. does not apply to:
(1) "Bodily injury" or "property damage" for which the vendor Is obligated to pay damages by reason of the
assumption of liability In a contract or agreement. This exclusion does not apply to liability for damages
that the vendor would have in Iha absence of the contract or agreement;
(2) Any express warranty uneuthorlzed by you;
(3) Any physical or chemical change In the product made Intentionally by the vendor,
(4) Repackaging, except when unpacked solely for the purposa of Inspection, demonstration, lasling or Iha
substitution of parts under Instructions from the manufacturer, and then repackaged in the original
container; 4
(5) Any failure 10 make such inspections, adjustments, tests or selVicing as the vendor has agreed to make
or normalty undertakes to make in the usual course of business, in connection with the distribution or
sale of the products;
(6) Demonstration, Installation, servicing or repair operalions, except such operations petformed at Ihe
vendor's premises in connection with the sale of the product;
(7) Products which, after dlstrlbutlon or sale by you, have been labelad or relabeled or used as a container,
part or Ingredient of any other thing or substance by or ior the vendor; or
(8) "Bodily InjUlY" or "property damage" arising out of the sole negligence of the vendor for ils own acts or
omissions or those of fts employees or anyone else acting on its beha~. However, this exclusion does
not apply to:
(a) The slfceptions contained In Subparagraphs 4. or 6.; or
(b) Such inspections, adjustments, tests or servicing as the yendor has agreed to make or normally UI>-
dertakes 10 make in the usual course of business, in connection >Mth the distribution or sale of the prod-
ucts.
VCGl.06020Q
1..,1'-<Xlp'fI1ghted _of \"""""",..rvIceo 0fI1ce, Inc.
copyright 2004, OneBe9con Inswance Group
Pagelof7
(9) Any person or organization If the "products-completed operations hazard" Is excluded either by the pro-
visions of Ute Coverage Form or by endorsement.
b, This Insurance does not apply to any Insured person or organization, from whom you have acquired such
products, or any Ingredient, part or container, entering into, accompanying or containing such products.
2. ADDITIONAL INSURED - CONTRACT, AGREEMENT OR PERMIT
a. Section II " WIlD Is An Insured Is amended to include as an additional insured any person(s) or organiza-
tion(s) with whom you agreed In a written contract, written agreement or permit to provide insurance such
as is afforded under this Coverage Part, but only with respeel to liability for "bodily injury". "property dam-
age" or "personal end edVertising injury" caused, in whole or in part. by your ects or omissions or the acts or
omissions of those acting on your behalt.
1, In the performance of "your work" for the additionallnsured(s) at the location designated in the contract.
agreement or permi~ or .
2, In the maintenance, operation or use of equipment leased to you by such person(s) or organization(s),
or
3, In connection with premises you own, rent, lease or occupy.
This Insurance applies on a primary or primary and rion-coniribulory basis II that Is required In writing' by the
contract, agreement or permit.
b, The insurance provided to the additional Insured herein Is limited. This Insurance does not apply: .
1. Unless
(a) the written contract, agreement or permit is curren~y in effect or becomes effectlve during the term
of this policy; and
(b) the contract or agreement was executed or permit issued prior to the "bodily injury", "property dam-
age". or "personal and advertising Injury";
2. To any person or organization included as an insured under the Additional Insured - Broad Form Ven-
dors provision of this endorsement;
3. To any person or organization included as an Insured by an endorsement Issued by us and made part
01 this Coverage Part;
4. To any person or organization It the "bodily injury", "property damage", or "personal and advertising In-
jury" arises oul of the rendering of or tailure to render eny professional architectural. engineering or
surveying services by or 10r you Including:
(a) The preparing, approving, or failing to prepare or approve, maps. shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
(b) Supervisory, inspection, architectural or engineering activities.
5. To any:
(a) Lessor of equipment alterthe.equipmentlease expires; or
(b) Owners or other interests from whom land has been leased; or
(c) ~~nagers or lessors of premises if:
(1) The "occurrence" takes place alter you cease to be a tenant in that premises; or
(2) The "bodily Injury". "property damage", "personal and advertising Injury" arises oul 01 structural
alterations, new construction or demolition operations performed by or on behalf of the man-
ager or lessor.
6. To "bodily Injury, or "property damage" occurring alter.
(a) All work on the project (other than service, maintenance or repairs) to be performed by or on be-
half of the additional insured at the site of the covered operations has been completed; or
(b) That pomon of "your work" out 01 which the Injury or damage arises has been put to Its intended
use by any person or organization other than another contractor or subcontractor engaged in per-
forming operations for a principal as part of the same project.
c. Umits of Insurance applicable to the additional Insured are those specified In the contract. agreement or
permit or in the Declarations ol1his policy, whichever Is less, and fix the most we will pay regardless of the
number of: .
1. Insureds;
Page2of7
IncI<.des COf>\'IiITIed materlal of /r1s(JW1Ce SeM:es 0f1lce. Inc.
eop."fgti 2004, OneBeacon Insurance Group
VCG 205 02 06
2, Claims made or .sults. brough~ or
3. Persons or organizations making claims or bringing .sults".
These limits of Insurance are Inclusive of and not in addition to the Limils of Insurance shown In the Decla-
rations.
3. AGGREGATE UMIT PER LOCATION
a. Under Section 11I- Limits of Insurance, the General Aggregate Limn applies separately to each of your
"locations. owned by or rented or leased to you.
. b, Under Section V - Definitions, the following definition Is added:
"Location. means premises Involving the same or connecting lois, or premises whose connection is in-
terrupteil only by a street, roadway, waterway or right-of-way of e railroad.
4. BLANKET WAIVER OF SUBROGATION.
Section IV .. Transfer of Rights of Recovery Against Others to Us Condition is amended to add the following:
We will waive any right 01 recovery we may heve against any person or organization because 01 payments we
make for injury or damage arising out of your ongoing operations done under a written contract or agreement
with that pe"rson or oiganization and Included in "your work" or the "products-<:ompleted operations hazard".
This waiver applies only to persons or organizations with whom you have a written contract, executed prior to
the "bodiry injury" or "property damage", that requires you to waive your rights of recovery.
5. BODILY INJURY REDEFINED - MENTAL ANGUISH
Under Section V the defll1ilion of "bodily Injury" Is replaced by the following:
"Bodily injury" means bodily Injury, sickneSs, or disilase sustained by a person, InclUding mental angUish or
death resulting from any of these at any time.
6. BROADENED NAMED INSURED
Section II .. Who IS An Insured Is amended to Include as an Insured the following:
Any organization which Is a legally Incorporated entity In which you own a financial interest of more than 50
percent ofthe voting stock on the effective date of this endorsement will be a Named Insured unUl the 180. day
or the end of the policy period, whichever comes first, provided there is no other similar insuranoe available to
that organization.
The Insurance afforded herein does not apply to any entity which is also an insured under enother policy or
would be an insured under such policy but for Its termination or the exhaustion of Its limits of Insurance.
7. BROADENED PROPERTY DAMAGE - BORROWED EQUIPMENT, CUSTOMERS' GOODS AND USE OF
ELEVATORS
The insurance for .property damaga" liability is subject to the following:
a. The Damage To Property exclusion under Section I Coverage A is amended as follows:
1, The exclusion for personal property In the care, custody or control of the Insured does not apply to
"property damage" to equipment you borrow while at a job sne and provided IT is not being used by
anyone to perform operations at the Ume of loss.
2. The exclusions for
,'..-;- -..:_,_ -."0.
(al Property loaned to you;
(b) Personal property In the care, custody or control of the insured; and
(c) That particular part of any property that must be restored , repaired or replaced because "your
work" was incorrectly performed on It
do not apply to "property damege" to .customers' goods" while on your premises nor do they apply to
"property damage- arising from the use of elevators at premises you own, rent, lease or occupy.
SUbject to the Each Occurrence Limn, the most we will pey for "property damage" to .Customers'
Goods" Is $25,000 per .occurrence".
b, Under Section V - Definltlons, the toliowlng definition is added:
"Customers' Goods. means goods of your customer on your premises for the purpose of being:
1. Repaired; or
2. Used In your manufacturing process.
c. The insurance afforded by this provision Is excess over any other valid and collectible property insurance
Oncluding any deductible) available to the insured whether such insurance Is primary, excess, contingent or
VCG 205 02 05 I_OOflITlghted..- of 11lSUTIlI'<:Il_ 0fIk:e. Inc. Page~ of7
CopyrIght 2004, OneBeacon InsunlInce Group
on any other basis. Any payments by us will follow the Other Insurance - Excess provisions In the COM-
MERCIAL GENERAl UABIUTY CONDITIONS.
8. BROADENED PROPERTY DAMAGE - RENTED PREMISES
a. In the Damage To Property exclusion under Section I Coverage A, the exclusion for "property damage" to:
Property you own, rent or occupy;
does not apply to real property you rent or temporarily occupy with pennission of the owner.
b, In Section 11- Umlts Of Insurance, the Damage To Pmmlses Rented To You L1m~ is amended as follows:
Subjeclto the Each Occurrence Llm~, $500,000 Is the most we will pay under Coverage A for damages
because of "properly damage" to anyone premises while rented to you or ()ccupied by you with permission
of the owner. If any amount other than $500,000 Is shown In the Declarations as the Damage To Premises
Rented To You Limit, the amount shown In the DeclaraUons will replace $500,000 as the Um~ of Insurance
provided forthls coverage. '
c, The insurance afforded by this Provision 8, Is excess over any other valid and collectible property Insurance
Qncluding any deductible) avallabte to the insured whether such Insurance Is primary, eXC8S$, contingent or
on any other basis. Any payments by us will follow the Other Insurance - Excess Insurance provisions in the
Cor..t\-lERCIAL GENERAl LIABILITY CONDITIONS.
9. COVERAGE TERRITORY - WORLDWIDE
The definiUon of "coverage territory" is replaced by fhe following:
"Coverage territory" means anywhere. However, the Insured's responsibility to pay damages must be
determined in a settlement wa agree to or In a "sulf' on the merits brought within the United States of
America ~ncluding its territories and possessions), Puerto Rico or Canada: "
10, DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
Section IV - Duties In The Event Of Occurrence, Claim or Suit is amended by adding the following paragraphs:
a. The requirements that you must
1. notify us of an "occurrence" offense, claim or "sui!" and
2. send us documents concerning a claim or .suit"
epply only when such "accident" claim, "suit" or "loss" Is known to:
1. You, If you are an indMdual;
2. A partner, if you are a partnership;
3. An executive officer of the corpomtion or insurance manager, if you are a corporation; 9f
4. A manager, if you are a fim~ed liability company.
b. The requirement that you must notify us as soon as practica~e of an "occurrence- or an offense that may
result In a claim does not apply if you report an -occurrence- to your workers compensation Insurer which
later develops into a liability claim lor which coverage is provided by this policy. However, as soon as you
havo definite knowledge that the partioular "ocourrence" is a Dability c1aim rather than a workers oompensa-
tion claim, you must comply with the Duties In The Event Of Occurrence; Offense, Claim Or Suit Condi-
tion.
11, EXPECTED OR INTENDED INJURY (PROPERTY DAMAGE)
The Expected Or Intended Injury exclusion under Coverege A Bodily Injury and Property Damage Is
replaced by:
"Bodily injury" or "property damage" expeeled or intended from the standpoint of the Insured. this exclusion
does not apply to "bodily injury" or "property damage" resulting from the use of reasonable lorce'to proteel
persons or property. "
12. INCIDENTAL MEDICAL MALPRACTICE - EMPLOYED PHYSICIANS, NURSES, EMT'S AND PARAMEDICS
a. Under Section 0 - Who Is An Insured the paragraph that excludes an employee or volunteer worker as in-
sured for "bodily injury" or "personal and advertising Injury" arising out of his or her providing or failing to
provide professional health care services does not apply to a physician, dentist, nurse, emergency medical
teohniclan or paramedic employed by you If you are not engaged in the business or ocoupation of providing
medical, paramedical, surgical, dental, Hay or nursing services.
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Includes copylIg1\1ld material of Il18lr.lIlOe ServIces Otlice, Inc,
CopyrIght 2004, OneBeacon Insurance Group
VCG 205 02 0Ii