HomeMy WebLinkAboutInsurance Certificate: WinterSpring Center
. "'heryl Wrts At: Protectors Insurance FaxlD: 541-772-1906 To; City of Ashland Date: 5/1312010 04:36 PM Page: 1
r.C--;:;;y CERTIFICATE OF LIABILITY INSURANCE SAN I DATE fMMlDDM'YV)
OPID 05/~3/~0
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 POUCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S~ AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORT ANT: II tno cortmcaro holder Is an ,tho pOllCytl05J must DO ondorsoa. I , subJocllO
the torms and conditions of the policy, certain panties may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER NAME:
proteetors InsU%ance, LLC ~":o,EId:J: I (AIC, No]:
Pi10t Rock :Ina Aqency LLC (=l
PO Box 46a9 ACCRESB~
Medford OR 9750~ CUSTOMER II) *: WINTS-4
Phone:54~-773-535B Fax:54~-772-~906 INSURERIS) AFFORDING COVERAGE _.
INSURED INSURER A : C;:;I~t a-1"1c:.;m lruruunl:e CIUQI.
WinterSprinq Center INSURER iii ;
Transfo~nq Grief & Loss
PO Box B~69 INSURER C ; ,
Medford OR 9750~ INSURER D ;
INSURER E :
INSURER F ~
of5
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTlFY THl\T TH: PO-ICIES OF INSlFN'.CE LISTED BELOWtil\VE BEEN ISSUED TOlliE INSIJ'iED NflMEDABOVE FOR TtIE POLICY PERIOD
If>OICATED. NOTWlTHST.ANDING lW'r' REQUIREMENT, TERM OR COJ'umON Cf" mY CONTRACTOR OTHER DOCLto1ENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSlIED OR MAY PERTAIN. ~F.: INSIjRJl.NCE AFFORDED RYTHE POLICIES DF.SCRIBED HEREIN IS Sl..fU:CTTO I'Lt THF. TERMS,
EXCLUSIONS AND CWDlTIONS OF SUQ-J DaUCIES UMlTS SHOWN MAY Hl\VE BEEN REDLCED BY PAID CL.AJMS
INS. TYPE: OF INSURANCE ADOI. I Win' POllCYE ""... LlMIT'S
lTR INSR POUCY NUMBER (M""'ONYYY) (ItIMlODJYYYY)
GENERAL LIABILITY EACH OCC~RENCE ,1,000,000
A ex CCMlERCI..a.L GENER..a.L LIABILITY X PAC8639497 ~0/D1/0' 10/01/10 f'r~EMISES (Ea occurrence) '100,000
I CLAIMt>--MAOE [!] UCCUR MED EXP (My ()/lO Jlor~on) I) 5,000
~ E'rofessional PACB639497 10/Q1/0' 1.Q/01/1Q PERSONAl. & PDV IN-U<:Y ,1,000,000
I- GE/'.ERALAGGREGAlE ,~,OOO ,000
GEN'L AGGhEGATE LIMIT APPliEs PER: f'ROOUCTS - COW/UI-' AGG $1,000,000
n~OLlcy-H-j~ hlOC Prof $1,000,000
AUTOMOBLE LIASIUTY COMBINED SI~LE LIMIT ,
I- (EeaccllJ$rt)
/lNYAUTO BODILY INJURY (p(lI' peorson) ,
-
All OVVNED AUTOS BODilY INJURY (Per ccc;idert) $ 300 ,000
-
SCl-ECtII...ED Al../TOS PRCFERTY DAMO.GE
X ,
A HIRED AUTOS PAC8639497 ::I.O/01/n 10/0::1./10 (Pereccldert)
-
A ~ NON-OWNED AUTOS PACB639497 :1.0/01/09 10/0:1.110 ,
,
UMaRcL.LA LIAS H ~CCUR EAa~ OCCtJ:(RENCE ,
-
EXCESS UAS CLAMS-MADE: AGGREGAlE ,
- DEDUCTIOlE ,.
RETENTICtJ I ,
ATOON [Tooy LIMITS I j'ER"
AND EMPLOYERS' L.lABIUTV YON
flNY PROPRIETORIPARfl'\.ERIEXECUTIVE D 'A EL. EACH ACCIt.:t:NT ,
OFFlCERJMEI.18ER EXCLUDED?
(Mandatory In NH) E,L. DISEASE- EA ENPLOYEE ,
~~tR4PWC: ~~TICU; celOlf E,L, DISEASE- POliCY LIMIT ,
OESCRtPTION OF OPERATIONS I LOCATIONS , VEHICLEiS JA1tae'n ACORD 101, AddKlonal Rlmarb Sc:'nI4.iI4l, Ifm~ spaell, requ~
The City of Ash~andi its 0 fieers, ~~o~es and agents are itiona1
InsuredS for Genera Liabi1ity per OGe 24-1201 attached.
CERTIfiCATE HOLDER
CANCELLATION
CITYAS2
SHOULD ANY OF THE A.BOVE DESCRIBED POUCIES BE [:ANCB.LED BEFORE
n-a::; EXPRATlON DA.TE THEREOF, NOTICE 'MLL BE OELNEREO l1'li
"C~ORDANCS WITH THE POUCV PRC.."SION!I.
City of Ashland
20 B: Main st
Asb~and OR 97520
AUTHORlZEiD REPRE&EiNTATlVE
~
ACORD 25 (2009/09)
@ 988.2009 ACORD CORPORATION. AD rights rBSBrVBd.
Tho ACORD namo and logo are registered marks of ACORD
From: Sheryl Wrts At: Protectors Insurance FaxID:541-772-1906 To: City of Ashland
Date: 5/1312010 04:36 PM Page: 2 of5
C . S1'IOI02/09-PAC8839497-00
0263327
ORIG IMAGE COPY
GREAT AMERICAN ASSURANCE CO
~ AdmlnlnratlvllI OffiCI"
580 Wlllnut Street
GDD'&'TA... Clnclnnlltl. OhIo 41$10'
..,.,........."n/rJ1i'RICAM T.I: 1-&13-315..15000
IW5\lR111CEIlIIOUP
CG 82 24
(Ed, 12 01)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SOCIAL SERVICE AGENCY GENERAl LIABIUTY BROADENING ENDORSl3VIENT
This endorsemenl modifies insurance provided under the following:
COMMERCIAL GENERAL LiABILITY COVERAGE PART
5. AUTOMATIC ADDITIONAL INSURED(S)
(2) With respect 10 the insurance ef,
forded the AddlUonal Insured
idenlllied in Paragraph A.(1) of
this endorsement, the following
additional provisions apply:
1, The following proVISIon Is added 10 SECTION
II . WHO 18. AN INSURED
a. Additional Insured
LeS$or of Premises
Manager or
(0) This Insurance applies only
to liability arising out of the
ownership. maintenance or
use of that portion of the
premises _ leased to you.
(1) this policy is amended 10 Include
es en Insured any person or or-
ganlzatlon (hereinafter called Ad-
ditional Insured) from whom you
leose or rent property and which
requires you to add such person
or organlzaUon es an AddlUonal
Insured on this policy undsr.
(a) a written contrect: or
(b) The Umlts of Insurance ap-
plicable to the Addltionel In-
sured are the lesser of those
specified In the wrilllln con-
tract or agreement or in the
Declarations for this poDcy
and subj\lCl to all the tenns,
condUions, end exclusions
fur this policy. The Umils of
Insurance applicable to the
Additional Insured are Inclu-
sive of and not In addition to
the Limits of Insurance
shown in the Declarations.
(b) an orei agreement or con-
tract where a CertifICate of
Insurance showing thet per-
son or organlzation as an
Additional Insured has been
issued;
but the written or oral contract or
agreement must be an "1l1SI.Ired
contract,. and,
(I) currently -In effect or be-
come effective during the
term of this policy: and
(c) In no event shall the cov-
erages or Limits of .Insurance
in this Coverage Form be in-
creesed by suoh contract. .
(II) executed prior to the "bodily
Injury," "property damage;
"personal and advertising in-
jury."
(d) coverage provIded herein Is
excess over any other valid
and collectible 'insurance
avellable to the Add"lonaJ In-
sured whether the other In-
surance fs primary, eXC86S.
Includes copyrighted material of Insurance Service Office with its permission.
Copyrigh~ Insurance Services Office, Inc_. 2001
CG 82 24 (Ed. 12/01) XS (Page 1 of 4)
From: Sheryl \.^.Arts At: Protectors Insurance FaxlD: 541-772-1906 To: aty of Ashland
Date: 5/131201004:36 PM Page: 3 of5
C . S1.10/02/09-PAC8839497-00
0263327
ORIG IMAGE COPY
GREAT AMERICAN ASSURANCE CO
contingent or on any other
basis unless a written con-
tractual arrangement specifi-
cally requires this Insurance
to be primary.
(3) This insurance does not apply 10:
(a) Any "occurrence" or offense
which takes piece after you
cease to be a tenant in that
premises.
tomerily provided by the
policy forme specified. In and
required by the contract.
(c) In no event shall the cov-
erages of L1mlls of Insurance
in this Coverage Form be in-
creased by such contract.
b. AdditIonal
Sources
Insurad
Funding
c. Additional Insured
Obligations
(1) This policy Is amended to Includa
aa an Insured any pefSOn or or-
g"ni...tion (hereinafter called Ad-
ditional Insured) that you are re,
quired by a written "insured con-
tract" to Includa aa an Insured,
subject to all of the following
provislon6:
Contractual
(b) S\I1,Ic\ural alterations, new
construction. or demollllon
operations performed by or
on behelf of the "Additional
Insured."
(1) This policy Is amended to include
as an Insured any Funding Source
which requires you In a written
contract to name the Fundin9
Source (hereinafter called Addi-
tional Insured) as an Insured but.
only with respect to liability aris-
ing out of your premises, "your
work" for such Additional Insured,
or acts or omissions of such Ad-
dlllonal Insured in connection with
tha ganeral supervision of "your
work" and only to the axtent set
forth as follows;
(a) Coverage Is limited to lIablllty
arlslng out of:
(I) your ongoing oper-
ations performed for
such Additional Insured:
or
(a) The Limits of Insurance. ap-
plicable to the Additional In-
sured are the lesser of those'
specilied in the written con-
tract or agreement or in the
Dacia rations for this policy
and subject to all the terms,
conditions, and exclusions
for this poncy. The Limits of
Insurance applicable to the
Additional Insured are Inclu-
sive of and not In eddition to
the Limits of Insurance
shown In the Declarations.
(ii) that Insured's financial
control . of you; or
(in) tha maintanance, opera-
tion or usa by you of
aquipment leased to
you by such Additional
Insured; or
(Iv) a state or po,tical sub-
division permit issued
to you,
(b) Coverage does not apply to
any "occurrence" or offense:
(I) whIch took place be-
fore the execution of,
or subsequent to the
completion or expira-
tion of, lI1e written "In-
sured contract", or
(b) The coveraga provided to
the . AddItIonal Insured(s) is
not greater than that cus.
(II) which takes place after
you cease to be a ten-
ant In that premises,
Includes copyrighted material of Insurance ServIce Office with its permission.
90pyrigh~ Insurance Services Office, Inc,. 2001
CG 82 24 (Ed, 12/01) XS (Page 2 of 4)
From: Sheryl V\lirts At: Protectors Insurance FaxID: 541-772-1906 To: oty of Ashland
C ~ Sl~10/02/09~PAC8639497-00
0253327
(e) WIth respect 10 architects,
engineers, or. surveyors,
coverage dOBS nol apply to
"Bodily . Injury," 'Property
Damaga," "Parsonal and Ad-
vertising Injury" arising out
cf the rendering or the fai~
ura to render any profes-
sional services by or for you
Including:
(I) the preparing, approv-
ing, or failing to pre-
pare or approve maps,
drawings, opinions, re-
ports, surveys, change
orders, designs or
speclflcations; and
(ii) supervisory, inspection,
or englneertng services,
If an Additional Insured endorsement Is et-
tached 10 this policy and specifically names a
person or organization as an Inaured, than the
coverage in Section n WHO IS AN
INSURED 5. AulDmatic Additional Insured(s)
does not apply 10 that person or organization,
2, BLANKET WAIVER OF SUBROGATION
IV - COMMERCIAL GENERAL
CONDITIONS, Item 8. Is replaced
SECTION
LIABILITY
. wIth:
8, Tl"!nsfer of Rights of RecoverY Against
Others to us and Blanket Waiver of
Subrogation
a. If an Insured hBS rights 10 recover all
or part of any payment we have mede
under thIs Coverage Pert, those rights
are transferred to us. The Insured must
do nothing after loss to impelr them.
At our request, the Insured will bring
"suit" or transfer those rights to us and
help us enforce them.
b. If required by e written "insured co....
tract", we waive any right of recovery
we may have against any person or
organization because of payments we
make for Injury or damage arising out
of your ongoing operations or "your
Date: 5/131201004:36 PM Page: 4 of5
ORIG IMAGE COPY
GREAT AMERICAN ASSURANCE CO
work" done under a contract for that
person or organizatlon and Included in
the' 'products-completed operations
hazard.11
3. NON-OWNED
CRAFT
OR CHARTERED WATER-
Section I " Coverages, Coverage A, Item
:l.g.(2) is replaced with:
(2) A watercmfl . you do not own that Is:
(9) le~ than 51 feet long; and
(b) not being used to carry persons or
properly for e charge.
4. BROADENED PERSONAL AND ADVERTISING
INJURY
Unless "Personal and Advertising Injury" is ex-
el uded tram this policy:
SECTION V - DEFINITIONS Item 14, is re-
placed by:
14, 'Personal and Advertising Injury" means
Injury, including consequential "bodily In'
jury," arising out of one or more of the
following offenses:
a. false arrest.
ment;
or Imprison-
detention
b. malicious prosecution;
c. the wrongful eviction from, wrongful
enlly Into, or invasion of the right of
private occupancy of a room, dwellln9
or premises 1t1at a person occupies by
or on behalf of Its owner, landlord or
lessor;
d. cral, written, televised, vkfeotaped, or
electronic p~bUeation of material, in
any manner, that slanders or libels a
person or organization or disparages a
person's or organization's goods, pro-
ducts or servIces;
e, oral, writtan, televised, videotaped, or
electronic publication of material, In
any manner, that violates 8 person's
right of prIvacy; or
. Includes copyrighted material of Insurance Service Offioe with ilB permission.
Copyright, Insurance Services Office, Inc.. 2001
CG 82 24 (Ed. 12/01) XS (Page 3 of 4)
From: Sheryl \/'vIrts At: Protectors Insurance FaxlD: 541-772-1906 To: City of Ashland
C * 'Sl*tO/02/09'PAC8839497'OO
0253327
f, mantal injury. manlal angIJlsh. humili-
ation, or shock, if diractly resulting
from Iiams 14.a, through 14.B.
9' lha use of another's edvertising idea in
your "advertisement"; or
h. Infrln91ng upon another's copyright
trade dress or slogan in your 'adver-
tisement .
5, MENTAL INJURY, MENTAL ANGUISH,
HUMIUATION, OR SHOCK INCLUDED IN
BODILY INJURY DEFINITION
Sectlon V - Deflnlllons. llam 3, Is replaced
with:
3, 'Bodlly injury" means physical Injury, sick-
ness, cr disease, Including death cf a per-
scn. "Bodily Injury" also maanS mental In-
jurY, manial anguish, humlllaticn, or shock
if directly resulting from physical injury,
sickness, or disease to that peraon,
6, MEDICAL PAYMENTS.
A. The Medical Expense Umit in Paregraph 7,
of SECTION III - LIMITS OF INSURANCE
is replaced by tha fcllcwing Medical Ex-
panse Limit.
The Medical Expense Limit provided by
1his poDcy shall be the greater of:
a. $10,000; or
b. The emount shown in the Daclarations
for Medical Expense LImit.
B, This provision 7, is subject to all ihe terms
of SECTION III - LIMITS OF INSURANCE.
C, This provision 7, does not apply If
COVERAGE C. MEDICAL PAYMENTS is
excludlld either by the provisions of the
Covernge Part or by endorsemant.
7, DAMAGE TO PREMISES RENTED TO YOU
UMIT
A, SECTION III - LIMITS OF INSURANCE,
Item 6. Is replaced with:
Date: 5/1312010 04:36 PM Page: 5 of 5
ORIG IMAGE COPY
GREAT AMERICAN ASSURANCE CO
Subject to 5. above, the Damage to Prem-
Ises Rented to You Limit is the most we
will pay under' Coverage A for damages
because of "property demege" tc your
buDding, or to personal property of others
in your care, custody and ccntrol while at
premises rented to you or temporarily
occupied by you with permission of the
owner, arising out of anyone fire,
To You
Damage
The Damage to Premises Rented
Limit Is replaced by the following
10 Premises Rented To You Limit,
The Damage to Premises Rented To You
Umll Is the greater of:
(1) $300,000; or
(2) the amount shown in the Declarations
for Damage to Premises Rented to
You Umi!.
B. Thisl provision is subject to all the terms
of SECTION III - LIMITS OF INSURANCE,
C, This provision 6. does not apply If Damage
to Premises Rent to You Liability of COV-
ERAGE A (SECTION I) Is excluded . either
by the provisions of the Coverage Pert or
by endorsement.
8. SUPPLEMENTARY PAYMENTS
A. In the SUPPLEMENTARY PAYMENTS
COVERAGES A and B provision, Item 1,b"
and 1.d are repleced with:
1,b, Up to $500 for cost of bail bonds
requi~d because of accidents or traf-
fic law violations arising cut of the use
cf any vehicle to which the Bodily In-
jury Liability Coverage applies. We do
not have to furnish these bonds,
1,d. All reasonsble expenses incurred by
the Insured at our request to assist us
In the Investigaflon or defense of the
claim or 'sult; Including actual loss of
eamlngs up 10 $500 a day because of
time off wcr1<.
This endorsement does not change any other
provision of the policy,
Includes copyrighted malenal of Insurance Service Office with its permission.
Copyright, Insumnce Services Office, Inc., 2001
CG 82 24 (Ed. 12/01) XS (Pege 4 of 4)