HomeMy WebLinkAboutInsurance Certificate: Taylor Site Develoment
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ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY)
,~ 10/08/10
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 be endorsed. If SUBROGATION IS WAIVED, subject to
. the terms and conditions of the policy, certain policies may require an endorsemenL A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsementts).
PRODUCER 541-245-1111 ~~~1~CT Diana M. Thomas
United Risk Solutions, Inc. 541-245-1112 I r,::gNJo En'. 541-245-1111 I rffc No'. 541-245-1112
PO Box 936 ..MAIL d' th slll>,'t d . k
Medford, OR 97501-0067 ~~.DRESS: lana. omas un. e rlS .com
~~~~g~~~ID#: TAYL02C
Michelle M. Savage INSURERf51 AFFORDING COVERAGE
NAle#
INSURED Taylor Site Development Inc. INSURER A: American Fire & Casualtv Ins.
1501 Sage Rd., Ste. B INSURER 8:
Medford" OR 97501-1762 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER'
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 U II,reM~~ powev EXP UMITS
LTR POwey NUMBER MMfDDfYYYY
GENERAL UABIUTY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X BKA 1154278864 10/08/10 10/08/11 ~~~~~~9E~~~E;'ence $ 100,00
I CLAIMS-MADE [!] OCCUR MED EXP (Anyone person) $ 10,00
- PERSONAL &ADV INJURY $ 1,000,00
,-- GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APnS PER: PRODUCTS - COMPIOP AGG $ 2,000,00
~. PDLlCY-iXl- p~'p.; LOC $
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $
- (Eaaccidenl)
- ANY AUTO BODILY INJURY (Per person) $
- ALL OWNED AUTOS BODILY INJURY (Per accident) $
- SCHEDULED AUTOS PROPERTY DAMAGE
$
- HIRED AUTOS (Per accident)
NON-OWNED AUTOS $
-
$
UMBRELLA UAB H ~CCUR EACH OCCURRENCE $
-
EXCESS LIAS CLAIMS-MADE AGGREGATE $
- DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION I ,.~~$I~JI~~ I I Ol~-
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $
~~s(:~fp-n8~ O~OPERA TIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddItional Remarks Schedule, If more space Is requlred)~ .~V RECORDER
Re: Certificate Holder, City of Ashland and Oregon Department of C IT
Transportation are Additional Insured when required bJ: written contract, as
respects to North Main Pump Station, per policy form o. CG 8579 0505
attached.
CERTIFICATE HOLDER
CANCELLATION
CITASOl
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS,
90 N Mountain
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
~dd
ACORD 25 (2009/09)
@1988-2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
CG 8579 05 05.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
GENERAL LIABILITY MASTER PAK PLUS@
FOR CONSTRUCTION
(OREGON)
Subiect
~ ~lAddiii6i1'al'nsurea(Owri€rs/Less<:!~ oU90iiii"iiCtOrsj)
Fire, Lightning, Explosion and Sprinkler Leakage Damage to Premises You Rent
Non-Owned Watercraft
Supplementary Payments (Bail Bonds)
Personal And Advertising Injury - Electronic Publication Extension
Aggregate Limits (Per Location)
Aggregate Limits (Per Project)
Voluntary Properly Damage Coverage
Off Premises Care, Custody or Control Coverage
Newly Formed or Acquired Organizations
Duties in the Event of Occurrence, Offense, Claim or Suit
Bodily Injury (Mental Anguish)
~:W~~(9iTr~lisier of.Rfgt:li? '9TR~cov~ry Againsibihers
Medica' Payments
Broad Named Insured
Broadened Mobile Equipment
Incidentai Malpractice Liability
Non-Owned Aircraft
Properly Damage - Elevators
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
CG 8579 05 05
E 587 00
Page
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3
4
4
5
5
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Page 1 of9
-7 0:.\Jii;ANKET. ADDITIQNAl,INSURED'(Owners;'LElssees.0r Contractors))
(Includes a Primary/Non-Contributory provision)
Section II - 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 in a written contract or written
agreement. The written contract or written agreement must be currently in effect or becoming effective
during the term of this poiicy and executed prior to the "bodily injury," "property damage" or "personal
and advertising injury."
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
The insurance provided the additional insured is limited as follows:
A. The person or organization is only an additional insured with respect to liability caused by your
negligence and:
1. Arising out of real property, as described in a written contract or written agreement, that you
own. rent, lease or occupy; or
2. Caused by your ongoing operations performed for the additional insured.
The insurance provided the additional insured in 1.A.2. above does not apply to:
a. Coverage A - Bodily Injury and Property Damage Liability. Coverage B . Personal and
Advertising Injury Liability or defense coverage under the Supplementary Payments
arising out of an architect's, engineer's or surveyor's rendering of or failure to render any
professional services including:
(1) The preparing, approving, or failing to prepare or approve maps. shop drawings,
opinions, reports, surveys, field orders, change orders or drawings and specifications:
and
(2) Supervisory, inspection, architectural or engineering activities.
b. "Bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work,
on the project (other than service, maintenance or repairs) that was performed by or on
behalf of the additional insured(s) at the site where the covered operations have been
completed; or
(2) That portion of "your work" out of 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 performing operations for a principal as part of the same
project.
B. The limits of insurance applicable to the additional insured are those specified in a written contract or
written agreement or the limits of Insurance as stated in the Declarations of this policy and defined in
Section III . Limits Of Insurance of this policy, whichever are less. These limits are inclusive of and
not in addition to the limits of insurance available under this policy.
C. The insurance provided the additionai insured does not apply to the liability resulting from the
negligence of the additional insured.
CG 8579 05 05
E5B800
Includes copyrighted material of ISO Properties, Inc., with its permission.
Page 2 of 9
D. As respects the coverage provided to the additional insured under this endorsement, Section IV-
Conditions is amended as follows:
1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim, or
Suit
An additional insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence" or an offense, that may result in a claim or "suit" under
this insurance to us;
b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have
insurance available to the additional insured; and
c. Agree to make available any other insurance which the additional insured has for a loss we
cover under this Coverage Part.
2. The following is added to Condition 3. Legal Action Against Us:
We have no duty to defend or indemnify an additional insured under this endorsement until we
receive written notice of a claim or "suit" from the additional insured.
3. The following is added to Paragraph a., Primary Insurance of Condition 4. Other Insurance:
If the additional insured's policy has an Other Insurance provision making its policy excess, and
a Named Insured has agreed in a written contract or written agreement to provide the additional
insured coverage on a primary and noncontributory basis, this policy shall be primary and we will
not seek contribution from the additional insured's policy for damages we cover.
4. The following is added to Paragraph b., Excess Insurance of Condition 4. Other Insurance:
Except as provided in Paragraph 4.a. Primary Insurance as amended above, any coverage
provided hereunder shall be excess over any other valid and collectible insurance available to
the additional insured whether primary, excess, contingent or on any other basis. In the event an
additional insured has other coverage available for an "occurrence" by virtue of also being an
additional insured on other policies, this insurance is excess over those other policies.
2. FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT
If Damage To Premises Rented To You under Coverage A is not otherwise excluded from this policy,
the following applies:
A. The last paragraph of 2. Exclusions of Section I - Coverage A is replaced by the fOllowing:
If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do
not apply to damage by fire. lightning, "explosion" or sprinkler leakage to premises whiie rented to
you or temporarily occupied by you with permission of the owner. A separate limit of insurance
applies to this coverage as described in Section III - Limits Of Insurance.
B. Paragraph 6. of Section III " Limits Of Insurance is replaced by the following:
6. Subject to 5. above, the higher of $300,000 or the Damage To Premises Rented To You Limit
shown in the Summary of Limits and Charges section of this policy is the most we will pay under
Coverage A for damages because of "property damage" to premises rented to you or
temporarily occupied by you with the permission of the owner arising out of anyone fire.
lightning. "explosion" or sprinkler leakage incident.
CG 8579 05 05
E 589 00
Includes copyrighted material of ISO Properties, Inc., with its permission.
Page 3 of9
C. Paragraph b.(l)(b) of Condition 4. Other Insurance (Section IV - Conditions) is replaced by the
following:
(1) That is Fire, Lightning. Explosion or Sprinkler Leakage insurance for premises rented to you or
temporarily occupied by you with the permission of the owner;
D. Paragraph 9.a. of the definition of "insured contract" in Section V- Definitions is replaced by the
following:
9. "Insured contract" means:
a. A contract for the lease of premises. However. that portion of the contract for a lease of
premises that indemnifies any person or organization for damages by fire, lightning,
"explosion" or sprinkler leakage to premises while rented to you or temporarily occupied by
you with the permission of the owner is not an "insured contract";
E. The following definition is added to Section V - Definitions:
"Explosion" means a sudden release of expanding pressure accompanied by a noise, a bursting
forth of material and evidence of the scattering of debris to locations further than would have
resulted by gravity alone.
"Explosion" does not include any of the following:
1. Artificially generated electrical current including electrical arcing that disturbs electrical devices,
appliances or wires;
2. Rupture or bursting of water pipes;
3. Explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by
you. or operated under your control; or
4. Rupture or bursting caused by centrifugal force.
3. NON-OWNED WATERCRAFT
Subparagraph g.(2) of Paragraph 2., Exclusions of Section I - Coverage A is replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than 51 feet long; and
(b) Not being used to carry persons or property for a charge;
4. SUPPLEMENTARY PAYMENTS
In the Supplementary Payments" Coverages A and B provision:
The limit for the cost of bail bonds in Paragraph 1.b. is changed from $250 to $1000.
CG 8579 05 05
E59000
Includes copyrighted material of ISO Properties, Inc., with its permission.
Page 4 of 9
5. PERSONAL AND ADVERTISING INJURY - ELECTRONIC PUBLICATION EXTENSION
Paragraphs 14.b., d. and e. of Section V - Definitions are replaced by the following:
b. Malicious prosecution or abuse of process;
d. Oral, written, televised, videotaped or electronic publication of material that slanders or libels a
person or organization or disparages a person's or organization's goods, products or services;
e. Oral, written. televised, videotaped or electronic publication of material that violates a person's right
of privacy;
The following is added to Paragraph 14. "Personal and Advertising Injury" of Section V - Definitions:
h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but
only if such discrimination or humiliation is:
(1) Not done intentionally by or at the direction of:
(a) An insured; or
(b) Any "executive officer" director, stockholder, partner or member of the insured; and
(2) Not directly or indirectly related to the employment, prospective employment or termination of
employment of any person or persons by any insured.
Subparagraphs b. and c. of 2., Exclusions of Section 1- Coverage B - Personal And Advertising
Injury Liability are replaced by the following:
b. Material Published With Knowledge Of Falsity
"Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic
publication of material, if done by or at the direction of the insured with knowledge of its falsity;
c. Material Published Prior To Policy Period
"Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic
publication of material whose first publication took place before the beginning of the policy period;
6. AGGREGATE LIMITS OF INSURANCE (PER LOCATION)
The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your
"locations" owned by or rented to you or temporarily occupied by you with the penmission of the owner.
"Location" means premises involving the same or connecting lots, or premises whose connection is
interrupted oniy by a street, roadway, waterway or right-of-way of a railroad.
7. AGGREGATE LIMITS OF INSURANCE (PER PROJECT)
The General A9gregate Limit under Section III Limits Of Insurance applies separately to each of your
projects away from premises owned by or rented to you.
CG 8579 05 05
E591 00
Includes copyrighted material of ISO Properties, Inc., with its permission.
Page 5 of9
8. VOLUNTARY PROPERTY DAMAGE COVERAGE
At your request, we will pay for "loss" to property of others caused by your business operations. The
most we will pay for this coverage is $500 each "occurrence." The "loss" must occur during the policy
period. The "occurrence" must take place in the "coverage territory".
"Loss" means unintended damage or destruction. "Loss" does not mean disappearance, abstraction or
theft.
This coverage does not apply to:
1. Damage arising out of the use of any "auto";
2. Property you own, occupy, rent or lease from others; or
3. Property on your premises for sale, service, repair or storage.
None of the other policy exclusions apply to this coverage.
If the policy to which this endorsement is attached is written with a property damage liability deductible,
the deductible shall apply to Voluntary Property Damage. The limit of coverage stated above shall not
be reduced by the amount of this deductible.
9. OFF PREMISES CARE, CUSTODY OR CONTROL COVERAGE
A. We will pay those sums that you become legally obligated to pay as damages because of "property
damage" to personal property of others while in your or your "employees" care, custody or control or
real property of others over which you or your "employees" are exercising physical control if the
"property damage" arises out of your business operations. This Coverage is subject to sections B.,
C., D. and E. below.
B. Exclusions
This insurance shall not apply to:
1. "Property damage" of property at premises owned, rented, leased, operated or used by you;
2. "Property damage" of property while in transit;
3. The cost of repairing or replacing:
(a) Any of your work defectively or incorrectly done by you or by others on your behalf; or
(b) Any product manufactured, sold or supplied by you, unless the "property damage" is caused
directly by you after delivery of the product or completion of the work and resulting from a
subsequent undertaking; or
4. "Property damage" of property caused by or arising out of the "products-completed
operations hazard".
C. Limits Of Insurance - The most we will pay for "property damage" under this Section 9. is $25,000
for each "occurrence". The most we will pay for the sum of all damages covered under this Section
9. because of "property damage" is an annual aggregate limit of $25,000.
The Limits Of Insurance provided under this Section 9. are inclusive of and not in addition to any
other limits provided in the policy or endorsements attached to it.
D. Deductible - We wiil not pay for "property damage" in anyone "occurrence" until the amount of
"property damage" exceeds $250. If the policy to which this endorsement is attached contains a
"property damage" deductible, that deductible shall apply if it is greater than $250.
E. In the event of "property damage" covered by this endorsement, you shall, if requested by us,
replace the property or furnish the labor and materials necessary for repairs thereto at your actual
cost, excluding profit or overhead charges.
CG 8579 05 05
E 592 00
Includes copyrighted material of ISO Properties, Inc., with its permission.
Page 6 of9
10. NEWLY FORMED OR ACQUIRED ORGANIZATIONS
A. Paragraph 4. of Section II - Who Is An Insured is deleted and replaced by the following:
4. Any business entity acquired by you or incorporated or organized by you under the laws 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:
a. Coverage under this provision applies only until the expiration of the policy period in which
the entity was acquired or incorporated or organized by you.
b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before the
entity was acquired or incorporated or organized by you.
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense
committed before the entity was acquired or incorporated or organized by you.
d. Records and descriptions of operations must be maintained by the first Named Insured.
B. This Section 10. does not apply to newly formed or acquired organizations if coverage is excluded
either by provisions of the Coverage Part or by other endorsement(s) attached to it.
11. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
A. The requirements in Section IV - Conditions, Paragraph 2.a., that you must see to it that we are
notified of an "occurrence" applies only when the "occurrence" is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. A member or manager. if you are a limited liability company;
4. An executive officer or designee, if you are a corporation;
5. A trustee, if you are a trust; or
6. A designee, if you are any other type of organization.
B. The requirements in Section IV " Conditions Paragraph 2.b. that you must see to it that we receive
written notice of a claim or "suit" will not be considered breached unless the breach occurs after
such claim or "suit" is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. A member or manager if you are a limited liability company;
4. An executive officer or designee, if you are a corporation;
5. A trustee, if you are a trust; or
6. A designee, if you are any other type of organization.
Knowledge of an "occurrence," claim or "suit" by the agent, servant or "employee" of any insured
shall not in itself constitute knowiedge of the insured unless an officer or designee shall have
received notice from its agent, servant or "employee".
12. BODILY INJURY
Paragraph 3. of the definition of "bodily injury" in the Section V - Definitions is replaced by the
following:
3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental
anguish or death resulting from any of these at any time.
CG 8579 05 05
E59300
Includes copyrighted material of ISO Properties. Inc., with its permission.f
Page 7 of9
~ \'13iWll~!YEJ~tQF.~1:!~~~cOF'Rlqt!:r~(~E',RECQ'lE;R;-((gG~!tI~rr!P1LI:lE~S)
We have the right to recover our payments from anyone liable for an injury covered by this policy. We
will not enforce our right against any person or organization for whom you perform work under a written
contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the agreement.
14. MEDICAL PAYMENTS
If Coverage C Medical Payments is not otherwise excluded, the Medical Expense Limit provided by this
policy shall be the greater of:
A. $10.000; or
B. The amount shown in the Declarations.
15. BROAD NAMED INSURED
Paragraph 2.a.(1 lid) of Section II - Who Is An Insured is replaced by the following:
(d) Arising out of his or her providing or failing to provide professional health care services. However,
this exclusion does not apply to nurses, emergency medical technicians or paramedics who are
employed by you to provide medical or paramedicai services to your employees.
16. BROADENED MOBILE EQUIPMENT
Paragraph 12.f.(1) of Section V - Definitions is replaced by the following:
(1) Equipment designed primarily for.
(a) Snow removal;
(b) Road maintenance, but not construction or resurfacing; or
(e) Street cleaning provided that vehicles have a Gross Vehicle Weight of 1.000 pounds or greater;
17. INCIDENTAL MALPRACTICE LIABILITY
Paragraph 3. of Section V - Definitions is replaced by the following:
3. "Bodily injury" means bodily injury. sickness, disease or "incidental medical malpractice" sustained
by a person, including mental anguish or death resulting from any of these at any time.
The following is added to Section V - Definitions:
23. "Incidental medical malpractice" means injury arising out of the negiigent rendering or failure to
render medical or paramedical services to persons by any physician, dentist, nurse, emergency
medical technician or paramedic who is employed by you to provide such services to your
empioyees, provided you are not engaged in the business or occupation of providing any
services referred to in this definition.
18. NON-OWNED AIRCRAFT
The following is added to Subparagraph g. of 2., Exclusions of Section I - Coverage A Bodily Injury
And Property Damage Liability:
(6) An aircraft with a paid crew, that is hired, chartered or loaned but is not owned by any insured.
CG 8579 05 05
E 594 00
Includes copyrighted material of ISO Properties. Inc., with its permission.
Page 8 of9
. .
19. PROPERTY DAMAGE - ELEVATORS
The following is added to Subparagraph j. of 2., Exclusions of Section I - Coverage A Bodily Injury
And Property Damage Liability:
Paragraphs (3) and (4) of this exclusion do not apply to damages that result from the use of elevators.
All other terms and conditions of your policy remain unchanged.
CG 8579 05 05
E59500
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Page 9 of9