The URL can be used to link to this page

Home My WebLink AboutInsurance Certificate: WinterSpring Center > ~ ~R CERTIFICATE OF LIABILITY INSURANCE I. DATE (MMlDDNYVY) OPID SAW. ,IC ;/1 10 06 10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES aELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT aETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMI'URTANT: IT tne eertmeale nOlaer IS an ADDITIONAL INSUREO, the palleY(',eslmust be endarsed. "SUaROGAT'ON IS WAIVED, SUbject ta 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 NAME~" I Protectors Insurance, LLC iAiCNNt:o, Extl: I ,;va, No): Pilot Rock Ins Agency LLC (CA) PO Box 4669 iDDR~ss: Medford OR 97501 CUSTOMER 10 #: w.INTE-4 Phone: 541-773-5358 Fax: 541-772-1906 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Great. American Inauranoe Comp. WinterSpring Center INSURER B : Transfor.ming Grief & Loss PO Box 8169 INSURER C : Medford OR 97501 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. LT. TYPE OF INSURANCE INSR WVD POLICY NUMBER (~~) (MM/DOfYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A 'x COMMERCIAL GENERAL LIABILITY PAC8639497 10/01/10 10/01/11 PREMISES (Ea occurrence) , 100,000 'CLAIMS.MADE ~ OCCUR MED EXP (Anyone person) , 5,000 ~ Professional X PAC8639497 10/01/10 10/01/11 PERSONAL & ADV INJURY " 1,000,000 GENERAL AGGREGATE $1,000,000 I-- , 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPJOP AGG II POLICY n ~:& n LOC Prof '1,000,000 AUTOMOBIL.E L.IABIL.ITY COMBINED SINGL.E LIMIT , I-- (Eaaccident) ANY AUTO BODILY INJURY (per person) , I-- ALL OWNED AUTOS BODILY INJURY (Per accident) $ 300,000 - - SCHEDULED AUTOS PROPERTY DAMAGE , A ~ HIRED AUTOS PAC8639497 10/01/10 10/01/11 {Per accident) A ~ NON-OWNEO AUTOS PACa639497 10/01/10 10/01/11 , , UMBRELLA LIAB H IOCCUR EACH OCCURRENCE , I-- EXCESS LIAB CLAIMS.MADE AGGREGATE , - DEDUCTIBLE , RETENTION , , WORKERS COMPENSATION ITORYLlMrTS I IU~~. AND EMPLOYERS' LIABILITY YI" ANY PROPRIETORfPARTNERlEXECUTlVtJ EL EACH ACCIDENT $ OFFICERJMEMBER EXCLUDED? IA (Mandatory!n NH) E.L. DISEASE _ EA EMPLOYE . ~~~c~~b~ ~~d;'pERAT10NS below EL DISEASE - POLICY LIMIT , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES t'ttach ACORD 101, Additional Remarks SChedule, If more space Is requlredl The City of Ashland! its of icers, ~loyees and agents are Additional InsuredS for Genera Liability per CG8 24-1201 attached. CERTIFICATE HOLDER CANCELLATION CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Ci.ty of Ash1and 20 E Main st Ash1and OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) c 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ~ t.,. C * Sl*10/02/09*PAC8639497-00 0253327 ORIG IMAGE COpy GREAT AMERICAN ASSURANCE CO ~ Administrative OfflcllIs 680 Walncrt Streot G ClnclnlWltl. Ohio 46202 REATAMER.lCA1\t. Tel; 1-5UaS!l1Ja5000 1llI_:l..a... CG 82 24 (E<.!. 12 01) THIS ENDORSEMENT CHA:NGES THE POUCY. 'PLEASE READ IT CAREFULLY. SOCIAL SERVICE AGENCY GENERAL LIABIUTV BROADENING ENDORSEMENT this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following proVISion Is added to SECTION II . WHO IS. AN INSURED a. Additional Insured Lessor of Premises Manager or [2) With respect to the insurance af. forded the Additional Insured identified in Paragraph A.(1) of this endorsement. the following additional provisions apply: (a) This insurance applies only to liability arising out of the ownership, maintenance or use of that portlon of the premises leased to you. 5. AUTOMATIC ADDITIONAL INSURED(S) (1) This policy is amended to include as an Insured any person or or. ganization (hareinafter called Ad- ditional Insured) from whom you lease or rent property and which requires you to add such person or organization as an Additional Insured on this policy under. (e) e written contract; or (b) The Limits of Insurance ap- plicable to the Additional In- sured are the lesser of those specified in the written con- tract or agreement or in the Declarations for this policy and subj\lCl to all the telms, conditions, and exclusions fOr this policy. The Limits of Insurance applicable to the Additional Insured are inclu- sive of and not In addition to the Umits of Insurance shown in the Declarations. (b) an oral agreement or con- tract where a Certificate of Insurance showing that per. son or organfzation as an Additional Insured has been issued; but the written or oral contract or agmement must be an "insured contract; and. (I) currently In effect or be- come effective. during the term of this policy; and (e) In no event shall the cov- erages or L1mlls of ,lnsurance in this Coverage FOIm be in. cleased by such 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 available to the Additional In- sured whether the other in- surance is primary, excess, 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) C * Sl*10/02109*PAC8639497-00 0263327 contingent or on any other basis unless a written con- tractual arrangament specifi. cally requires this insurance to be primary. (3) This insurance does not apply to: (a) Any "occurrence' or offense which takes place after you cease to be a tenant in that premises. (b) Slnicturai alterations, new construction. or demolnJon operations performed by or on' behalf of the "Additional Insured.' b. Additional Sources Insured Funding (1) This policy Is amended to include as an Insured any Funding Source which requires you in a written contract to name the Funding Source (hereinafter called Addi- tlonai 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- ditional Insured in connection with the general supervision of "your work" and only to the extent set forth . es follows: (a) The Umits of Insurance. ap- plicable to the Additional In- sured are the lesser of those' specified in the written con- tract or agreement or in the Declarations for this policy and subject to all the terms, conditions, and exclusions for this policy. The Umils of Insurance applicable to the Additional Insured are inclu- sive of and not in addftion to the Umits of Insurance shown in the Declerations. (b) The coverege provided to the Additional Insured(s) is not greater than that cus- . :1 ORIG IMAGE COPY GREAT AMERICAN ASSURANCE CO tomarily provided by the policy forms specified. In and require<.! by the contract. (c) In no event shall the cov- erages of Limits of Insurance in this Coverage Form be in- creased by such conirect. c. Additional Insured Obligations Contractual (1) This policy is amended to include as an Insured any person or or- ganization (hereinafter called Ad- ditional Insured) that you are re- quired by a written "insured con- tract" to include as an Insured, subject to all of the following provisions: (a) Coverage is limited to liability arising out of: (I) your ongoing oper- ations pertormed for such Additional Insured; or (ii) that Insured's financial control . of you; or (iiI) the maintenance, opera- tion or use by you of equipment leased to you by such Additional Insured; or (Iv) a state or polmcal 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, the written "in- sured contract", or (II) which takes place after you cease to be a ten- ant in that premises. Includes copyrighted materiel of Insurance SelVice Office with its permission. Copyright, Insurance Services Office, Inc., 2001 CG 82 24 (Ed. 12/01) XS (Page 2 of .4) , I ,,------ ~. C - Sl-10/02/09-PAC8639497-00 0253327 (e) WIth respect to architects, engineers, or. surveyors, coverage does not apply to 'Bodily . Injury,' 'Property Damage," npersonal and Ad- vertising I njl,.lryll arising out of the rendering or the fai~ ure 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 specifications; and (il) supervisory, inspection, or engineering servIces. If an Additional Insured endorsement is at- tached to this policy and specificelly names a person or organization es an Insured, then the coverage In Section II . WHO IS AN INSURED 5. Automatic Additional Insured(s) does not apply to that person or organization. 2. BLANKET WAIVER OF SUBROGATION SECTION LIABILITY with: IV COMMERCIAL GENERAL CONDITIONS, Item 8. Is replaced 8. T",nsfer of Rights of Recovery Against Others to us and Blanket Waiver of Subrogation e. If en Insured has rights to racover ell or part of any payment we have made under this Coverage Part, those rights are transferred to us. The Insured must do nothing alter loss to impair them. At our request, the I nsured will bring "suit" or transfer those rights to us and help us enforce them. b. If required by a written "insured con- tract", we waive eny 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 ORIG IMAGE COPY GREAT AMERICAN ASSURANCE CO work" done under a contract for that person or organization and included in the "produCIS-completed operations hazard. II 3. NON-OWNED OR CHARTERED WATER. CRAFT Section I ' Coverages, Coverage A, Item 2.g.(2) is replaced with: (2) A watercraft. you do not own that Is: (.) less than 51 feet long; end (b) not being used to carry persons or property for a charge. 4. BROADENED PERSONAL AND ADVERTISING INJURY Unless 'Personal and Advertising Injury" is ex- cludad from this policy: SECTION V - DEFINmONS 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, detention ment, or imprison- b. malicious prosecution; c. the wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies by or on behalf of Its owner, lend lord or lessor; d. oral, written, televised, videotaped, or electroniC publlesUon of male~al, In any menner, that slanders or libels a person or organization or disparages e person's or organizatIon's goods, pro- ducts or services; e. oral, wriIlen, televised, videotaped, or electronic publication of material. in any manner, that violates a person's rtght of privacy; or Includes copyrighted matertal of Insurance Service Ollies with its permission. Copyright, Insurance Services OffIce, Inc., 2001 CG 82 24 (Ed. 12/01) XS (Page 3 of 4) C * 'S1 *10/02/09*PAC8639497-00 0253327 f. mental injury, mental anguish, humili- ation, or shock, if directly resulting from ~ems 14.a. through 14.e. g. the use of anrithe~s advertising idea in your "advertisement"; or upon anothe~s copyright or slogan In your "adver- h. infringing trade dress tisement" 5. MENTAL INJURY, MENTAL ANGUISH, HUMILIATION, OR SHOCK INCLUDED IN BODILY INJURY DEFINITION Section V - Definitions, Item 3. is repleced with: 3. "Bodily injury" means physical injury, sick- ness. Dr disease, including death of a per- son. "Bodily injury" also means mantal in- jurY, mental anguish, humiliation, or shock if directly resulting from physical injury, sickness, or disease to that person. 6. MEDICAL PAYMENTS A. The Medical Expense Limit in Paragraph 7. of SECTION III - LIMITS OF INSURANCE is I1lplaced by the following Medical ex- pense Lim~. The Medical Expense Limit provided by this policy shall be the greater of: a. $10,000: or b. The amount shown in the Declarations for Medical Expense Umit 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 excluded eill1er by the provisions of the Coverage Part or by endorsement. 7. DAMAGE TO PREMISES RENTED TO YOU LIMIT A. SeCTION III - LIMITS OF INSURANCE, Item 6. is replaced with: -. ~~ ORIG IMAGE COPY GREAT AMERICAN ASSURANCE CO Subject to 5. above, the Damage to Prem- ises Rented to You Lim~ is the most we will pay under Coverage A for damages because of 'properly damage" to your building, or to personal property 01 others in your care, custody and control while at premises rented to you or temporarily occupied by you with permission of the owner, arising out of anyone fire. The Demage to Premises Rented To You Limit Is replaced by the following Demege to Pramises Rented To You Lim~. The Damage to Premises Rented To You Lim~ Is the greater of: (1) $300,000; or (2) the amount shown in the Declarations for Damage to Premises Rented to You Limit. B. This provision is subject to ell the terms of SECTION III - LIMITS OF INSURANCE. C. This provision 5. does not apply il Damage to Premises Rent to You Liability 01 COV. ERAGE A (SECTION I) is excluded either by the provisions 01 the Coveraga Part or by endorsement 8. SUPPLEMENTARY PAYMENTS A. In the SUPPLEMENTARY PAYMENTS COVERAGES A and B provision, Item 1.b., and 1.d are replaced with: i.b. Up to . $500 for cost 01 bail bonds requlrE;ld because of accidents or traf- fio law violations arising out of the use of any vehicle to which the Bodily In- jury Liability Coverage applies. We do not have to fumish these bonds. 1.d. All reasonable expenses incurred by the Insured at our request to assist us In the investigation or defense of the claim or "suit," including actual loss 01 earnings up to $500 a day because 01 time 011 wor1<. This endorsement does not change any other provision of the policy, \, Includes copyrighted material of Insurance Service Office with lis pennission. Copyright, Insurance Services Ollice, Inc., 2001 CG 82 24 (Ed. 12101) XS (Page 4 of 4)