HomeMy WebLinkAboutInsurance Certificate: Southern OR Automatic Door
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ACORD'" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMiDDIVYVY)
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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 endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER ~~~~~CT Pam Dressler
Little River Investments ~A~~N.7_ lOw". (541)536-1726 I ;:,~ No\: (541) 536-1568
Bancorp Insurance iOMOA~~SS: parn@banc::orpinsurance.com
P.O. Box 327, 51477 Hwy 97 ~~,~~~~~~ 10 .POOl1053
La Pine OR 97739 INSURERfSI AFFORDING COVERAGE NAIC /I
INSURED INSURER A:Am Hallmark Ins Co of TX
Robert Jerome Keller INSURER B:
DBA: Southern Oregon Automatic O'oor INSURER C :
200 Rogue Rim Dr INSURER D :
INl;IURERE:
Merlin OR 97532 INSURERI' :
COVERAGES
CERTIFICATE NUMBER'CL1011910460
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
II\'DICATED. NOT\I\I1THSTANDING 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 POllCIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.
INSR TYPE OF INSURANCE ~:_L1; ~; POllCYEFF POLICY EXP LIMITS
CTR POLICY NUMBER MMIDDIYYYY MMIOOIYYYY
GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
- ~~~j~~J?E~~~'~?enca 100,000
X COMMERCIAL GENERAL L1ABlllTY S
A I CLAIMS.MADE [i] OCCUR X 4CL446596 0/10/2010 0/10/2011 MED EXP (Anyone person) S 5,000
- PERSONAL &. ADV INJURY S 1,000,000
GENERAL AGGREGATE S 2,000,000
- 2,000,000
-il~ AGGREAE FlIMIT APFt PER PRODUCTS. COMP/oP AGG 5
X POLICY ~~8r lOC 5
I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000
- . (Ea accidenl)
- ANY AUTO BODll Y INJURY (Per person) S
A All OWNED AUTOS X 44CL446596 0/10/2010 0/10/2011
- BODll Y INJURY (Per accirienl) S
X SCHEDULED AUTOS
X PROPERTY DAMAGE S
HIRED AUTOS (PNaccirJenll
X NON. OWNED AUTOS PIP-Basic.: S 15,000
-'- Unins.urarJmoloris.tcombinarJ 5 1,000,000
.UMBRELLA L1AB H ~CCUR EA.CH OCCURRENCE 5
-
EXCESS L1AB CLAIMS-MADE AGGREGATE 5
DEDUCTIBLE S
-
R"TENTION S S
WORKERS COMPENSATION I T"X%.;T ~IN~ I 10,1;"
AND EMPLOYERS' LIABILITY Y'N
ANY f'!-lUf'f.OETU!-IiP/l.RTNERiEXt::CUTl'jE D NIA EL. EACH ACCIDENT 5
OFFICER/MEMBER EXCLUDED,
{Milndiltory,nNHI EL DISEASE - EA EMPLOYEE S
~s~:-p"-g~ 'gt'OPERATIONS below EL DISEASE - POLlCY LIMIT 5
I
DESCRIPTION OF OPERATIONS I LOCATIONS 'VEHICLES (Alta<;:h ACORD 101, Addltlonill Rumarks S<;:hodulo, if mOIll spa<;:o Is requirod)
Certificate holder is listed as an Addi ti ona 1 Insured per EN~MP97670408 attached.
CERTIFICATE HOLDER
CANCELLATION
(541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTIC E WILL 8E DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
Purchasing Representative 'AUTHORIZED REPRESENTATIVE
Attn: Kari Olson
90 N Mountain Avenue
Ashland, OR 97520 '7~ .z-... - , - eo'
Pam Dressler/BETH
ACORD 25 (2009/09)
INS025 (200"1OG!
@1988.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo arc registered marks of ACORD
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Bancorp Insurance Agency
P.O. Box 327
La Pine, OR 97739
(800) 452-6826
Fax (541) 536-1568
beth@bancorpinsurance.com
I Fax Message I
To:
Company:
From:
Date:
Total all pages:
Purchasing Representative
City of Ashland
The desk of Beth Winter
November 09,2010
5
Certificate
Attached please find a Renewal Certificate w/Add'IINS EN on Robert Jerome Keller DBA:
Southern Oregon Automatic Door to update your records on him.
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Bancorp Insurance
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c. The following is added to A.2. Property Not Covered of the BUILDING AND PERSONAL PROPERTY
COVERAGE FORM:
r. Property while slored or operated underground in connection wilh any mining operalions.
d. The fallowing is added to Paragraph 2. of B. Exclusions of lhe CAUSES OF LOSS. SPECIAL FORM:
n. We will not pay for loss or damage caused by puncture, blowout and road damage to lires and tubes mounted on
vehicles. However, we do pay tor puncture, blowoul or road damage caused by a specified peril.
o. We will nol pay tor loss caused by humidity, dampness, dryness or changes in or extremes of temperalure.
p. We will not pay for loss caused by lhe weight of a load which, under the operating condilions allhe time of a loss,
exceeds the registered Iifling capacily of any equipment or machine.
q. We will not pay for loss due to theft or mysterious disappearance from any vehicle or atlached conlainer. We
will pay for loss due to burglary when lhere are signs of forcible entry to a locked vehicle or container.
e. E.7. Vatuation at the BUtLDlNG AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the
following:
7. Valualion
We will determine the value of covered property in the event of loss or damage as follows:
a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in
paragraphs b. and c. following.
b. Pair or Set. The value of a lost or damaged article which is part of a pair or set is based on a reasonable
proportion of the value of the enlire pair or set. The loss is nol considered a lotalloss of the pair or set.
c. Loss to Parts. The value of a lost or damaged part of an item Ihat consists of several paris when it is
complete is based on the value of only the losl or damaged part or the cost 10 repair or replace it.
2. Rental Reimbursement
In the evenl of loss by a covered perillo covered contractors' equipment that you own, we will reimburse you for your
expense to renl similar equipment while your equipment is inoperable. The most we will reimburse you for renlal
reimbursement expenses is $",000. We will continue 10 reimburse you for the renlal of equipment aller lhe expiration
date of this coverage provided lhe loss occurred before lhe expiration date.
/
Wc will nol reimbursc you:
a. If you can continue or resume your operations with similar equipmenllhat is available to you at no additional
expcnse to you; or
b. For the renlal expense of any equipmenl unless you make every reasonable effort 10 repair, replace or rebuild the
inoperable equipmcnt aller lhe covcrcd loss occurs.
3. With respeclto lhis Additional Coverage, Contractors Equipment Coverage, Section D. Deductible olthe BUILDING
AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the following:
D. Deductible
We will not pay for loss or damage in anyone occurrence untillhe amounl of loss or damage exceeds $500. We will
lhen pay lhe amounl of loss or damage in excess of $500 up 10 the applicable limit of insurance.
We will nol reimburse you' for lhe rental of equipment until after 72 hours have passed since Ihe covered properly
was rendered inoperable. After 72 hours have passed, we will only reimburse you for the renlal expense thai you
aclually incur.
The deduclible of $500 does nol apply to renlal rcimbursement expenses.
General Liability Additional Coverages
The following Addilional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM.
A. Blanket Additional Insured Coverage
1. SECTION 11- WHO IS AN INSURED of lhe COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to
include as an insured any person or organization (referred 10 as Addilionallnsured) whom you are required 10 add as an
Additional Insured on lhis policy under:
a. A writlcn contract or agreemenl; and
b. Where a ceriificate of insurance showing Ihat person or organization as an additional insured has been issued: and
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Includes copyrighted material of ISO Properties, Inc. and
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c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect
during the term of Ihe policy and executed prior to Ihe "bodily injury," "properly damage," or "personal and
advertising injury."
2. The insurance provided to the Additional Insured is limited as follows:
a. The Additional Insured is only an addilional insured for:
(1) "Bodily injury," "properly damage," or "personal and advertising injury" caused in whole or in part by negligent
acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for
whose acls a Named Insured may be liable.
(2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or
organization's status as an insured under this coverage ends when your operations for that insured are
completed.
b. The Limits of Insurance applicable to the Addilional tnsured are those specified in the written contract or agreement
but not more than Ihe Limits of Insurance specified in the Declarations for this policy. The Limits of Insurance
applicable 10 the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the
Declarations for the Named Insured.
3. In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM, Ihe insurance provided to the Additional Insured does not apply to:
a. "Property damage" to:
(1) Property owned, used, occupied by, loaned or rented to the Additional Insured:
(2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured are for any
purpose exercising physical control; or
(3) "Your work" performed for the Additional Insured.
b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or
surveyor's rendering or failure to render any professional services for you, for the Additional Insured or for others,
including, but not limited to:
(1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change
orders, designs or specifications; or
(2) Supervisory, inspection or engineering services.
c. "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
Ihan service, maintenance or repairs) to be performed by or on behalf of the additional insured at the site of the
covered operations has been completed; or
(2) ThaI portion of "your work" out of which the injury or damage arises has been put 10 its inlended use by any
person or organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
4. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, is amended 10 add
the following subparagraph:
d. Additionallnsured's Other Insurance As Excess Insurance
To the extent required by an "insured contract," tliis insurance is primary on behalf of the Addilionallnsured; and any
other insurance maintained by the Additional Insured is excess and not contributory with this insurance. If the
"insured contract" does not require this provision, then paragraph a. above will apply.
B. Mobile Equipment Broadened Coverage
V.12.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following:
(1) Equipment designed primarily for:
(a) Snow Removal;
(b) Road mainlenance, but not construction or resurfacing; or
(c) Street cleaning.
Except the above provisions do not apply to self-propelled vehicles of less than 1 ,ODD pounds gross vehicle weight which
are not intended for use on a highway.
C. Aggregate Limit Per Project
The General Aggregate Limit under SECTION lit - LIMITS OF INSURANCE of Ihe COMMERCIAL GENERAL LIABILITY
COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you.
MP 97 67 04 08
Includes copyrighted material of ISO Properties, Inc. and
American Association of Insurance Services, Inc., used with their permission
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D. Btanket Waiver Of Transfer Of Rights Of Recovery Against Others To Us
The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV - COMMERCIAL GENERAL
LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against any person or organization to whom you by written contract or
agreement have waived your own right or recovery for loss caused by that person or organization because of payments we
make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or
organization and inciuded in the "products-completed operations hazard."
Additional Conditions
A. Insurance Under Two or More Coverages
The following is added to paragraph C. Insurance under Two or More Coverages of the COMMERCIAL PROPERTY
CONDITIONS:
If a Coverage Form is attached to this policy that provides a limit for any coverage provided by this endorsement; the limit
shown in the SCHEDULE and the coverage provided by this endorsement are deleted and replaced by the limit and
coverage provided by the Coverage Form.
B. Limits of Insurance
Regardless of the number of buildings at a location covered by this endorsement, the most we will pay under this Coverage
Enhancement endorsement in anyone occurrence is the applicable Limits of Insurance shown in the SCHEDULE on page 1
of this endorsement
C. Deductibles
The Deductible described in section D. of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM applies to
each of the Coverage Enhancements except as shown below:
We will not pay for loss or damage in anyone occurrence until the amount of loss or damage exceeds $500. We will then
pay the amounl of loss or damage in excess of $500 up 10 the applicable Limit of Insurance for the following enhancements:
1. Personal Effects and Property of Olhers
2. Valuable Papers and Records (Other than Eleclronic Data)
3. Accounts Receivable
4. Property Off-Premises (Including Laptops and Other Electronic Equipment)
5. Outdoor Property (Named Perils)
6. Money and Securities
7. Water Back.Up and Sump Overflow
8. Electronic Data
9. Property in Transit (Including Laptops and Other Electronic Equipment)
No deductible provisions apply to the following enhancements:
1. Arson Reward
2. Recharging of Fire Extinguishers
3. Inventory or Appraisal Cost
4. Rental Reimbursemenl
D. Additional Definitions
The following Addltfonal Definitions apply to this endorsement only:
1. "Banking Premises" means the interior of thaf porfion of any building occupied by a banking instilution or similar safe
depository.
2. "Business Income" means the:
a. Net income (Net Profit or Loss before income taxes) that would have been earned had no loss occurred; and
b. Conlinuing normaf operating expenses incurred, including payroll.
For manufacturing risks, Net Income includes the net sales value of production.
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Includes copyrighted ma1erial of ISO Properties, Inc. and
American Associa1ion of Insurance Services. Inc., used with their permission
M P 97 67 04 08