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HomeMy WebLinkAboutInsurance Certificate: Tashman Johnson LLC ACc;;d;,-- CERTIFICATE OF LIABILITY INSURANCE OPID KL I OATEIMMlOOIYYYY) ~ 0J./07/n 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). ' 'PRODUCE~.. "'^-r;:~-;.-'''''---;'.-,-' i -'~."~_.-.-_.,. ._P.. NAME: 'u" --- ---+_._- n_: r'F~l~'e~~o~~~:~~~c~nli)~~~; ! ! \ r~g,NJo,Ext\: i ~'~L:'''f' i;-::.<,.I r~;NO):I: -;.~- :P.'-O:-'Bbx--290l8"-"'--~-"- !, ~~D~~SS: .n..~,:.,-,-'c_'.""~"" '. ,-,', , " . Port1:and. OR ..9 7 2 9 6- 9 0'1.8.' ,- I lp~on~:5,03~274~65J.J. Fai:~d3-~74-6524 CUSTOMER ID #: Tl\:SHM-J. ,,'; ,'.-,,'.' I u. : ~ .,', INSURER(S) AFFORDING ,COVE~GE " -.-.7,<~,~- ..' ',~ NAlC # ! ',~'~;~::1 G : -..'. .::.' 'Fi~st, Nlltionlll"Insii~-a.nce:;co.:' .,.,.". ..- "",:,;""",ic..,] '. ~' " Tashman Johnson LLC I Nina Johnson : 735 SwSt CJ.air.Ave;;Apt.J.906 PortJ.and OR 97205 , , INSURE~ A: " INSURER B : INSURER C :- INSURER D : INSURER E :. INSURER F : Ame~i~a.n States In.~i:llIie~,.co~:;:. .,. ,24724'- J.9704 Maxum Indenmity' Company" , COVERAGES CERTIFICATE'NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L1STEO 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. ~~ TYPE OF INSURANCE INSR WO POLICY NUMBER ~~) (~1i,'rl5~) LIMITS GENERAL LIABILITY , : ., ": '. .. EACH OCCURRENCE , J.OOOOOO - ,. ,',-:.' ., ... . l' M;,,.~:' A X COMMERCIAL GENERAL LIABiLiTY 0J.CI30J.2842 Q1/14I.11 . 01/.14/12:;' 'PREMISES {Ea occurrenc'e} ,J.OOOOOO, .- ,:~_1. p;LAI~S:~.AEJ~ -,E!J ;~)cCUR . - n__n___ _. ..' .-----J--.....- "'--- .------.. -- , I ,MEDEXP {Any one"personj" ',J.OOOO, .'>,:~. :~ \' _. ~ 2;;<f ; :~',-r-. ,~,:..:, , .. .". . ~.. ~. u. "........ . .~ , .. .. ~ X !"C:F.r:.=. &~.~' .~:--~C~, .,,, . .-.- 'PERSONAL&'ADV INJURY' ,.J.OOOOOO ~ :.. :':- '~~,!,,: .'. ,~ ..\,....,....~ .- -- -. .~. ~'- ,...,.~ l!;,:'i..,l '..~';':'.. . .' .c::..:: r. r.~N:';;; ':, r~ :';"1' : lI::'f".~" - ,.- - --.- - GENERAL'AGGREGATE '2000000 . . - L,~';~-. ':. .. ~'L AGG~EnE L'IMIl APnS PER: .. .C .. - - PRODUCTS - COMP/OR AGG" , 2000000 i . ~ POLICY,. jrc?,: LOC '".: -,--- -- .,. -- ... .-_. ..- .." " .., AUTOMOBILE LIABILITY ... .~,.; _.~ , ~ . '''-~ - ~ --. .... .., . ..... COMBINED SINGLE LIMIT ' , J.OOOOOO 'f-- .. (Eaaccidenl) A ANY AUTO 0J.CI30J.2842 01/14/11 01/14/12 BODILY INJURY (Per person) , C- ALL OWNED AUTOS BODILY INJURY (Per accident) , f-- f-- SCHEDULED AUTOS PROPERTY DAMAGE JC.. HIRED AUTOS (Per accident) , r!- NON-OWNED AUTOS , , B JC.. UMBRELLA LIAB ~ 10CCUR 0J.XSJ.5745530 01/14/11 01/14/12 EACH OCCURRENCE 'J.,OOO,OOO EXCESS L1AB CLAIMS. MADE AGGREGATE 'J.,OOO,OOO DEDUCTIBLE i----~-- " L. xl RETENTION , , WORKERS COMPENSATION I T1l',\'v'!,~WS I IOJ~. AND EMPLOYERS' LIABILITY VIN ANY PROPRIETORlPARTNERfEXECUTIVO IA E.l. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. D!SEASE - POLICY LIMIT , DESCRIPTION OF OPERATIONS below C Professional Liab I PFP 6 0 14 3 3 9 0 J. 12/29/10 12/29/11 eachclaim 2000000 Claims Made RETRO DATE J.2/29/04 aqqreqate 2000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more shea Is required) Professional Liability deductible $2,500. The City of As land, its officials, officers, employees are additional insureds. r ~ tP.J!9 3.~ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of AshJ.and AUTHORIZED REPRESENTATIVE 90 North Mountain Ashland OR 97520 ~.- I ACORD 25 (2009/09) @1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . . - "~ ~Insurance .. Policy Number: 01 CI3012841 COMMERCIAL GENERAL LIABILITY CG 76350905 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Ashland ADDITIONAL INSURED - BY WRITTEN CONTRACT, AGREEMENT OR PERMIT, OR SCHEDULE (2) Your ongoing operations for that insured, whether the work is performed by you or for you; The following paragraph is added to WHO IS AN INSURED (Section II): (3) The maintenance, operation or use by you of equipment leased to you by such person or organization, subject to the following additional provisions: 4. Any person or organization shown in the Schedule or for whom you are required by written contract, agreement or permit to provide insurance is an insured, subject to the following additional provisions: a. The contract, agreement or permit must be in effect during the policy period shown in the Declarations, and must have been executed prior to the "bodily injury," "property damage," "personai and advertising injury." (a) This insurance does not apply to any "occurrencen which takes place after the equipment lease expires; (b) This insurance does not apply to "bodily injury" or "property damage" arising out of the sole negligence of such person or organization; b. The person or organization added as an insured by this endorsement is an insured only to the extent you are held liable due to: (1) The ownership, maintenance or use of that part of premises you own, rent, lease or occupy, subject to the following additional provisions: (4) Permits issued by any state or political subdivision with respect to operations performed by you or on your behalf, sUbject to the following additional provision: (a) This insurance does not apply to any "occurrence" which takes place after you cease to be a tenant in any premises leased to or rented to you; This insurance does not apply to "bodily injury," "property damage: "personal and advertising injury" arising out of operations performed for the state or municipality. CG 76 35 09 05 (b) This insurance does not apply to any structural alterations, new construction or demolition operations performed by or on. behalf of the person or organization added as an insured; Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 Safeco and the Safeco logo are registered trademarks of Safeco Corporation Page 1 of 3 EP c. The insurance with respect to any architect, engineer, or surveyor added as an insured by this endorsement does not apply to "bodily injury," "property damage," "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: ,,~:~.t;i'::"-::~ (1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and (4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or (2) Supervisory, inspection or engineering services. (5) "Bodily injury" or "property damage" arising out of the operation of any of the equipment listed in paragraph f.(2) or f.(3) of the definition of "mobile equipment." d. This insurance does not apply to "bodily injury" or "property damage" included within the "products- completed operations hazard." (6) An aircraft you do not own provided it is not operated by any insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. TENANTS' PROPERTY DAMAGE LIABILITY No coverage will be provided if, in the absence of this endorsement, no liability would be imposed by law on you. Coverage shall be limited to the extent of your negligence or fault according. to the applicable principles of comparative fault. When a Damage to Premises Rented to you Limit is shown in the Declarations, Exclusion J. of Coverage A, Section I is replaced by the following: j. Damage To Property "Property damage" to: g. "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading." (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT LIABILITY Exclusion g. of COVERAGE A (Section I) is replaced by the following: :, (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured. if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or. loaned to any insured. (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations. if the "property damage" arises out of those operations, or This exclusion does not apply to: (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. (1) A watercraft while ashore on premises you own or rent; (b) Not being used to carry persons or property for a charge; Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits Of Insurance. (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insuied; CG 76 35 Og 05 Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 Safeco and the Safeco logo are registered trademarks of Safeco Corporation Page 2 of 3 EP ~ '/", :""1' .... ..~ . ' ,. . Paragraph (2) of this exclusion does not apply if the premises are uyour work" and were never occupied, rented or heid for rental by you. Paragraphs (3), (4), (S) and (6) of this exclusion do not appiy to iiabiiity assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products-completed operations hazard." ' .Rr Paragraph 6. of Section III is replaced by the following: 6. Subject to 5. above, the Damage To Property Limit is the most we will pay under Coverage A for damages because of "property damage" to anyone premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with; permission of the owner. The Tenants' Property Damage to Premises Rented to You limit is the higher of $200,000 or the amount shown in the Declarations as Damage to Premises Rented to You Limit. WHO IS AN INSURED - MANAGERS The following.is added to Paragraph 2.a. of WHO IS AN INSURED (Section II): Paragraph (1) does not apply to executive officers, or to managers at the supervisory level or above. SUPPLEMENTARY PAYMENTS - COVERAGES A AND B - BAIL BONDS Paragraph 1.b. of SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is replaced by the following: b. Up to $2,000 for cost of bail bonds required be- cause of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. . EMPLOYEES AS INSUREDS - HEALTH CARE SERVICES Provision 2.a.(1) d. of WHO IS AN INSURED (Section II) is deleted, unless excluded by separate endorsement. EXTENDED COVERAGE FOR NEWLY ACQUIRED ORGANIZATIONS Provision 4.a. of WHO IS AN INSURED (Section II) is replaced by the following: a. Coverage under this p.rovision is afforded only until the end of the policy period. ""-~ -'"~~.,i''''''''' , . ' EXTENDED "PROPERTY DAMAGE" Exclusion a. of COVERAGE A. (Section I) is amended to read: a. "Bodily injury" or "property damage" expected 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 force to protect persons or property. INCREASED MEDICAL EXPENSE LIMIT The medical expense limit is amended to $10,000. KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): Knowledge of an "occurrence," claim or "suit" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee. UNINTENTIONAL FAILURE TO DISCLOSE ALL HAZARDS The following is added to Paragraph 6. Represenlations of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. LIBERALIZATION CLAUSE The following paragraph is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): 10. If a revision to this Coverage Part, which would provide more coverage with no additional premium, becomes effective during the policy period in the state shown in the Declarations, your policy will automatically provide this additional coverage on the effective date of the revision. Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 Safeco and the Safeco logo are registered trademarks of Safeco Corporation Page 3 of 3 EP CG 76 35 Og 05