Loading...
HomeMy WebLinkAboutInsurance Certificate: Marquess & Associates (3) Aco CERTIFICATE OF LIABILITY INSURANCE DATE 0810912011 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(les) must be endorsed. N 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 Phone: (360)598-3700 Fax: (360)598-3703 CONTACT MICHAEL J. HALL&COMPANY NAME: MICHAEL J.HALL&COMPANY - PHONE (360)598-3700 (360)598.3703 A C No HALL&COMPANY E-MAIL 19660 10TH AVENUE N.E. ADDRESS: PRODUCER 2738 POULSBO WA 98370 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE° NAIC0 INSURED INSURERA . Travelers Casualty and Surety Co of America 31194 Marquess&Associates Inc PO Box 490 INSURER B : The Travelers Indemnity Company of America 25666 Medford,OR 97501-0033 INSURER : The Travelers Indemnity Company 25658 INSURER D: The Travelers Indemnity Company of America 25666 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 142817 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 ALLTHE TERMS, VITS SHOWN MAY HAVE BEEN RFDUC.Pn RV PAIn r.1 AUJq INSR TYPE OF INSURANCE ADD'L SUER POLICY NUMBER POLICY EFF POLICY ExP LIMITS LTR INSR WVD MIMMONYYYI fMMMDr`YYY1 B GENERAL LIABILITY 6806146N63A 05129111 05129/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 360,660 PREMISES EeamrM,® $ CLAIMS-MADE X OCCUR MED.EXP(Any one person) $ 5,000 X XCU,BFPD,OCP PERSONAL&ADV INJURY $ 1,000,000 X Separation of Insureds GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC $ D AUTOMOBILE LIABILITY BA61148144011 05/29111 05129112 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO (Ea accident) BODILY INJURY(Per person) $ X ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (PeraccidenI $ X NON-OWNED AUTOS $ C X UMBRELLA LIAR X OCCUR CUP3196T698 05/29/11 05/29/12 1 EACH OCCURRENCE $ 5,000,000 EXCESS L. CLAIMS-MADE AGGREGATE $ 5,000,000 DEDUCTIBLE $ X RETENTION $ 1D'000 $ WORKERS COMPENSATION WC STAT4 pTK $ AND EMPLOYERS' LIABILITY YIN YLIMI S _ ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? NIA (MmdRwy In NN) E.L.DISEASE-EA EMPLOYEE $ If M.dmla undM DESCRIPTION OF OPERATIONS h i E.L.DISEASE-POLICY LIMIT $ A Professional Liability:Claims Made Forth 105320158 07126111 07126112 $1,000,000 Per Claim $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule.N more space Is required) SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER CA CANCELLATION City of Ashland NY THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E Main St IRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NCE WITH THE POLICY PROVISIONS. Ashland,OR 97520-1814 A REPRESENTATNE Attention: James H.Olson shle�Hurd ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. . The ACORD name an o marks of ACORD SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #142817 AUG DATE 92011 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Project:Schofield/Monte Vista LID Project No.200508 City of Ashland,Oregon and Its elected officials,officers and employees are Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured.This Insurance is primary insurance and any other Insurance maintained by the Additional Insured shall be excess only and non-contributing with this Insurance. i EE] Certificate# 142817 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorse- (d) Costs for extended warranties,.Credit Life ment, the provisions of the Coverage Form apply Insurance, Health, Accident or Disability unless modified by the endorsement. Insurance purchased with the loan or A. PERSONAL EFFECTS COVERAGE lease; and SECTION III — PHYSICAL DAMAGE COVER- (e) Carry-over balances from previous loans AGE, A. Coverage, 4. Coverage Extensions is or leases. amended by adding the following: C. COVERAGE EXTENSION. — AUDIO, VISUAL Personal Effects Coverage AND DATA ELECTRONIC EQUIPMENT NOT DESIGNED SOLELY FOR THE PRODUCTION We will pay up to $400 for "loss" to wearing ap- OF SOUND parel and other personal effects which are: SECTION III — PHYSICAL DAMAGE COVER- (1) owned by an"insured"; and AGE, B. Exclusions, exception paragraph a. to (2) in or on your covered "auto"; exclusions 4.c & 4.d is deleted and replaced with in the event of a total theft "loss" of your covered the following: "auto". a. Equipment and accessories used with such No deductibles apply to Personal Effects Cover- equipment, except tapes, records or discs, age. provided such equipment is permanently in- B. AUTO LOAN LEASE GAP COVERAGE stalled in the covered "auto"at the time of the "loss" or is removable from a housing unit SECTION III — PHYSICAL DAMAGE COVER- which is permanently installed in the covered AGE, A. Coverage, 4. Coverage Extensions is "auto" at the time of the "loss", and such amended by adding the following: equipment is designed to be solely operated Auto Loan Lease Gap Coverage for Private by use of the power from the "auto's" electri- Passenger Type Vehicles cal system, in or upon the covered "auto"; or In the event of a total "loss"to a covered "auto"of D. WAIVER OF DEDUCTIBLE—GLASS the private passenger type shown in the Schedule SECTION III — PHYSICAL DAMAGE COVER- or Declarations for which Physical Damage Cov- AGE, D. Deductible is amended by adding the erage is provided, we will pay any unpaid amount following: due on the lease or loan for such covered "auto" No deductible for a covered "auto" will I to less the following: apply y glass damage if the glass is repaired rather than (1) The amount paid under the Physical Damage replaced. Coverage Section of the policy for that"auto" E. HIRED AUTO PHYSICAL DAMAGE COVER- and AGE (2) Any: SECTION III — PHYSICAL DAMAGE COVER- (a) Overdue lease/loan payments at the time AGE, A. Coverage, 4. Coverage Extensions is of the"loss"; amended by adding the following: (b) Financial penalties imposed under a Hired Auto Physical Damage Coverage Exten- lease for excessive use, abnormal wear sion and tear or high mileage; If hired "autos" are covered "autos" for Liability (c) Security deposits not returned by the les- Coverage and this policy also provides Physical sor; Damage Coverage for an owned "auto", then the CA T4 20 07 06 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Includes the copyrighted material of The St.Paul Travelers Companies, Inc. COMMERCIAL AUTO Physical Damage Coverage is extended to tent required of you by a written contract exe- "autos" that you hire, rent or borrow subject to the cuted prior to any "accident" or "loss", pro- following: vided that the"accident"or"loss"arises out of (1) The most we will pay for"loss" in any one the operations contemplated by such con- "accident" to a hired, rented or borrowed tract. The waiver applies only to the person or auto"is the lesser of: organization designated in such contract. (a) $50,000; G. BLANKET ADDITIONAL INSURED (b) The actual cash value of the dam- SECTION II— LIABILITY COVERAGE, part A. 1. aged or stolen property as of the time Who Is An Insured, paragraph c. is amended by of the"loss"; or adding the following: (c) The cost of repairing or replacing the Any person or organization that you are required damaged or stolen property with to include as an additional insured on this Cover- other property of like kind and quality. age Form in a written contract or agreement that (2) An adjustment for depreciation and is signed and executed by you before the "bodily physical condition will be made in deter- injury" or "property damage" occurs and that is in mining actual cash value in the event of a effect during the policy period is an "insured" for Liability Coverage, but only for damages to which total"loss". this insurance applies and only to the extent that (3) If a repair or replacement results in better person or organization qualifies as an "insured" than like kind or quality, we will not pay under the Who Is An Insured provision contained for the amount of betterment. in Section II. (4) A deductible equal to the highest Physical H. EMPLOYEE HIRED AUTOS Damage deductible applicable to any SECTION II — LIABILITY COVERAGE, A. Cov- owned covered "auto". erage, 1.Who Is An Insured is amended by add- (5) This Coverage Extension does not apply ing the following: to: An "employee" of yours is an "insured" while op- (a) Any"auto"that is hired, rented or bor- erating an "auto" hired or rented under a contract rowed with a driver; or or agreement in that "employee's" name, with (b) Any"auto"that is hired, rented or bor- your permission, while performing duties related rowed from your"employee". to the conduct of your business. F. BLANKET WAIVER OF SUBROGATION 1. COVERAGE EXTENSION—TRAILERS SECTION IV— BUSINESS AUTO CONDITIONS, SECTION I — COVERED AUTOS, C. Certain A. Loss Conditions, 5. Transfer Of Rights Of Trailers, Mobile Equipment and Temporary Recovery Against Others To Us is deleted and Substitute Autos, paragraph 1. is deleted and replaced by the following: replaced by the following: 5. Transfer Of Rights Of Recovery Against 1. "Trailers" with a load capacity of 3,000 Others To Us pounds or less designed primarily for travel We waive any right of recovery we may have on public roads. against any person or organization to the ex- Page 2 of 2 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. CA T4 20 07 06 Includes the copyrighted material of The St.Paul Travelers Companies, Inc. Marquess&Associates Inc Policy#6806146N63A COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED INSURANCE (Section III) for this Coverage (Section II): Part. Any person or organization that you agree in a B. The following is added to Paragraph a. of 4. "contract or agreement requiring insurance" to in- -Other Insurance in:COMMERCIAL GENERAL clude as an additional insured on this Coverage LIABILITY CONDITIONS(Section IV): Part, but only with respect to liability for"bodily in- However, if you specifically agree in a"contract or jury", "property damage" or "personal injury" agreement requiring insurance"that the insurance caused, in whole or in part, by your acts or omis- provided to an additional insured under this Cov- sions or the acts or omissions of those acting on erage Part must apply on a primary basis, or a your behalf: primary and non-contributory basis,this insurance a. In the performance of your ongoing opera- is primary to other insurance that is available to tions; such additional insured which covers such addi- b. In connection with premises owned by or tional insured as a named insured,and we will not rented to you;or share with the other insurance,provided that: c. In connection with "your work" and included (1) The "bodily injury" or "property damage" for within the "products-completed operations which coverage is sought occurs;and hazard". (2) The "personal injury" for which coverage is Such person or organization does not qualify as sought arises out of an offense committed; an additional insured for "bodily injury", "property after you have entered into that "contract or damage" or "personal injury" for which that per- agreement requiring insurance". But this insur. son or organization has assumed liability in a con- ance still is excess over valid and collectible other tract or agreement. insurance, whether primary, excess, contingent or The insurance provided to such additional insured on any other basis, that is available to the insured is limited as follows: when the insured is an additional insured under d. This insurance does not apply on any basis to any other insurance. any person or organization for which cover- C. The following is added to Paragraph 8. Transfer age as an additional insured specifically is Of Rights Of Recovery Against Others To Us -added by another endorsement to this Cover- in COMMERCIAL GENERAL LIABILITY CON- age Part. DITIONS(Section IV): e. This insurance does not apply to the render- We waive any rights of recovery we may have ing of or failure to render any "professional against any person or organization because of services". payments we make for "bodily injury", "property f. The limits of insurance afforded to the addi- damage" or "personal injury" arising out of "your tional insured shall be the limits which you work" performed by you, or on your behalf, under agreed in that "contract or agreement requir- a "contract or agreement requiring insurance"with ing insurance" to provide for that additional that person or organization. We waive these insured, or the limits shown in the Declara- rights only where you have agreed to do so as tions for this Coverage Part, whichever are part of the"contract or agreement requiring insur- less. This endorsement does not increase the ance" with such person or organization entered limits of insurance stated in the LIMITS OF into by you before,and in effect when, the"bodily CG D3 81 09 07 ®2007 The Travelers companies,Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- erage Part, provided that the "bodily injury" and sonal injury"offense is'committed. property damage" occurs, and the "personal in- D. The following definition is added to DEFINITIONS jury"is caused by an offense committed: (Section V): a. After you have entered into that contract or "Contract or agreement requiring insurance' agreement; means that part of any contract or agreement un-, b. While that part of the contract or agreement is der which you are required to include a person or in effect;and organization as an additional insured on this Cov- c. Before the end of the policy period. Page 2 of 2 C 2007 The Travelers Companies,Inc. CG D3 8109 07 Includes the copyrighted material of Insurance Services Office,Inc.,with its pennission. UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY(UMBRELLA) INSURANCE The following is added to Paragraph 11., OUR RIGHT a. "Bodily injury"or"property damage" caused by an TO RECOVER FROM OTHERS., of SECTION IV — occurrence"that takes place;or CONDITIONS.: b. "Personal injury" or"advertising injury" caused by If the insured has agreed in a contract or agreement an"offense"that is committed; to waive that insured's right of recovery against any subsequent to_the execution,of the contract or agree- person or organization, we waiveour right of recovery merit. against such person or organization, but only for payments we make because of: UM 04 88 07 08 ®2008 The Travelers Companies,Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc.vrith its permission.