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Home My WebLink AboutOTAK - INSURANCE CERTIFICATE (2)PLEASE READ Dear Certificate Holder Attached please find a revised Certificate of Insurance for our mutual customer, Otak, Inc. which updates the Workers Compensation policy term only. All other policy terms, conditions and endorsements remain unchanged. Please pull forward, any/all attached endorsements with the prior Certificate issued as, in an effort to conserve paper products, we are not including these with this mailing. Thank you for your cooperation. Should you have any questions in this regard, please contact: Dana Miller JD Fulwiler & Co Insurance (503)977-5704 Any other unrelated issues or questions should be directed to your Contracts Department contact at Otak, Inc. J9AaJKQ CERTIFICATE OF LIABILITY INSURANCE aTE,am '^O010Eq (S03)293-8325 FAX (503)293-5418 03/21/ 3. D. Fulwiler & Co Insurance, Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF MFORMAI 5727 SW Macadam Ave ONLY AND DER.Tc No UPON THE CERTIFICATE PO Box 6950E RT ALE COVERA ICATE DOES OE AFFORDED O TH D•EXTENDi Portland, OR 97239 ' �� OTAK, INC. INSURERS AFFORDMIO COVERAGE NAIL 1 PO BOX 1379 "&ME"� American Ecoromy 19690 LAKE OSNEGO '"BAR 9, American States Insurance Co. 107na OR 97035 GACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(tes) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such erdorsemerd(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the poling, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(&). DISCLAIMER The Certificate of Insurance on the reverse side of this forth does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, "and or alter the coverage afforded by the policies listed thereon. AUU Ze IZeelmrt AC- CERTIFICATE OF LIABILITY INSURANCE 03/13" n"il PROGUClR (503)293-6325 FAX (SO3)293-5418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3.�O. Fulwiler & Co Insurance, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5727 SW Macadam Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEB BELOW. PO Box 69508 Portland, OR 97239 INSURERS AFFORDING COVERAGE NAICM PO BOX 1379 LAKE OSWEGO, OR 9703S 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. wSR TYPE OF INSURANCE POLICY NUMBER POLV EFFE POLICY FJRWI Di11i5 GENERAL UAmunf 02CDIS299150 12/09/2006 12/09/2007 EACH OCCURRENCE f 1 000 COMMERCIAL GENERAL LIABILITY DAMAGETORENTED f 20�n0 00( CLARRIMADE OCCUR MEDEXPIAIBDA.P ) S 10 A X Per project/locati PERSONAL aAMWHXMY i 1,000,00( GENERALAGOREGATE S 2.000 .000 GENL AGGREWIE LRBIAPPLIESPER: PRODUCTS - COWXIP AGO i 2,000.00 POLICY ACT LOC AUTOMDBII.E X LNIXJTY ANYAUTO OICC25708050 12/09/2DO6 12/09/2007 COMBMEO SINGLE LIMO (ES'..Nwt) f 1,000,00 eODXY N) IPa P.Iwnl f B ALL OWNED AUTOS SCHEDULED AUTOG BOOXY INJURY (P.r.00tler.l S HIRED AMOS NON -OWNED AUTOS PROPERTY DAMAGE (Px smM ) f GARAGE ILISILITY AUTOOHLY-EAAUGM11T S OTHERTHAN EA ACC f ANY AUTO q i AUTO ONLY: AGO IXCESSNMBRE W LNBRJTY EACH OCCURRENCE S OCCUR CLAIMSMADE AGGREGATE S f f DEDUCTIBLE i RETENTION S MIONCERS CUMPEHSATIDH AND 497431 OTAK INC 04/01/2006 04/01/2007 HIC STATu- DTN• C EMPLOYERS LMIIYTY ANYPROPRIETOePARTNEREECUTNE OPFICERMEMBEH EXCLUDED? EL FACH ACCXIENi S 500,00 EL. DISEASE -EA EMPLOYE S Soo, nyyee,, aM.' .� SPECDIPROWSIONS9elbx E.L.DWEARE-POLICY LMIT f Soo OTHER DEBGWTIONOFOP9N1DOR1TORSI (EXCLUSIONS BYE ENTISPECIALPROM e: Operations o t e Na nsured, slJ�ject to pot terms aT conditions he City of Fort Collins is included as additional insured, as their interests appear, per 7635 attached CERTIFICATE HOLDER CANCELWVM swum ANY OF THE ABOVE DEDcmacD POUCKII WE CAMCM ED INSURE THE FiPIMTxM MTETNEREOF, T11E 18BIII1fi WfUREp WILL ENOEAVpIm MAlI City of Fort Collins 30 H>AYawwTTSRHUT"ToTHECERTwATERDLONRHARNDm TIR:L . Attn: Clark Napes JUT P,w.MmmlXAn sucx HUTICe aHAU IRPoae xoowwnox UR LuwIn 261 N. College Avenue of AHY ImID woN THE WfURIX,nE AGHBITf aLR®RENEJLrArnNt Fort Collins, CO 90524 AUTIDRImD IMPIRSENTATNE Dana KillerjDANA `L'Y ACORD 26 )2001106) OACORD CORPORATION 1985 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), auftrized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACORD 26 (200 V06) Policy Number: 02CD15298150 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SAFECO LIABILITY PLUS ENDORSEMENT CG76351001 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Fort Collins ADDITIONAL INSuREo - BY WRITTEN CANTRACr, AGREEMENT OR PERMIT, OR SCHEDULE The following paragraph is added to WHO IS AN INSURED (Section II): 5. Any person or organization shown in the Schedule or for whom you are required by written contract, agreement or permit to provide insur- ance 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', 'personal and advertising injury'. 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: I ) The ownership, maintenance or use of that part of premises you own, rent, lease or occupy, subject to the following additional provisions: 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; b) This insurance does not apply to any structural alterations, new construction or demolition operations performed by or on behalf of the parson or organization added as an insured; 2) Your ongoing operations for that insured, whether the work is performed by you or for you; 3) The maintenance, operation or use by you of equipment leased to you by such person or organization, subject to the following additional provisions: a) This insurance does not apply to any "occurrence' 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 per -son or organization. 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: This insurance does not apply to 'bodily injury, "property damage', 'personal and advertising injury arising out of operations per- formed for the state or municipality. c. The insurance with respect to any architect, engineer, or surveyor added as an insured by this endorsement does not apply to 'bodily in-W,,'property damage', ' personal and advertising injury' arising out of the rendering of or the failure fo render any processional ser- vices by or for you, including: 1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specification; and; 2) Supervisory, inspection or engineering services. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY d. This insurance does not apply to "bodily injury' of 'property damage' included within the products -completed operations hazard A person or organization's status as an insured under this endorsement ends when your operations for that insured are completed. No coverage wig be provided if, in the absence of this endorsement no tiabilty would be imposed by law on you. Coverage shall be limited to the extent of your negligence or lautt according to the applicable principles of comparative fault NON -OWNED WATERCRAFT AND NON -OWNED AIRCRAFT LIABILITY Exclusion g. of COVERAGE A (Section 1) is replaced by the following: 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'. 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, I 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. This exclusion does not apply to: 1) A watercraft while ashore on premises you own or rent; 2) A watercraft you do not own that is: a) Less than 52 feet long; and b) Not berg used to carry personal or property for a charge; 31 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 insured; 4) Liability assumed under any'insured contract for the ownership, maintenance or use of aircraft or watercraft or 5)'Bodily injury' or'property damage' arising out of the operation of any of the equipment listed in paragraph L(2) or L(3) of the definition of 'mobile equipment". 6) An aircraft you do not own provided it is not operated by any insured. TENANT'S PROPERTY DAMAGE LIABILITY When a Damage to Premises Rented to you Limit is shown in the Declarations, Exclusion J. of Coverage A. Section 1 is replaced by the following: Damage to Property 'Property damage' to: 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 anhancement restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to anther's property; 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; 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 6) That particular part of any property that must be restored, repaired or replaced because *your work' was incorrectly per -formed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to 'property damage' (other than damage by fire) to premises including be 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. Paragraph (2) of this exclusion does not apply I the premises are'your work' and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to lability assumed under a sidetrack agreement Paragraph (6) of this exclusion does not apply to 'property damage' included in the 'products -completed operations hazard.' 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 dam -age" to any one premises, while ranted 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 asDamage to Premises Rented to You Limit, WHO IS AN INSURED - MANAGERS The following is added to Paragraph 2.s. of WHO IS AN INSURED (Section 11): 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 fallowing: b. Up to $2,000 for cost of bail bonds required because 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 them bonds. EMPLOYEES AS INSUREDS- HEALTH CARE SERVICES Provision 2.a.(1) d. of WHO IN AN INSURED (Section 11) is deleted, unless excluded by separate endorsement. EXTENDED COVERAGE FOR NEWLY ACQUIRED ORGANIZATIONS Provision 4.a. of WHO IS AN INSURED (Section 11) is replaced by the following: a. Coverage under this provision is afforded only until the end of the policy period. EXTENDED "PROPERTY DAMAGE" Exclusion a. of COVERAGE A. (Section 1) rs amended to read: a. 'Bodily Injury' or'property damage" expected or intended from the standpoint of the insured. This exclusion does not apply lo'bot ily in -jury' 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 to the Event of Occurrence, Offense, Claim or Suit of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section dt7: 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 fallowing Is added to Paragraph 6. Representations of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): lf 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. Hpwever, 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. CG76351D 01