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HomeMy WebLinkAboutOTAK - INSURANCE CERTIFICATE (3)ACORDT. CERTIFICATE OF LIABILITY INSURANCE 03/21/2 0 ) PRODUCER (503)293-8325 FAX (503)293-5418 3. D. Fulwil er & Co Insurance, Inc 5727 SW Macadam Ave PO Box 69508 Portland, OR 97239 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED OTAK, INC. PO BOX 1379 LAKE OSWEGO, OR 97035 INSURERA: American Economy 19690 INSURERS: American States Insurance Co. 19704 INSURERC: Saif Corporation INSURER D: INSURER E. f`AVFDAPFQ 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. INSR ADDL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDNYi POLICY EXPIRATION DATE (MMITIDMI LIMITS GENERAL LIABILITY 02CD15298150 12/09/2006 12/09/2007 EACH OCCURRENCE $ 1,000, OO COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 200,000 CLAIMS MADE FX OCCUR MED EXP (Any are person) $ 10,000 A X Per project/locati PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOG JECT AUTOMOBILE LIABILITY ANY AUTO 01CG25708050 % 12/09/2006 12/09/2007 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ -RETENTION $ WORKERS COMPENSATION AND 487431 OTAK INC 04/01/2007 04/01/2008 wl; LIMIT FR C EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT $ SOO,OO E.L. DISEASE - EA EMPLOYEE $ S001000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DLSEASE- POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e: Operations of the Named Insured, subject to policy terms and conditions The City of Fort Collins is included as additional insured, as their interests appear, per G7635 attached City of Fort Collins Attn: Clark Mapes 281 N. College Avenue Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRrrTEN NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS AUTHORIZED REPRESENTATIVE Mil ACORD 26 (2001/08) CACORD CORPORATION 1988 ACORDT. CERTIFICATE OF LIABILITY INSURANCE 03/21/2 0 ) PRODUCER (503)293-8325 FAX (503)293-5418 3. D. Fulwil er & Co Insurance, Inc 5727 SW Macadam Ave PO Box 69508 Portland, OR 97239 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED OTAK, INC. PO BOX 1379 LAKE OSWEGO, OR 97035 INSURERA: American Economy 19690 INSURERS: American States Insurance Co. 19704 INSURERC: Saif Corporation INSURER D: INSURER E. f`AVFDAPFQ 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. INSR ADDL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDNYi POLICY EXPIRATION DATE (MMITIDMI LIMITS GENERAL LIABILITY 02CD15298150 12/09/2006 12/09/2007 EACH OCCURRENCE $ 1,000, OO COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 200,000 CLAIMS MADE FX OCCUR MED EXP (Any are person) $ 10,000 A X Per project/locati PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOG JECT AUTOMOBILE LIABILITY ANY AUTO 01CG25708050 % 12/09/2006 12/09/2007 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ -RETENTION $ WORKERS COMPENSATION AND 487431 OTAK INC 04/01/2007 04/01/2008 wl; LIMIT FR C EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT $ SOO,OO E.L. DISEASE - EA EMPLOYEE $ S001000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DLSEASE- POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e: Operations of the Named Insured, subject to policy terms and conditions The City of Fort Collins is included as additional insured, as their interests appear, per G7635 attached City of Fort Collins Attn: Clark Mapes 281 N. College Avenue Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRrrTEN NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INS AUTHORIZED REPRESENTATIVE Mil ACORD 26 (2001/08) CACORD CORPORATION 1988 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), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) ACORDa CERTIFICATE OF LIABILITY INSURANCE 03ii3/20071 PRODUCER (503)293-8325 FAX (503)293-5418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.-D. 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 POLICIES BELOW. PO Box 69508 Portland, OR 97239 INSURERS AFFORDING COVERAGE NAIC # INSURED OTAK, INC. INSURERA-. American Economy 19690 PO BOX 1379 INSURER : American States Insurance Co. 19704 LAKE OSWEGO, OR 97035 INSURERC. Saif Corporation INSURER D. INSURER E. rrnvcoecvc 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. DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMWODfYYI POLICY EXPIRATION DATE (MMIDDNYI LIMITS GENERAL LIABILITY 02CDIS2981SO 12/09/2006 12/09/2007 EACH OCCURRENCE $ 1,000,00 rA COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (E&nccu0MQML.__ $ 200,000 CLAIMS MADE I OCCUR MED EXP (Any one person) $ 10,000 X Per project/locati PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO OICG25708050 12/09/2006 12/09/2007 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 487431 OTAK INC 04/01/2006 04/01/2007 WC STATU- OTH- C EMPLOYERS'LIABILITV ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.EACHACCIDENT $ SOO,OO E.L. DISEASE - EA EMPLOYE $ 500, 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS e: Operations of the Named Insured, subject to policy terms and conditions The City of Fort Collins is included as additional insured, as their interests appear, per G7635 attached ^Aun O, , wT,nu SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Fort Collins 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn : Clark Mapes BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 281 N . Col 1 ege Avenue OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE (-Ql(j!Y( a-1w��Av(\ L��1 t�� Fort Collins, CO 80524 Dana Miller/DANA ACORD 26 (2001108) ©ACORD CORPORATION 1988 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), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) Policy Number: 02CD15298150 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SAFECO LIABILITY PLUS ENDORSEMENT CG 7 6 3 51 0 01 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Fort Collins ADDITIONAL INSURED - BY WRITTEN CONTRACT, 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: 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". 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: 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 person 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", "persona! and advertising injury" arising out of operations per- formed for the state or municipality. The insurance with respect to any architect, engineer, or surveyor added as an insured by this endorsement does not apply to "bodily in jury", "property damage", " personal and advertising injury" arising out of the rendering of or the failure to render any professional 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" or "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 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, 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, 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. 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 being used to carry personal or property for a charge; 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 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 f.(2) or f.(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 I 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, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another'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 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. Paragraph (2) of this exclusion does not apply if 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 liability 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 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 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 1.1b. of SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is replaced by the following: 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 these bonds. EMPLOYEES AS INSUREDS - HEALTH CARE SERVICES Provision 2.a.(1) d. of WHO IN 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 provision is afforded only until the end of the policy period. yl��U]��iH�:A79�3;i7�1_15I« Exclusion a. of COVERAGE A. (Section 1) 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 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 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 fallowing is added to Paragraph 6. Representations 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. CG7635 10 01