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HomeMy WebLinkAboutPM 2004-14 - Certificate of Insurance - 1/9/2009 CERTIFICATE NUMBER CERTIFICATE OC INSURANCE NYC 002981070-01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE 44 WHIPPANY ROAD POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE PO BOX 1966 AFFORDED BY THE POUCIES DESCRIBED HEREIN. MORRISTOWN,NJ 07962 COMPANIES AFFORDING COVERAGE Attn:Morristown.Certrequest@Marsh.com Fax 212-948-0979 - ----- --- COMPANY 08990-ALL-CAS-08-09 CLIE A Liberty Mutual Insurance Company INSURED COMPANY SUBURBAN PROPANE PARTNERS,L.P. B Liberty Insurance Corporation 1 SUBURBAN PLAZA COMPANY P.O.BOX 206 WHIPPANY,NJ 07981 C N/A COMPANY D COVFRRAGE8 This certificate supersedes and replaces any Previously Issued Certificate for the policy period noted below. 1 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAN)CLAMS. CO TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIOD/YY) DATE(MMIDD/YY) i A GENERAL LIABILITY T62-631-507975-038 03/01/08 03/01/09 GENERALAGGREGATE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 2,000,000 I CLAIMS MADE Fx—]OCCUR PERSONAL 8 ADV INJURY $ 2,000,000 OWNERS 8 CONTRACTOR'S PROT EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE(Any one fire) $ 250,000 MED EXP(Any oneperson) $ 10,000 A AUTOMOBILE LIABILITY AS2-631-507975-048 03/01/08 03/01/09 COMBINED SINGLE LIMIT $ 2,000,000 X ANY AUTO X ALL OWNED AUTOS BODILY INJURY $ X SCHEDULEDAUTOS (Per person) X HIRED AUTOS r �y BODILY INJURY $ X NON-OWNED AUTOS RISK �� f�^ ❑ i- E N f�� i 1 1 l'� (Per accident) 'T- AP o1v11@d. !l L 1 rJ PROPERTY DAMAGE $ GARAGE LIABILITY App angas: AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: . Sig i gn _ ',,.� EACH ACCIDENT $ _ AGGREGATE $ EXCESS LIABILITY EACHOCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND WA7-63D-507975-018(AOS) 03/01/08 03/01/09 X I TORYLIMITS ER EMPLOYERS'LIABILITY g WC7-631-507975-028 (OR) 03/01/08 03/01/09 EL EACH ACCIDENT_ $ 1,000,000 THE PROPRIETOR/ EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVEN OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECNLL ITEMS THE CITY OF FRESNO,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE ADDITIONAL INSURED AS RESPECTS TO GENERAL AND AUTO LIABILITY INSURANCE.THIS INSURANCE IS PRIMARY AND OUR OBLIGATIONS ARE NOT AFFECTED BY ANY OTHER CONTINGENT OR ON ANY OTHER BASIS. CERTIFICATE HOLDER CANCE"TION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL A DAYS WRITTEN NOTICE TO THE CITY OF FRESNO CERTIFICATE.HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR CONSTRUCTION MANAGEMENT DIVISION ATTN:MARYANN LEWIS LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES.OR THE 1721 VAN NESS AVENUE ISSUER OF THIS CERTIFICATE FRESNO,CA 93721 AUTHORIZED REPRESENTATIVEorManhUSAlno- Br: MaryPadaszewski MMI(3102) VALID AS OF:08/15/08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations The City of Fresno, its officers, officials, employees, agents and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section 11 -- Who Is An Insured is amended to in- A. In the performance of your ongoing operations; or clude as an additional insured the person(s) or organi- B. In connection with your premises owned by or zation(s) shown in the Schedule, but only with respect rented toou. to liability for "bodily injury", "property damage" or y "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: This endorsement is executed by the LIBERTY MUTUAL FIRE INSURANCE COMPANY Premium $ NPC. Effective Date 08/15/2008 Expiration Date 03/01/2009 For attachment to Policy No. TB2-631-507975-038. Audit Basis Issued To Suburban Propane Partners, L.P. and Subsidiaries and as per Endorsement 1 ` SECRETARY PRESIDENT Countersigned by _.............._._.-..-.. -.... .,....-..__._...------------------------------ Authorized Representative Issued Sales Office and No. End.Serial No.56 ks 9/18/08 Buffalo, NY CG 20 2G 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsemeffModifieinsurancqDrovidednderthefollowing: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM WithrespecttocoveragqDrovideOythisendorsementf,eprovisioneftheCoverageFormapplyunless=4 fiecbythisendorsement. This endorsemerimentifieperson(s)ororganization(sVhoare"insuredstindertheWhols An InsuredProV- sionoftheCoveragEForm This end orsemerttoesnotaltercoverag(provideahtheCoveragEForm. SCHEDULE Refer to Designated Insured Schedule. NameofPerson(s)orOrganization(s): The City of Fresno, its officers, officials, employees, agents and volunteers. (If noentrNappearsabove,informationequiredlocomplet�hisendorsemeftllbeshownintheDeclarations as applicabWotheendorsement.) Each personororganizatioshowrintheScheduleis an1nsured forLiabiIityCoveragej)utonlytotheextent thatpersonor organ izatioqualifiesas an "insured"underthe Who Is An Insured Provisioncontained insectioril oftheCoveragEForm. POIICy NO:AS2-631-507975-048 Issued By:Liberty Mutual Fire Insurance Co. Effective Date98/15/2008 Expiration Dat@3/01/2009 Sales Office: 0822 Endt Serial No: 115 CA 20480299 CopyrightpsurancEServicesOfficejnc., 1998 Pagel oft WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury Covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires ,you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. i S �.nd.C,rsertte w is not apl-, ..�.os"ALle .in the states KY, r'.t+�. NH, �:� iVt,. Schedule Wr.ere regj,-red by contract or written agreement. This eldorsemerTt is executed Gy the Liberty -Insurance CQr p )rat-Jon 21 614 Premium$ Etlectivt Date Exogration Dave For attachment to Poi€cy No WA?-w 3, _?7 97 s i Gounters:gned by Authorized Representative End.Senal No. 15 WC 00 03 13 Ed, 4/1.°1984 aopyripht.1983 National Councr on Compersal;or insurarT,e.