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Home My WebLink AboutPM 2009-06 - Certificate of Insurance - 12/8/2010 RESCINDS AND REPLACES CERTIFICATE ISSUED ON 10/22/10 ACORDO CERTIFICATE OF LIABILITY INSURANCE DATE 11/4/2010Y) 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). PRODUCER CONTACT __ _ ....... .... ....._ Alliant Insurance Services,Inc. NAME, PHONE: _ 1301 Dove St.,Suite 200 _- Are.NO: Newport Beach,CA 92660 E-MAIL ADDRESS: 949-756-0271•Fax 949-756-2713•License No.OC36861 PRODUCER: _m. CUSTORER,ID 1 INSURED: SPECIAL LIABILITY INSURANCE PROGRAM(SLIP)MEMBER: INSURER(S)AFFORDING COVERAGE NAIC A FRESNO COUNTY EMPLOYEES'RETIREMENT ASSOCIATION AS ___..___,.__......_.._._.___..__ __._...__......_............_. RESPECTS TO BUILDING LOCATED AT 1111 H.STREET,FRESNO, INSURER A: ALLIED WORLD NATIONAL ASSURANCE CO. 10690 CA 93721 INSURER B: -... . .._...............................-_..................................................._...._........._......._._._.__._._......._......_._..._..._..__........._._............................... 1111 H STREET INSURER C. FRESNO,CA 93721 ---. �__._.._.._..— _.__..�... _....._.......... .... ........................ INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER Lia INSR wVD (MM/DD/YY) (MM/DDIYY) LIMITS A GENERAL LIABILITY X 0305-9514 09/29/10 09/29/11 EACH OCCURRENCE $5,000,000 XAMA E RE ED COMMERCIAL GENERAL LIABILITY PREMISES Ea Occurrence $1,000.000 CLAIMS MADE F.X OCCUR MED EXP(Any One person) N/A GL DED: $5,000$5,000 PERSONAL&ADV INJURY $5 000,000 _GEN'L AGGREGATE LIMIT APPLIES_PER: GENERAL AGGREGATE NA` X POLICY PRO- LOC PRODUCTS-COMP/0PAGG. $5,000,000 A AUTOMOBILE LIABILITY 0305-9514 09/29/10 09/29/11 COMBINED SINGLE LIMIT _iEaAccidentl.._._.__._. ............................$5,000,000 .......... ................................. ANY AUTO BODILY INJURY(Per person) .............. ._.............-............................................I................._.... .............................................................. ALL OWNED AUTOS BODILY INJURY(Per accident) SCHEDULED AUTOS PROPERTY DAMAGE ........................_.......................... .......... ....................... X HIREDAUTOS ....._.._. ..._......................._._..............._...... X NON-OWNED AUTOS _ ....._...................................................................._....... .. .....-"_—........ .. .. AUTO DED: $5,000$5,000 UMBRELLA LIAB OCCURRISE X NIAT64 LAVIZ-I OCCURRENCE ................. ._........... EXCESSLIAB Ap roved CLAIMS AGGREGATE DEDUCTIBLE Ap ro hanges: RETENTION WORKERS COMPENSATION wcsrATu- _0TH EMPLOYERS LIABILITY Ylti_ r-� ie roavuMns ER ANYPROPRIETORY/PARTNER/EXECUTIVE N/A Lj OFFICER I MEMBER EXCLUDED'/ L_ I� E.L.EACH ACCIDENT _.____�._...___......._..__....................._._...._.__......_.__.__.....,._._................ (MANDATORY IN NH)IF YES.DESCRIBE E.L.DISEASE-EA EMPLOYEE _ UNDER DESCRIPTION OF OPERATIONS BELOW E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES(Attach Acord 101,Additional Remarks Schedules,if mora space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS TO SUBDIVISION AGREEMENT PARCEL MAP NO.2009-06,CITY OF FRESNO,PUBLIC WORKS DEPARTMENT,P.W.FILE NO.5494-2009-06 FOR MODIFICATION OF CURB RAMPS AND MISCELLANEOUS REPAIRS&UPDATES AT THE BUILDING AT 1111 H.STREET,FRESNO,CA. CITY OF FRESNO,ITS OFFICERS,OFFICIALS,AGENTS,EMPLOYEES AND VOLUNTEERS SHALL BE NAMED ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND NOT AFFECTED BY ANY OTHER INSURANCE CARRIED BY SUCH ADDITIONAL INSURED WHETHER PRIMARY.EXCESS. CONTINGENT,OR ON ANY OTHER BASIS. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS,CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER CANCELLATION CITY OF FRESNO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE %CONSTRUCTION MANAGEMENT DIVISION,ATTN:MARYANN THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN LEWIS ACCORDANCE WITH THE POLICY PROVISIONS. 2600 FRESNO STREET FRESNO,CA 93721-3603 AUTHORIZED REPRESENTATIVE ACORO 25(2009/09) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION All rights reserved AGENCY CUSTOMER ID: LOC#: AC o D° ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED:SPECIAL LIABILITY INSURANCE PROGRAM(SLIP)MEMBER ALLIANT INSURANCE SERVICES, INC. FRESNO COUNTY EMPLOYEES'RETIREMENT ASSOCIATION AS POLICY NUMBER RESPECTS TO BUILDING LOCATED AT 1111 H.STREET,FRESNO,CA 0305-9514 93721 1111 H STREET CARRIER NAIC CODE FRESNO,CA 93721 ALLIED WORLD NATIONAL ASSURANCE CO. 10690 EFFECTIVE DATE:09/29/10 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25(2009109) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice slating when,not less than sixty(60)days thereafter,such cancellation shall be effective.Provided that the Participating Named Insured fails to discharge,when due,any of its obligations in connection with the payment of premium for the policy or any installment thereof,the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement,written notice stating when,not less than ten(10)days thereafter,such cancellation shall be effective- /L e—ACORD 101(2008101) 02008 ACORO CORPORATION All nghts reserved. The ACCRO name and logo are registered marks o(ACORD ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION IT IS AGREED THAT THE FOLLOWING ARE ADDED AS ADDITIONAL INSURED(S)HEREUNDER BUT ONLY AS RESPECTS LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED, AND FURTHER PROVIDED THAT THE INCLUSION OF SUCH ADDITIONAL INSURED SHALL NOT SERVE TO INCREASE THE COMPANY'S LIMIT OF LIABILITY AS SPECIFIED IN THE DECLARATIONS OF THE POLICY. SCHEDULE NAMED INSURED: FRESNO COUNTY EMPLOYEES'RETIREMENT ASSOCIATION AS RESPECTS TO BUILDING LOCATED AT 1111 H.STREET,FRESNO,CA 93721 1111 H STREET FRESNO,CA 93721 NAME OF PERSON OR ORGANIZATIONXERTIFICATE HOLDER: CITY OF FRESNO PUBLIC WORKS DEPARTMENT 2600 FRESNO STREET FRESNO,CA 93721-3603 CITY OF FRESNO,ITS OFFICERS,OFFICIALS,AGENTS,EMPLOYEES AND VOLUNTEERS SHALL BE NAMED ADDITIONAL INSURED AS RESPECTS TO SUBDIVISION AGREEMENT PARCEL MAP NO.2009-06,CITY OF FRESNO,PUBLIC WORKS DEPARTMENT,P.W.FILE NO.5494-2009-06 FOR MODIFICATION OF CURB RAMPS AND MISCELLANEOUS REPAIRS& UPDATES AT THE BUILDING AT 1111 H.STREET,FRESNO,CA. THIS INSURANCE IS PRIMARY AND NOT AFFECTED BY ANY OTHER INSURANCE CARRIED BY SUCH ADDITIONAL INSURED WHETHER PRIMARY,EXCESS,CONTINGENT,OR ON ANY OTHER BASIS. PER CERTIFICATES OF INSURANCE APPROVED BY THE COMPANY,AND ON FILE WITH THE COMPANY EFFECTIVE DATE OF THIS ENDORSEMENT: 09/29/10 ATTACHED TO AND FORMING A PART OF POLICY NO.: 0305-9514 All other terms and conditions remain unchanged. Insurer: ALLIED WORLD NATIONAL ASSURANCE CO. Special Liability Insurance Program(SLIP) Effective September 29, 2010 to September 29, 2011 DATE ISSUED: 11/4/2010 FRESNO COUNTY EMPLOYEES'RETIREMENT ASSOCIATION BOARD OF RETIREMENT Eulalio Gomez,Chair James E. Hackett,Vice Chair Michael Cardenas Nick Cornacchia Franz Criego Vicki Crow Steven J.Jolly Roberto L. Pefia Phil Larson Retirement Administrator John P.Souza Ronald S. Frye,Alternate November 5, 2010 Jon Bartel City of Fresno Public works Department 2600 Fresno Street Fresno, CA 93721-3603 Dear Mr. Bartel: This letter serves as formal confirmation that the Fresno County Employees' Retirement Association (FCERA) does not own any automobiles, and therefore does not carry automobile insurance as required by the Subdivision Agreement. Please call me or Becky Van Wyk at 559.457.0681 if you have any further questions. Sincerely, oberto L. Pena Retirement Administrator RLP:BVW RI%'31', MA (AGEMENT DIVI-;--,v Aper v--cj: 'I/C "ec" Ap, r ved /Changes: Dr V Signed Dute 1111 H Street, Fresno, CA 93721,Tel 559.457.0681 Fax 559.457.0318 CO Cert Heate of Self-insurance g6 Risk Mmmgement Division.2220 Tulare St,21 sl !='l..Fresno.CA 9.3,72 i C'oycagc: The C'oualty of rresno is self-insured for the: followin; coverage: Type of Coverage Self-]nsured l..AWt It'orlcers Compensation $2.000,000 -l-errnb, Conditions and "pecial Items 1. Ile cofficadon of scHAnsurance provided by this docunlem eorlfornls to the policies of the County of Fresno, which do not permit the assumption of liability arising f.roill the negligence of individi.tals rvllo ai•e not officers oi•enil)loyees oi'the C'otnity. This document is to be used to support indemnification agreements that do not extend to the negligence oi'others. 2. The provisions included in the General Liability section shall apply only NO. respect to claims allMng,out of the neoigent bels or mullions of the County of Fresno, or its olfaems and employees. Cancellation Should any of the above described self-insurance coverages be nxxlrled or cancelled before the expiration dale shown Wow the Colri.lty of Fresno "A provide 30 dy,,s written notice to the named certificate holder. Certitiuite Holder; Date Issued: November 18,2010 Cite of Fresno C.:crtificate expiradwi date 2400 lAvsno Street lune >0. 20l 1 Fresno,CA 93721-3603 (I Ftvsno Count} Retirement ANsoetalion preparation of a Gregory S. 13orboa Parcel XUp and eonstmobn orapproaelt and nm&;n improvemems.Construction to he done by indepcndettt Vsk Managcr iOnUaclor DIVISION /Changes: -2 Sigt1 CERTIFICATE NO. ISSUE DATE(MMIDDIYYYY) WC-1476 CERTIFICATE OF COVERAGE 11/1712010 THIS CERTIFICATE F'RTIFICATE 13 ISSUED AS A MAI I-ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C LRTI FICA I E HOLDER, THIS CERTIFICATE DOES NOT AFFIN"e'ATIVE1.y CSAC Excess Insurance OR NEGATIVELY AME NO.E XTE ND OR ALT F R THE COV I:RAG 317 AF FOR 13ED 6F-LOW 7HIS CERTiFiCATC OF COVERAGC DOES NOT CONSTITIT(JEA CONTRACT BETWEEN THE Authority fSSjiNG INSURER(S),AUTHORIZED RLPilizSuq rAI-IVI,-.OR PRODUCER,AND THE CFRTII-'ICA)E HOLDER C/O ALLIANT INSURANCE SERVICES,INC. PO BOX 6450 IMPORTANT*If the certificate holder is ferlimstirifIa WAIVER OF SILIBROGATION.the Mentorindunis of Coverage must be oridorsed.A statemen;on INS mbficLto does not confer NEWPORT BEACH,CA 92658-6450 nc)hts to 111L holder 111 li(-,'U Of Wolf LndO,'Se1ni?nL(9). PHONE(949)756-0271 1 FAX(619)699-0901 COVERAGE LICENSE i,'OC36861 AFFORDED BY: A-See attached schedule of insurers Member: COVI-'RACE' FRESNO COUNTY AFFORDED BY. B ATTN-DON GRAN! 2220TULARE STREET.21ST FLOOR COVERAGIz FRESNO.GA 93721-2108 AFFORDED BY C COVERAGE AFFORDED BY. D Coverages THIS IS TO CERTIFYTHAT THE MEMORANDUMS OF COVERAGE AND POLICY LISTED BELOW HAVE BEEN ISSUED TO'YHE MEMBER NAMED ABOVE FOR'THE PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREIAENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED By THE MEMORANDUMS AND POLICY DESCRIBED HEREIN 19 SUBJECT TO ALL THE TERMS,EXCLUSIONS.AND CONDITIONS OF SUCH MLMOIRANOUMS AND POLICY. TYPE Or COVERACE- MEMORANDUM/ COVERAGE EFFECTIVE COVERAGE EXPIRATION LIABILITY LIMITS LTR POLICY NUMBER DATE(fJWf;OfYYYY) DATE(MMiDDiYYYY) A EXCESS%-VORKER S' See attached for 0710112010 07,101/2011 WORKERS'COMPIE."NSWI ION. COMPENSATION& insurers policy Diffe,en(x!baNveen EMPLOYERS*LIABILITYnumbers Statutory and,%'wmbc,'& G500.000 Retention EMPLOYERS'LIAMLITY Off(drance b0.veen 55.000,000 and Member's $500.000 Retention I I LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED. Description of Or)cralioiis'l-octitioiis/Veh:.clesfSpeci@I Items: AS RESPECTS EVIDENCE OF COVERAGE FOR FRESNO COUNTY RETIREMENT ASSOCIATION PREPARATION OF A PARCEL_ MAP AND CONSTRUCTION OF ROADWAY IMPROVEMENTS. (PARCEL MAP 2009-06) R1 S NIA" AGEMENT Approve Appr ved +/Changes: 51�0 e I Certificate Holder SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMSOF COVEFZAGErPOLICIL-$ BE CACELLED Ki�ORL I'l-11'F-'XPIRATION NTICE WILL BF DLLIVERED CITY OF FRESNO ACCORDANCE WITHTHE ME'MORANOUMS OF COVETHEF4EOF.RAGOE41OUCIES PROVISIONS- IN 2600 FRESNO STREET FRESNO,CA 93721-3603 AUTHORIZE0 REPRIISENTArIVE CSI,C EXCI-SS 1R$UAA-jGE AUTHORITY .... ......... ....... ............... r CSAC EXCESS INSURANCE AUTHORITY EXCESS WORKERS' COMPENSATION PROGRAM 201012011 SCHEDULE OF INSURERS Fresno County PROVIDER POLICY NUMBER LIMIT CastlePoint National insurance Company WSRSWC 100001 03 Workers'Compensation: (80%quota share) $ 875,000 maximum each accident/each employee for disease 1 $ 875,000 maximum each accident for communicable disease CSAC Excess Insurance Authority(20% ! EIA 10 EWC-04 (difference,between $1,000,000 and the individual quota share) ( member SIR) t Employers Liability: $ 875,000 Each Accident $ 875,000 Each Employee for Disease (difference between$1,000,000 and the individual member SIR) CSAC Excess Insurance Authority j EIA 10 EWC-04 I $ 4,000,000' each accident or each employee for disease ' `(Maximurn$4,000,000 or the difference of $5,000,000 and individual member SIR greater than I $1,000,000) ACE Arnarican Insurance Company WCL C4571312A $45,000,000 each accident/each employee for disease excess of$5,000,000 f $45,000,000 each accident for communicable disease excess of$5,000,000 National Union Fire Insurance Co.of 488-0465 ; Statutory each accident/each employee for Pittsburgh, PA(Chartist' disease excess of$50,000,000 FWC below$1MIL PAGE 2 of 2