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HomeMy WebLinkAboutPM 2009-08 - Certificate of Insurance - 8/4/2011 SCTA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 7/28/2011 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). ACT PRODUCER (559)432-0222 NAME: IC�DiBuduo&DeFendis Insurance Brokers, LLC (PA o Ext: A/C No: License#OE02096 E-MAIL P.O. Box 5479 ADDRESS: Fresno,CA 93755-5479 CUSTOMER ID#:BOMBDIG-01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Shields&Armstrong,Tandem Reductions INSURER A:Travelers Property Casualty Company of A c/o Northstar Management Attn: Cindy Shipstead INSURER B: 7108 N. Freso St.,Suite 370 INSURER C: Fresno,CA 93720- 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 UBR POLICY EFF POLICY EXP LIMITS LTR INSR POLICY NUMBER MM/DD/YYYY MM/DDrrM GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 6804631 B443 10/15/2010 10/15/2011 pREMISESEa occurrence $ 300,000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000000 GENERAL AGGREGATE $ 2,000000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO $LOC < EVT AUTOMOBILE LIABILITY pproved COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO A pp ved /Changes .�r BODILY INJURY(Per person) $ ALL OWNED AUTOS r BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY�') HIRED AUTOS S G at f (Per accident)AMAGE $ NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 2,000,00 A CUP9613W869 10!1512010 1011512011 DEDUCTIBLE $ X RETENTION $ NIL $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: P.W. File No.5494-2009-08-Sub Division Agreement "The City of Fresno,its officers,officials, employees agents and volunteers"are to be named as additional insured as respects to general liability per form CG2013 11 85-Other Insurance-Excess B.PROVISIONS Any other insurance available to the insured designated above shall be considered to be excess of this insurance and this insurance shall apply as primary per form CGT34807 86. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. %Construction Management Division, Attn: MaryAnn Lewis 1721 Van Ness Avenue Fresno,CA 93721- AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 68046318443 ISSUE DATE: 7/28/11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED STATE OR POLITICAL SUBDIVISIONS PERMITS RELATING TO PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State or Political Subdivision: Re: P.W. File No. 5494-2009-08- Sub Division Agreement "The City of Fresno,its officers,officials, employees agents and volunteers" City of Fresno % Construction Management Division,Attn: MaryAnn Lewis 1721 Van Ness Avenue Fresno, CA 93721 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED(Section II)is amended to 1. The existence, maintenance, repair,construction, include as an insured any state or political sub- erection,or removal of advertising signs,awn division shown in the Schedule,subject to the follow- ings,canopies,cellar entrances,coal holes, ing additional provision: driveways, manholes, marquees,hoist away openings,sidewalk vaults,street banners,or This insurance applies only with respect to the follow- decorations and similar exposures;or ing hazards for which the state or political sub- 2. The construction,erection,or removal of division has issued a permit in connection with elevators;or premises you own, rent,or control and to which this insurance applies: 3. The ownership, maintenance,or use of any elevators covered by this insurance. CG 20 1311 85 Copyright, Insurance Services office, Inc., 1984 Page 1 of 1 POLICY NUMBER: 6804631B443 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 7/28/11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - EXCESS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. SCHEDULE Designated Insured Re: P.W. File No. 5494-2009-08 - Sub Division Agreement "The City of Fresno, its officers, officials, employees agents and volunteers" City of Fresno % Construction Management Division, Attn: MaryAnn Lewis 1721 Van Ness Avenue Fresno, CA 93721 (If no entry appears above, information required to complete this endorsement will be shown in theDeclarations as applicable to this endorsement.) B. PROVISIONS Any other insurance available to the insured designated above shall be considered to be excess of this insurance and this insurance shall apply as primary. CG T3 48 07 86 Page 1 of 1 E.P. Graham & Company PO Box 22920 Carmel, CA 93922 Phone: 831+624-2494 eFAX: 508+464-6626 Email: ernie(clJgrahamdevelloopment.com Website: www.graliamdevelopnieiit.c;om To: Kerry Trost From: Ernest P. Graham RE: Shields&Armstrong,Tandem Reductions,a California Limited Partnership I herby Certify that: Shields &Armstrong,Tandem Reductions,a California Limited Partnership does not own any of the following: Does not own any Commercial Auto's to require Auto Coverage Does not perform ant professional services requiring Professional Liability Does not have any employees requiring Workers Comp Coverage Sincerely, Ernest P.Graham City of MEMORANDUM DEVELOPMENT AND RESOURCE MANAGEMENT DEPARTMENT-DEVELOPMENT SERVICES DIVISION-2600 FRESNO STREET-FRESNO,CA 93721 DATE: July 27, 2011 TO: KERRY TROST Personnel Services Department FROM: JONATHAN BARTEL Development and Resource Management Department SUBJECT: REQUEST FOR CERTIFICATE OF LIABILITY AND ENDORSEMENT OF INSURANCE APPROVAL FOR PARCEL MAP NO. 2009-08 Attached are certificates of liability insurance required for the subdivision agreement for the Parcel Map. Please review for conformity to City acceptance policies. Thank you, Jonathan Bartel as c...s SCTA A`CO�RO CERTIFICATE OF LIABILITY INSURANCE FDA77126/DDIY2011 7/26/ 1 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). CONT PRODUCER (559)432-0222 NAMEACT DiBuduo& DeFendis Insurance Brokers, LLC PHONE FAX AIC No Ext): JAIC,No): License#OE02096 E-MAIL ADDRESS: P.O. Box 5479 PRODUCER Fresno, CA 93755-5479 CUSTOMER ID u:BOM BDIG-01 INSURER(S)AFFORDING COVERAGE NAIC C INSURED Shields&Armstrong,Tandem Reductions INSURER A:Travelers Property Casualty Company of A c/o Northstar Management Attn: Cindy Shipstead INSURER B: 7108 N. Freso St., Suite 370 INSURERC: Fresno, CA 93720- 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. ILTR TYPE OF INSURANCE NSRAN DL SUBR POLICY NUMBER MM/DDIYYYY MM DPLICY EFFCD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A ICOMMERCIAL GENERAL LIABILITY 680463113443 10/15/2010 10/15/2011 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE I X I OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,010000 GENERAL AGGREGATE $ 2,00000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PE O- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 A CUP9613W869 10/15/2010 10/15/2011 DEDUCTIBLE $ X RE"fENTION $ NIL $ WORKERS COMPENSATION WCysTATO- ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yyes describe under as, OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space i5 required) Re: P.W.File No.5494-2009-08-Sub Division Agreement City of Fresno,Public Works Department,its officers,Officials agents employees and volunteers are to be named as additional insured as respects to general liability form CGD3250104-insurance policies shall be primary and no contribution shall be required by the City per policy forms and conditions form CGD0370405. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fresno,Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. Scott L.Mozier PE City-Engineer I Assistant Director 2600 Fresno Street,4th Floor Fresno,CA 93721-3623 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD CG D3 25 01 04 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MORTGAGEE, ASSIGNEE, SUCCESSOR OR RECEIVER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON OR ORGANIZATION: City of Fresno, Public Works Department DESIGNATION OF PREMISES: Re: P.W. File No. 5494-2009-08 -Sub Division Agreement City of Fresno, Public Works Department, its officers, Officials agents employees and volunteers are to be named as additional insured as respects to general liability form CGD3250104- insurance policies shall be primary and no contribution shall be required by the City per policy forms and conditions form CGD0370405. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). 1. WHO IS AN INSURED(Section II)is amended to include as an insured the person(s)or organization(s)shown in the Schedule but only with respect to their liability as mortgagee, assignee,successor or receiver and arising out of the ownership, maintenance,or use of the premises by you and shown in the Schedule. 2. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. CG D3 25 01 04 COMMERCIAL GENERAL LIABILITY FHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury"or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However,if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis,or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph(1) ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy,including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs;and o= CG DO 37 04 05 Copyright 2005 The St.Paul Travelers Companies,Inc.All rights reserved. Page 1 of 1 00381 Jon Bartel From: Tammy Scrivner [tscrivner@dibu.com] Sent: Tuesday, July 26, 2011 4:53 PM To: Scott Mozier; 'S. Thomas McLaughlin'; 'Larry Russel'; 'Ernest P. Graham' Cc: 'Edward Dunkel'; 'Terra Mortensen'; Greg Loosigian (E-mail) Subject: Shields Armstrong--Tandem Reductions Re: PM 2008-09 Attachments: Certificate City of FresnoPublic Works.pdf; FORM CGD0370405.doc Good Afternoon Attached please find the certificate of insurance as requested. As per Greg Loosigian email dated 7113/11 please see comments regarding requirements below. This entity Shields &Armstrong, Tandem Reductions: Does not own any Commercial Auto's to require Auto Coverage Does not perform ant professional services requiring Professional Liability Does not have any employees requiring Workers Comp Coverage This entity Shields S Armstrong, Tandem Reductions: will only be required to provide the city Commercial General Liability coverage-- naming the city of Fresno as an Additional Insured and Subdivider Insurance will be Primary and No Contribution shall be required of the City. Should you have any further questions and/or concerns please contact our office. Thank you! Tammy Scrivner Assistant to Greg Loosigian DiBuduo & DeFendis Brokers LLC 6873 N. West Ave. #101 Fresno, Ca 93711 (559) 437-6650 (559) 437-6651 FAX TscrivnerCNdibu.com License OEO2096 Coverage cannot be bound or altered without confirmation from your agent or agency personnel. This communication, including attachments, is for the exclusive use of addressee and may contain proprietary, confidential and/or privileged information. If you are not the intended recipient, any use, copying, disclosure, dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify,the sender immediately by return e- mail, delete this communication and destroy all copies. 1