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HomeMy WebLinkAboutPM 2010-02 - Certificate of Insurance - 6/11/2012 City of ClDCt0k\1U\I� MEMORANDUM% rn!Q iw .amw DEVELOPMENT AND RESOURCE MANAGEMENT DEPARTMENT•DEVELOPMENT SERVICES DIVISION-2600 FRESNO STREET-FRESNO,CA 93721 DATE: June 8, 2012 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. 2010-02 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 �- rT' W A�" CERTIFICATE OF LIABILITY INSURANCE 6�7�2012YYY) 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(les)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 Kathie Thatcher NAME: EATON & EATON INSURANCE BROKERS PHONE AIC. . (559)485-7100 F'O'X Nol. (559)485-6476 2115 Kern Street, Suite 100 EDAIL .kthatcher@eatonandeaton.com INSURERS AFFORDING COVERAGE NAIC 0 Fresno CA 93721 INSURER A:Fireman Is Fund 108315 INSURED DeWayne Zinkin INSURER B: INSURER C: 5 River Park Place West INSURER D: Suite 203 INSURER E: Fresno CA 93720 INSURER F: COVERAGES CERTIFICATE NUMBER:DeWayne Zinkin 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 1 TYPE OF INSURANCE D UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/D MM/DD YYY GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 AGE ToRENTED x COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE Fx] OCCUR tfI L NIIA14AGEMENT Dl ION 7/1/2012 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 I"7p OV w/Ch ges• GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 }{ POLICY JFrT PRO LOC $ AUTOMOBILE LIABILITY J COMBINED SINGLE LIMIT Es ccidentl $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X ZX80931461 7/1/2011 7/1/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Medical payments $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 8,000,000 A [:�EXCESS LIAB CLAIMS-MADE AGGREGATE $ 8,000,000 DED RETENTIONS U48456735 7/1/2011 7/1/2012 $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N —ITORY LIMITS ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) The City of Fresno and its officers, officials, employees, agents, and volunteers are additional insured per policy section attached. Policies include a 30 notice of cancellation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. 2600 Fresno Street Fresno, CA 93721-3603 AUTHORIZED REPRESENTATIVE R Gregory Eaton/LISAH 1�-2-� -- ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. I N S 0 2 5(201005).01 The ACORD name and logo are registered marks of ACORD MultiCover® - CG 71 58 12 07 Policy Amendment(s) Commercial General Liability Coverage Form Your Commercial General Liability Coverage Form is (3) Coverage B does not apply to per- revised as follows: conal and advertising injury arising - out of an offense committed before 1. Broadened Named Insured you acquired or formed the organ- - ization. A. SECTION II - WHO 1S AN INSURED, item 3., is deleted and replaced by the follow- B. SECTION II - WHO 1S AN INSURED,the _ ing: last paragraph, is deleted and replaced by the following: 3. Any organization that you own at the inception of this policy, or newly acquire No person or organization is an insured with _ or form during the policy period, and respect to the conduct of any current or past over which you maintain during the pol- partnership, joint venture, or limited liability icy period majority ownership or major- corr►pany that is not shown as a Named In- sured interest, will qualify as a Named sured in the Declarations. However, this does Insured if: not apply to a limited liability company that meets all of the conditions in Section 11 - a. There is no other similar insurance Who is An Insured, item 3., above. available to that organization; and 2. Additional Insured b. The first Named Insured shown in SECTION II - WHO IS AN INSURED, sub- the Declarations has the responsi- section 2.e., is added as follows: bility of placing insurance for that organization; and e. Any person or organization is included as an additional insured, but only to the extent such c. That organization is incorporated or person or organization is held liable for organized under the laws of the bodily injury, property damage or personal and United States of America. advertising injury caused by your acts or omissions. With respect to the insurance af- forded to such insured, all of the following (1) Coverage under this provision 3 is additional provisions apply: afforded only until the next occur- (1) You and such person or organization ring annual anniversary of the be- have agreed in a written insured contract ginning of the policy period shown that such person or organization be in the Declarations,or the end of the added as an additional insured under this policy period, whichever is earlier; policy; and (2) The bodily injury, property damage or (2) Coverage A does not apply to bodily personal and advertising injury for which injury or property damage that oc- said person or organization is held liable curred before you acquired or occurs subsequent to the execution of formed the organization; and such insured contract; This Form must be attached to Change Endorsement when issued after the policy is written. One of the Fireman's Fund Insurance Companies®as named in the policy Secretary President CG7158 12-07S Copyright 2007, Fireman's Fund Insurance Company, Novato,CA. All rights reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page I of 7 (a) Bodily injury or property damage for into, accompanying or containing such which the vendor is obligated to pay products. damages by reason of the assump- tion of liability in a contract or However, if an Additional Insured - Vendors agreement. This exclusion does not elidorsement is attached to this policy that apply to liability for damages that specifically names a person or organization as the vendor would have in the ab- an insured, then this subsection 21 does not Bence of the contract or agreement; apply to that person or organization. (b) Any express warranty unauthorized 4. Additional Insured - Limited Primary and Non- by you; contributory Provision (c) Any physical or chemical change in The following is added as a second paragraph to the product made intentionally by Section IV Conditions, Condition 4. Other Insur- the vendor; ance, I'011owing paragraph b.(2): im (d) Repackaging, unless unpacked solely However, if you have added any person, organza- =_ for the purpose of inspection, dem- tion or vendor of yours as an additional insured to onstration, testing, or the substi- this policy by way of this MultiCover® endorse- tution of parts under instructions ment And have agreed in a written insured contract from the manufacturer, and then re- that tiiiis insurance is primary and non-contribu- packaged in the original container; tory with other insurance available to that addi- tional insured, this insurance is primary and we (e) Any failure to make such in- will not seek contribution from such additional spections, adjustments, tests or ser- insured's other insurance. This provision does not vicing as the vendor has agreed to apply to other insurance to which such additional make or normally undertakes to insured has been added as an additional insured. make in the usual course of busi- ness, in connection with the distrib- 5. Waiver of Subrogation ution or sale of the products; SECTION IV - COMMERCIAL GENERAL (f) Demonstration, installation, servic- LIABILITY CONDITIONS, item 8., is deleted ing or repair operations, except such and replaced by the following: operations performed by the vendor in full compliance with the man- 8. I'ninsfer of Rights of Recovery Against Oth- ufacturer's written instructions at the ers to Us and Blanket Waiver of Subrogation vendor's premises in connection with the sale of the product; a. If the insured has rights to recover all or part of any payment we have made under (g) Products which, after distribution this Coverage Part, those rights are or sale by you, have been labeled or transferred to us. The insured must do relabeled or used as a container, part nothing after the loss to impair those or ingredient of any other thing or rights. At our request, the insured will substance by or for the vendor; or bring suit or transfer those rights to us and help us enforce them. (h) Bodily injury or property damage arising out of the liability of the b. If required by a written insured contract vendor for its own acts or omissions executed prior to the occurrence or of- or those of its employees or anyone fense, we waive any right of recovery we else acting on its behalf. may have against any person or organ- ization named in such insured contract, (2) This insurance does not apply to any in- because of payments we make for injury sured person or organization from whom or damage arising out of your operations you have acquired such products or any or your work for that person or organ- ingredient, part or container, entering ization. CG7158 12-07S Copyright 2007, Fireman's Fund Insurance Company, Novato,CA. All rights reserved. Includes copyrighted material of Imurance Services Office, Inc„ mth its pem!.s,on. Page 3 of 7 CERTHOLDER COPY NE COMPENSATIONP.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 INSURANCEFUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-07-2012 GROUP: 000702 POLICY NUMBER: 0000037-2011 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 04-01-2013 04-01-2012/04-01-2013 THE CITY OF FRESNO NE 2600 FRESNO ST FRESNO CA 93721-3620 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. W14.""" G/ ,— tAu7thoriRepresentative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - DEWAYNE ZINKIN PRES - EXCLUDED. ENDORSEMENT #1901 - ZINKIN, DEWAYNE - EXCLUDED. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2012-06-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: THE CITY OF FRESNO EMPLOYER ZINKIN, DEWAYNE NE 5 E RIVER PARK PL W STE 203 FRESNO CA 93720 [81J,NE] PRINTED : 06-07-2012 (REV,8-2010)