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HomeMy WebLinkAboutT-5531 - Certificate of Insurance - 11/19/2014 CifyQf MEMORANDUM rr1—=Z PUBLIC WORKS DEPARTMENT LAND DIVISION 2600 FRESNO STREET FRESNO,CA 93721 DATE: November 17, 2014 TO: LORI NAJERA Personnel Services Department FROM: JONATHAN BARTEL Public Works Department SUBJECT: REQUEST FOR CERTIFICATE OF LIABILITY AND ENDORSEMENT OF INSURANCE APPROVAL FOR THE FINAL MAP OF TRACT NO. 5531 Attached are certificates of liability insurance required for the subdivision agreement for the Final Map. Please review for conformity to City acceptance policies. The Certificate Holder is Ken Turner in Public Works. If you have any questions, please contact me at 621-8684. Thank you, Jonathan Bartel C =4 rTj p �=;CD c� rn cn DATE(MMIDDlri'YY) ,�tRo CERTIFICATE OF LIABILITY INSURANCE 111312014 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 2 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'p NAME: Aon Risk Services Central, Inc. PHONIEFAx Southfield MT Office (AIC.No.Ex,): (866} 283-7122 (A/C.No.): (800) 363-0105 SuitteT300ocenter RISK MANAGEMENT D VfSI ppRESS:MAIL _ Southfield MI 48075 USA q A�1pCQYBd INSURER{S)AFFORDING COVERAGE NAIC# INSURED Y INSURER A: Old Republic insurance Company 24147 Centex Homes, a Nevada 4��DM INSURER B: General Partnership i; 6210 Stoneridge Ma11 Dr. INSURERC: 5th FloorINSURER D: Pleasanton, CA 94588 USA ' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055856751 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- Limits shown are as requested POLICY EFF POLICY EXP LTR INSIR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM1DD MMOD LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY3021513 04/01/2015 EACH OCCURRENCE $2,000,000 CLAIMS-MADE ❑X OCCUR S2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $5,0()o PERSONAL&ADV INJURY $2,000,000 h GEN'LAGGRFGATE LIMITAPPLIES PER: GENERALAGGRFGATE $2,000,000 16 x POLICY ❑JECT ❑LOC PRODUCTS AGS $2,000,000 N OTHER: o r` A AV70MORPLE LIABILITY MWTB301156 04/01/2014 D4/01/2015 COMBINED SINGLE LIMIT 'n Ea accident $2,000,000 X ANYAUTO BODILY INJURY(Per person) O Z ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) - HIREDAUTOS NON-OWNED PROPERTY DAMAGE V AUTOS (Per accident) 1r d UMBRELLA LIABOCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND MWC30215700 04/01/2014 04/01/2015 X PER STATUTE I OTH- EMPLOYERS'LIABILITY y I N ER ANY PROPRIETOR 7 PARTNER 1 EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICERIMEMRER EXCLUDED? NNIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below S.L.DISEASE-POLICY LIMIT $2,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Fresno, its officers, officials, agents, employees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability poliCieS. General Liability and Automobile Liability 111121-Aevidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance !Wi with the policy's provisions. A waiver of subrogation is granted in favor of City of Fresno, its officers, officials, agents, employees and volunteers in accordance with the policy provisions of the workers' compensation policy. R 6J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE � POLICY PROVISIONS. City of Fresno AUTHORIZED REPRESENTATIVE Attn: Heidi Briggs, Risk Management Di Vi Si On 2600 Fresno St., Room 1070 Fresno CA 93721-3612 USA ©1988-2014 ACORD CORPORATION.Al rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations When required by written contract On file with company Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does nota 1 to "bodily Injury" or damage" or "personal and advertising injury" property damage occurring after: apply y caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its I. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 0413 O Insurance Services Office, Inc., 2012 Page 1 of 2 MIN7V'1n94FR Mdfnl:rni.n !n& na1A112naa-nAIM121T9 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 O Insurance Services Office, Inc., 2012 Page 1 of 1 MMV7V 40914R PultnArnun Inr nAlmi9llld-nd/n1MA15 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Organization(s) Location And Description Of Completed Operations When required by written contract On file with corn pany Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section ill—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused,in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-curnploted operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law,and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 (D Insurance Services Office, Inc.,2012 Page 1 of 1 MWZY 302158 PulteGroup,Inc. 0410112014-0410112015 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US SCHEDULE Number of Days Notice of Cancellation: 30 Person or Organization: City of Fresno Address: 2600 Fresno Street, Room 1030 Fresno, CA 93721 Provisions If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. PIL 028 05 10 MIA/7V in21SR Pidta mim !nr nam-119MA-neinriMV; THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (03-10)AND CA 00 01 (03-06) IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSUREDIDESIGNATED INSURED AMENDMENT - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Designated Person(s)or Organization(s): City of Fresno WHO IS AN INSURED (SECTION II) is amended to include the person(s)or organization(s) shown in the above Schedule, but only with respect to "accidents" arising out of work being performed for such person(s)or organization(s). As respects any person(s) or organization(s) shown in the above Schedule with whom you have agreed in a written contract to provide primary insurance on a non-contributory basis, this insurance will be primary to and non-contributing with any other insurance available to such person(s)or organ izations(s). PCA 048 06 07 MM/TR 46i1SS P211fGrrnlln 1nr AG/h1/9l11Q_polflR/?A1R THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (10-13) IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED/DESIGNATED INSURED AMENDMENT - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Designated Person(s) or Organization(s): City of Fresno WHO IS AN INSURED (SECTION II) is amended to include the person(s)or organization(s) shown in the above Schedule, but only with respect to "accidents" arising out of work being performed for such person(s)or organization(s). As respects any person(s) or organization(s) shown in the above Schedule with whom you have agreed in a written contract to provide primary insurance on a non-contributory basis, this insurance will be primary to and non-contributing with any other insurance available to such person(s) or organizations(s). PCA 048 10 13 Page 1 of 1 ULA/TR IA4199 Pirffor.m"n lnr nAIMIMIA.nA1A1/91),fF IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US SCHEDULE Number of Days Notice of Cancellation: 30 Person or Organization: City of Fresno Address: 2600 Fresno Street, Room 1030 Fresno, CA 93721 Provisions If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. PIL 028 05 10 mwrp 7ni45n Aulfchmun Inr nAYMI nda-nAIMI n9R WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 124 (4-84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 4-1-14 at 12.01 A.M. standard time,forms a part of (DATE) Policy No. MWC302157 00 of the Old Republic Insurance Company (NAME OF INSURANCE COMPANY) issued to PulteGroup, Inc. Premium$ Authorized Representative 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 any one not named in the Schedule. Schedule City of Fresno Its officers, officials, agents, employees and volunteers WC 124(4-84) WC 00 03 13 Copyright 1983 National Council on Compensation Insurance. Page 1 of 1 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY WORKERS'COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY DESIGNATED ENTITY- NOTICE OF CANCELATION PROVIDED BY US SCHEDULE Number of Days Notice of Cancellation: 30 Person or Organization: CITY OF FRESNO ITS OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS Address. 2600 FRESNO STREET, ROOM 1030 FRESNO, CA 93721 Provisions If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancelation in the schedule above, we will mail notice of cancelation to the person or organization shown in the schedule above. V& will mail such notice to the address shown in the schedule above at least the number of days shown for cancelation in the schedule above before the effective date of cancelation. PC 009 0510 INSURED COPY DATE(MMIDDIYYYY) Awa CERTIFICATE OF LIABILITY INSURANCE I 1111312014 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). e PRODUCER CONTACT NAME: Aon Insurance Managers (USA), Inc. PH NB (802) 652-4400 FAX (802) 860-0440 d 76 St. Paul Street IA/C.No.Ext): (AIC.No.): -� 5th Floor E-MAIL O Burlington VT 05401 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: North American Builders Indem Co. 41920 Centex Homes, a Nevada INSURER B: General Partnership 6210 Stoneridge Mall Dr, 5th Floor, INSURER C: Pleasanton CA 94589 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055856699 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVR POLICY NUMBER MM1D0NYYY) (MMIDDIYYYYJ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I LI CLAIMS-MADE r—]OCCURA PREMISES Ea occurrence ,�,tla MAIN MED EXP(Any one person) ONAORMUTI PERSONAL&ADV INJURY � GEN'LAGGREGATF LIMIT APPLIES PER I�Q1t�� GENERAL AGGREGATELO POLICY �JECT LOC 11d r ' PRODUCTS-COMPIOPAGG co OTHER: u o AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT '11 Ea accident , ANYAUTO BODILY INJURY(Per person) Z LED SCHEDULED BODILY INJURY(Per accident) �d+ AUTOS Ip OS NON-OWNED PROPERTY DAMAGE O AUTOS (Per accident) w W A UMBRELLA LIAB X OCCUR GL2014 04/01/2014 04/01/2015 EACH OCCURRENCE 85,000,000 U IAB CLAIMS-MADE AGGREGATE $10,000,000 ETENTION WORKERS COMPENSATION AND PER STATUTE I OTH- EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR i PARTNER J EXECUTIVE ❑ E.L.EACH ACCIDENT OFFIOMMEMBER EXCLUDED? NIA (Mandatory in NHI E .DISEASE-EA EMPLOYEE If yes,tl'scribe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) . City of Fresno, its officers, officials, agents, employees and volunteers are included as Additional Insured in accordance with la, the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability evidenced herein is Primary and Nan-Contributory to other insurance available to an Additional Insured, but only in accordance � with the policy's provisions. A waiver of Subrogation is granted in favor of city of Fresno, its officers, officials, agents, employees and volunteers in accordance with the policy provisions of the workers' Compensation policy. The Excess Liability policy evidence herein will follow form of the General and Auto Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ■ POLICY PROVISIONS. City of Fresno AUTHORIZED REPRESENTATIVE C7 2600 Fresno St., Room 1070 Attn. Heidi Briggs, Risk Management 11� iision F Freesno CA 93721-3615 USA @11988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD