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Home My WebLink AboutT-5549 - Certificate of Insurance - 10/31/2008 CERTIFICATE OF COVERAGEISSUEDATE(MM/DD(YY) 09/03/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE HOUSING AUTHORITIES RISK RETENTION POOL POLICIES BELOW. 2500 MAIN STREET,SUITE 120 VANCOUVER,WASHINGTON 98660 COMPANIES AFFORDING COVERAGE (360)694-3500 (360)694-3600 FAX COMPANY IIARRP COVERED ENTITY Housing Authorities Risk Retention Pool HOUSING AUTHORITIES OF THE LETTER A CITY&COUNTY OF FRESNO 1331 FULTON MALL STREET P.O.BOX 11985 COMPANY us17E:R 11 FRESNO,CA 93776-1985 COVERAGES THIS IS TO CERTIFY THAT THE POUCIFS LISTED BELOW HAVE BEEN ISSUED TOTHF COVERED ENTITY NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NUTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OROTHF.R DOCUMENTS WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE.AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI.THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LATS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS LTR DATE(MM/DD,YY) DATE(MM/DD/YY) A GENERAL LIABILITY GENERAL AGGREGATE $2010000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000.000 CLAIMS MADE X OCCURRENCE 084-PLAF 03/25/08 09/30/09 FIRE DAMAGE(any one fire) 52,000,000 OWNERS'S&CONRACTOR'S PROT. MEDICAL EXPENSES EXCLUDED A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 ALL OWNED AUTOS BODILY INJURY $1,000,000 X SCHEDULED AUTOS (PER PERSON) 084-PLAF 01/01/08 09/30/09 _ HIRED AUTOS PROPERTY $1,000,000 _ NON—OWNED AUTOS rr �q/� �GEMENT (`��7DAMAGE � IVI DIYir,Jli"i'v ANNUAL $110001000 OVPC AGGREGATE ApDbyec /Changes: DESCRIPTION OF OPERATIONS/LOCA TIONS/VEHICLES/RESTRICTIONS/S kCIAL ITEMS AS RESPECTS: HOPE VI PROJECT,APN 477-709,TRACT NO.5549,LOTS 50,51,52 (Agreement of Early Issuance of Model Home Building Permits)The City of Fresno,its officers,officials,employees,agents and volunteers,per the interest of the CERTIFICATE IIOLDER/ADDITIONAL COVERED PARTY,As shown below. This applies only to negligence alleged to be caused solely by the Housing Authority. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, CITY OF FRESNO TILE ISSUING COMPANY WILL ENDEAVOR TO MAIL-V DAYS WRITTEN NOTICE TO THE:CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILUR F:TO MAIL.SUCH NOTICE SHALL IMPOSE NO OBI.XJATION OF LIABILITY OF %CONSTRUCTION MANAGEMENT DIVISION ! ANY KIND UPON THE COMPANY,ITS AGENT S OR REPRESENTATIVES. ATTN: MARYANN LEWIS At,F110RIZED REPRESENTATIVE 1721 VAN NESS AVENUE FRESNO,CA 93721 A WILLIAM E.GREGORY,EXECUTIVE DIRECTOR ZACertificates&Endorsements\2008-09'IFresno\Fresno-012.doc ENDORSEMENT COVERED ENTITY: HOUSING AUTHORITIES OF THE CITY&COUNTY OF FRESNO 1331 FULTON MALL STREET P.O.BOX 11985 FRESNO,CALIFORNIA 93776-1985 MEMBER NO.: 084-PLAF COVERAGE PERIOD: 03/25/08-09/30/09 LOCATION: AS RESPECTS: HOPE VI PROJECT,APN 477-709,TRACT NO.5549 LOTS 50,51,52(Agreement for Early Issuance of Model Home Building Permits),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 insurance carried by such Additional insured whether primary,excess,contingent,or on any Other basis. This applies only to negligence alleged to be caused solely by the Housing Authority. LIABILITY: IT IS HEREBY AGREED THAT THE FOLLOWING IS INCLUDED AS ADDITIONAL COVERED PARTV(IES)AS RESPECTS THEIR INTEREST IN THE PROPERTY(IES)NAMED ABOVE: CITY OF FRESNO %CONSTRUCTION MANAGEMENT DIVISION ATTN: MARYANN LEWIS 1721 VAN NESS AVENUE FRESNO,CA 93721 ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED i I 09/03/08 DATE WILLIAM E.GREGORY,EXECUTIVE DIRECTOR HOUSING AUTHORITIES RISK RETENTION POOL Z:\Certificates&Endorscments\2008-09\FresndFresno-022.doc ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYY) 9/16/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Alliant Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 600 Montgomery Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94111 INSURERS AFFORDING COVERAGE INSURED INSURER A: Safety National Casualty Corp. California Housing Workers INSURER B: Compensation Authority 1831 K Street INSURER C: Sacramento CA 95811 INSURER D: INSURER E: COVERAGES HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- INSR LTRTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION_DA DATE(MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE F-1OCCURMED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO-jFCT L1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS 1� iI', Pv A AGEMENTDIVISION BODILY INJURY $ NON-OWNED AUTOS (Per accident) k roved'W/Changes: RT `Per acccidentROP ideM) MAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO SI!^!r} d ate OTHER THAN EA ACC $ �� AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC ST TS OER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE1$ E.L.DISEASE-POLICY LIMIT 1$ SP-2F20- A A 7/1/2008 7/1/2009 OTHER E.L. Per Occ. $1,000,000 C Workers Compensation and Retention Per Occ. $500,000 Employers' Liability WC Limit Statutory DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS E: Housing Authority of the City of Fresno, 1331 Fulton Mall, Fresno, CA 93721 s respect to the Final Map of Tract No. 5549. (from 09/05/08 to 03/05/09)- This policy includes, Waiver of Subrogation. Endorsement to follow. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Fresno ILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE c/o Const. Mgmt. Div. , attn: Maryann Lewis ERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 1721 Van Ness Avenue 3HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Fresno CA 93721 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE W" ACORD 25-S(7197) O ACORD CORPORATION 1988 i IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97) J CALIFORNIA HOUSING WORKERS' COMPENSATION AUTHORITY (CHWCA) WORKERS' COMPENSATION COVERAGE WAIVER OF SUBROGATION ENDORSEMENT #1 CHWCA has the right to recover payments made for covered benefits for a work-related injury or illness under this Coverage. However, to the extent that the Housing Authority of the City and County of Fresno, a covered member of CHWCA, performs work under the contract described below that requires the Housing Authority of the City and County of Fresno to obtain this Waiver of Subrogation, CHWCA hereby waives any right of recovery CHWCA may have against the person or organization named in the Schedule below because of the payment of workers' compensation benefits for injury or illness arising out of the activity described in the Schedule below. This agreement shall not operate directly or indirectly to benefit any person or organization not named in the Schedule. This endorsement modifies coverage provided under and forms part of the following: CHWCA MEMORANDUM OF COVERAGE (2008-16) SCHEDULE Name of Person or Organization: City of Fresno % Construction Management Division Attention: Maryann Lewis 1721 Van Ness Avenue Fresno, CA 93721 Description of Activity: Work under the Subdivision Agreement between the Housing Authority of the City and County of Fresno, a covered member of CHWCA, and City of Fresno, % Construction Management Division, for Housing Authority of the City and County of Fresno to construct the improvements and develop the subdivision as described in the Final Map of Tract No. 5549, for the period effective September 5, 2008, and ending January 1, 2009. EFFECTIVE DATE: September 5, 2008 ON BEHALF OF THE CALIFORNIA HOUSING WORKERS' COMPENSATION AUTHORITY XWC 0275 00 1291 AMENDED ENDORSEMENT#10 WAIVER OF SUBROGATION In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed as follows: The SUBROGATION Section of this Agreement shall recognize any "waiver of subrogation" executed by the EMPLOYER in favor of the below listed third parties,and such SUBROGATION Section shall be waived only to the extent of the actual terms, conditions and legality of the executed "waiver", unless the damage or injury is based upon the sole or concurrent, active, negligent participation of the below listed third party(ies). Member: HOUSING AUTHORITY OF THE CITY&COUNTY OF FRESNO Waiver in favor of: CITY OF FRESNO CIO CONSTRUCTION MANAGEMENT DIVISION ATTN: MARYANN LEWIS 1721 VAN NESS AVENUE FRESNO, CA 93721 Effective Date: SEPTEMBER 5,2008 Job Description: SUBDIVISION AGREEMENT FOR TRACT 5549 Length of Contract: SEPTEMBER 5,2008—SEPTEMBER 5,2009 All other terms, conditions,agreements and stipulations remain unchanged. Attached to and forming a part of Excess Workers'Compensation and Employers' Liability Insurance Agreement No. SP -2F20-CA, issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to CALIFORNIA HOUSING WORKERS COMPENSATION AUTHORITY ET AL,dated July 1,2008. SAFETY NATIONAL CASUALTY CORPORATION President . .f Secretary XWC 0456 00 0908 ENDORSEMENT#11 BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time,September 5,2008 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language: The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contract that requires the EMPLOYER to obtain this agreement from the CORPORATION. This agreement shall not operate directly or indirectly to benefit anyone not named in this Agreement. All other terms,conditions,agreements and stipulations remain unchanged. Attached to and forming a part of Excess Workers'Compensation and Employers' Liability Insurance Agreement No. SP -2F20-CA, issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to CALIFORNIA HOUSING WORKERS COMPENSATION AUTHORITY ET AL,dated July 1,2008. SAFETY NATIONAL CASUALTY CORRORATION ,r President Secretary