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HomeMy WebLinkAboutT-5553 - Certificate of Insurance - 3/22/2010 City of rn1u:� A,` PLANNING&DEVELOPMENT DEPARTMENT•DEVELOPMENT SERVICES DIVISION-2600 FRESNO STREET-FRESNO,CA 93721 DATE: March 11, 2010 TO: KERRY TROST Personnel Services Department FROM: JONATHAN BARTEL Planning & Development Department SUBJECT: REQUEST FOR CERTIFICATE OF LIABILITY AND ENDORSEMENT OF INSURANCE APPROVAL FOR THE FINAL MAP OF TRACT NO. 5553 Attached are certificates of liability insurance required for the subdivision agreement for the Final Map. Please review for conformity to City acceptance policies. Final Map is scheduled for Council action on March 25, 2010. If you have any questions, please contact me at 621-8076. Thank you, Jonathan Bartel AD-M., CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (559)436-0833 FAX (559)256-6590 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. Ins. Brokers of CA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 45 East River Park Place West ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 408 Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURED DeYoung Communities, Inc. INSURERA- General Fidelity Insurance Co DeYoung Properties 5553 LP INSURERB: Nationwide Mutual 23787 2109 W. Bullard Ave. #101 INSURER C: Fresno, CA 93711 INSURER D'. INSURER E. COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR QD't TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSREGENERAL LIABILITY BAG000722600 10/30/2009 10/30/2010 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 7P CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,()00 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ Z'000'000 �EN.POLICY L AGGREGATE LIMIT APPLIES PER' PRODUCTS-COMP/OP AGG $ 2,000,00 PRO- JECT LOC AUTOMOBILE LIABIUTY ACP7822929376 05/31/2009 05/31/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 11000,000 ALL OWNED AUTOS BODILY INJURY B SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS $ (Per accident) RISK MA hG >V ENT Appr Ve+d, (Per accidentPROPERTY DAMAGE $ GARAGE LIABILITY Ak1pr C1C'—e.. z AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S - - -- AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY '� EACH OCCURRENCE S OCCUR ❑CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND TORY IMITS FR WC STATU- OTH- EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ It yes.describe Unde- SPECIAL PROVISIONS below El DISEASE-POLICY LIMIT $ OTHER Ten Day Notice of Cancellation Would Apply in Event of Cancellation for NonPayment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIpNS Re: Tract 5553 Replaces certificate issued 2/25/10 The City of Fresno, its officers, officials, mployees, agents and volunteers are included as additional insureds per CG2037 07/04 and G2026 07/04 attached as respects General Liability and per AC0102 03/09 attached respects uto Liability. Auto Primary wording per CA0001 03/06 attached.General Liability primary wording per L12 01 11/85 attached (Primary & Non-Contributory) CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL 1)MN**MAIL City of Fresno c/o Construction Management Division 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Maryann Lewis xxdf>>(d06X�(Mdyilfldli��ADtKifXNr )L1tXf(X 1721 Van Ness Avenue � 7@N((&lfi( (X1Ll(BiAtYl6)Of0�16k3ElEXXXXXXXXX Fresno CA 93721 AUTHORIZED REPRESENTATIVE / Donna Smith/DONNA �>r«���h-•�` ACORD 25(2001108) ©ACORD CORPORATION 1988 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 4 Rev POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE BAG0007226-00 02/25/2010 General Fidelity Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE DeYoung Communities Inc Insurance Specialty construction Group As Per Named Insured Endorsement 4501 Circle 75 Pkwy, Suite F620D 2109 W. Bullard Ave #101 Atlanta, CA 30339 Fresno, CA 93711 COVERAGE PARTS AFFECTED General Liability CHANGES In consideration of the(additional/return)premium specified on this endorsement and subject to all of the terms and conditions of the policy,It is hereby understood and agreed the following change is made to the policy: The coverage provided for City of Fresno,Tract 5553,per forms CG 2026 and CG 2037 is primary and non contributory with any other insurance available under any other third party liability policy. Amended CG 2026 to include volunteers. All other policy terms and conditions remain unchanged. Authorized Representative Signature Copyright, Insurance Services Office, Inc., 1983 Ll IL 12 01 11 85 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983 Original POLICY NUMBER:SA00007226-00 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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) City of Fresno, its officers, officials, agents, employees and volunteers 2600 Fresno Street Fresno CA 93721 RE: Tract 5553 Information required to complete this Schedule,if not shown above,will be shown in the Declarations. Section II - Who Is An Insured is amended to in- clude as an additional insured the person(s)or organi- zations) shown in the Schedule,but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations;or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties,Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: BAGo0o7226-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations The City of Fresno, its officers, Tract 5553 officials, employees, agents and volunteers 2600 Fresno Street Fresno CA 93721-3616 Information required to complete this Schedule,if not shown above,will be shown in the Declarations. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury"or"property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ BUSINE53 AUTO AC 01 02 03 09 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BUSINESS AUTO ENDORSEMENT FORM This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. CHANGES FOR TRAILERS AND FARM or organization qualifies as an'insured"un- EQUIPMENT der the Who Is An Insured Provision con- 1. Under SECTION I-COVERED AUTOS,the tarried in Section II- LIABILITY following are added to Paragraph C.Certain COVERAGE of the Coverage FormD, REPLACED EXCLUSIONS Trailers, Mobile Equipment and Temporary Substitute Autos: The Expected or Intended Injury Exclusion 4. 'Trailers"designed to be towed by a pri- IN SECTION II-LIABILITY COVERAGE is vale passenger type"auto"or a pickup, replaced by the following: panel truck or van if not used for busi- Expected or Intended Injury ness purposes, other than fanning or "Bodily Injury* "property ranching. 1 ry"or damage"which Is expected or intended by the 'insured'. This 5. Farm wagons or farm implements while exclusion applies even if the resulting"bod- being towed by a covered"auto'. ily injury"or"property damage": B. CHANGES FOR ADDITIONAL NEWLY a. is of a different kind, quality or degree ACQUIRED VEHICLES than initially expected or intended;or 2. Paragraph B.2 of SECTION 1 -COVERED b. is sustained by a different person,entity, AUTOS Is replaced by the following: real property, or personal property than 2. If Symbol 7 is entered next to a cover- that initially expected or intended. age in Item Two of the Declarations,an E. ADDITIONAL EXCLUSIONS 'auto' you acquire wAl be a covered The fo;lowing exclusions are added to "auto"for that coverage only if: SECTION II-LIABILITY COVERAGE: a. We already cover at least one"auto' Damage to Named Insured's Property you own for that coverage or it re- places an "auto' you previously Any claim or"suit"for"property damage'by owned that had that coverage;and You or on your behalf against any other per- son or entity that is also a Named Insured b. You tell us within 30 days after you under this policy. acquire it that you want us to carver Abuse or Molestation it for that coverage_ The most we will pay for Physical Damage "Bodily om ily injury" or "property daage"arisig n Coverage for'loss"under this Coverage Ex- tension is $100,000 per "auto% subject to a. The actual or threatened abuse or mo- the largest deductible applicable to any lestatlon by anyone or any person while "auto'for that Coverage. in the care,custody or control of any"in- C. BLANKET ADDITIONAL INSURED sured",or Any person or organization which you have b. The negligent: agreed to name as an additional insured in a 1) Employment; written contract, executed prior to an acci- 2) Investgafion; dent, other than a contract for the lease or 3) Supervision; rental of a vehicle Is an"Insured"for Liability Coverage,but only to the extent that person 4) Reporting to the proper authorities, or failure to so report;or AC 0102 03 09 Includes copyrighted material of Insurance Services Office,Inc., Page 1 of 4 with Its permission. 5. Other Insurance 7. Policy Period,Coverage Territory a. For any covered "auto"you own, this Cov- Under this Coverage Form, we cover "acci- erage Form provides primary insurance, dents"and"bases"occurring: For any covered"auto"you don't own,the a. During the policy period shown in the Dec- insurance provided by this Coverage Form larations;and is excess over any other collectible insur. b. Within the coverage territory. ante. However, while a covered 'auto' which is a "trailer"1s connected to another The coverage territory is: vehicle, the Liability Coverage this Cover- a. The United States of America; age Form provides for the"trailer"is: b. The territories and possessions of the (1) Excess while it is connected to a motor United States of America; vehicle you do not own. c. Puerto Rico, (2) Primary while It is connected to a cov- d. Canada;and ered"auto'you own. b. For Hired Auto Physical Damage Coverage, e_ Anywhere In the world if: any covered "auto"you lease, hire, rent or (1) A covered "auto"of the private passen- borrow is deemed to be a covered "auto" ger type is leased, hired, rented or bor- you own. However, any "auto" that Is rowed without a driver for a period of 30 leased, hired, rented or borrowed with a days or less;and driver is not a covered'auto". (2) The 'insureds' responsibility to pay c. Regardless of the provisions of Paragraph damages is determined in a"suit'on the a. above, this Coverage Form's Liability merits, in the United States of America, Coverage is primary for any liability as- the territories and possessions of the sumed under an"Insured contract'. United States of America, Puerto Rico, d. When this Coverage Form and any other or Canada or in a settlement we agree io. Coverage Form or policy covers on the same basis, either excess or primary, we We also rover"loss"to, or"accidents' involy- will pay only our share. Our share is the ing, a covered "auto' while being transported proportion that the Limit of Insurance of our between any of these places. Coverage Form bears to the total of the lim- S. Two Or More Coverage Forms Or Policies its of all the Coverage Forms and policies Issued By Us covering on the same basis. If this Coverage Form and any other Coverage S. Premium Audit Form or policy issued to you by us or any com- a. The estimated premium for this Coverage pany affiliated with us apply to the same'acci- Form is based on the exposures you told us dent', the aggregate maximum Limit of Insur- you would have when this policy began.We ante under all the Coverage Forts or policies will compute the final premium due when shall not exceed the highest applicable Limit of we determine your actual exposures. The Insurance under any one Coverage Form or estimated total premium will be credited policy. This condition does not apply to any against the final premium due and the first Coverage Form or policy issued by us or an at- Named Insured will be billed for the bal. fllistad company specifically to apply as excess ance, if any.The due date for the final pre- insurance over this Coverage Form. mium or retrospective premium is the date SECTION V—DEFINITIONS shown as the duo Cate on the bill.If the es- A. "&;ddent" Includes continuous or repeated expo- timated total premium exceeds the final sure to the same conditions resulting in"bodily in- premium due, the first Named Insured will jury"or"property damage" get a refund. B. "Auto"means: b, if this policy is issued for more than one 1. A land motor vehicle,"traller"or semitrailer de- year, the premium for this Coverage Form signed for travel on public roads;or will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. CA 00 0103 06 0 ISO Properties,Inc.,2005 Page 9 of 12 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(2001108) CERTHOLDER COPY NE • P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-22-2010 GROUP: POLICY NUMBER: 1901801-2010 CERTIFICATE ID: 11 CERTIFICATE EXPIRES:02-01-2011 02-01-2010/02-01-2011 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 10 DATED 02-25-2010 Attn:Maryann Lewis CITY OF FRESNO NE JOB:TRACT 5553 CONSTRUCTION MANAGEMENT DIVISION 1721 VAN NESS AVE FRESNO CA 83721-1130 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. �THCRIZEDREPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2010-02-25 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF FRESNO RISK MA �GEEMUNJT DIV;SIO�J App oved: Appy ve Changes: S.i l e EMPLOYER TEAM 5 PROPERTIES INC AND/OR DEYOUNG NE COMMUNITIES INC AND/OR DEYOUNG REALTY INC 2109 Y BULLARD AVE STE 101 FRESNO CA 93711 [B16,NE] (REV 2-05) PRINTED 03-22-2010 March 22, 2010 I'O WHOM THIS MAY CONCERN: This letter is to certify that DeYoung Properties 5553, L.P. has no employees. There is a Turn Key Agreement between DeYoung Properties 5553, L,. ". and Team 5 Properties, Inc. that allows Team 5 Properties to build the homes on the land owned by DeYoung Properties 5553, 1,.1'. Sincerely, DeYoung Properties 5553, LP, Ernie F scobedo Chicf Financial Officer To# - BRENTW®D'- Mailing Addim-Mm Office Box 5178.Fresno,Caldorrva 93755.559-135-0900 a fax 559 435-4414 e-mail infoVhoenlwotxihc,mes.com• websde www.brentwocxfhomes com BU$Iding YCOI Fufuie is Our Radibon'"