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HomeMy WebLinkAboutT-5838 - Certificate of Insurance - 4/7/2011 City MEMORANDUM DEVELOPMENT AND AND RESOURCE MANAGEMENT DEPARTMENT•DEVELOPMENT SERVICES DIVISION•2600 FRESNO STREET•FRESNO,CA 93721 DATE: March 25, 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 EARLY ISSUANCE OF MODEL HOME BUILDING PERMITS FOR THE FINAL MAP OF TRACT NO. 5838 Attached are certificates of liability insurance required for the covenant for early issuance of model home building permits for the Final Map. Please review for conformity to City acceptance policies. If you have any questions, please contact me at 621-8076. Thank you, Jonathan Bartel N O TM � C-j_r �+ -MITI IMI CD CD TE(MM/DDffYYY) A� CERTIFICATE OF LIABILITY INSURANCE 12/31/2012 DA2/28/2011 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). PRODUCER Lockton Insurance Brokers,LLC NAME: 19800 MacArthur Blvd.,Suite 550 A/C,PHONE Ext: A/C No CA License 4OF15767 E-MAIL Irvine 92612 ADDRESS: 949-252-4400 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Steadfast Insurance Company 26387 INSURED Granville Homes,Inc. INSURER B: 1072889 1396 W.Herndon Ave.,Ste.101 INSURER C: Fresno CA 93711 INSURER D: INSURER E: INSURER F: COVERAGES GRAH001 OG CERTIFICATE NUMBER: 11170477 REVISION NUMBER: XXXXXXX 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY Y N HBP9140836-02 12/31/2010 12/31/2012 EACH OCCURRENCE 5,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(ERENTED occurrence 100.000 CLAIMS-MADE�OCCUR MED EXP An one person) 25,000 X Silica.$1 M ea.OCC. PERSONAL&ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 10 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 10,000,000 X I POLICYFI JERCOT El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ XXXXXXX ANY AUTO NOT APPLICABLE BODILY INJURY(Per person) $ XXXXXXXALL AUTOS NED AUTOS ULED BODILY INJURY(Per accident $ XXXXXXX NON-OWNED PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS AUTOS Per aaident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE NOT APPLICABLE AGGREGATE $ XXXXXXX DED RETENTION$ $ WORKERS COMPENSATION WC STATU-I IOTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ANVCERIMEMBREXCLUEElEXECUTIVE < ARA AGEMENT DIVISION E.L.EACH ACCIDENT $ XXXXXXX OFFICERIMEMBER EXCLUDED N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE XXXXXXX II yes,descnbe under A, p oved. DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT XXXXXXX Pp w ange r 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/(A ch ACORD 101,Additional Remarks Schedule,If more space is required) Re:Tract:5838.City of Fresno.its officers,officials,agents,employees and volunteers are Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier Such Insurance as Is afforded by the policy is primary and any other insurance shall be excess and not contribute to the insurance afforded by this endorsement. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11170477 AUTHORIZED REPRESENTATIVE City of Fresno %Dept of Public Works Attn:Maryann Lewis 2600 Fresno St,Rm 4019 Fresno CA 93721 ACORD 25(2010/05) @11088-20111PACOft C RPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD Home Builders Protective Policy Endorsement ZURICH Steadfast Insurance Company Dover,Delaware Administrative Offices-1400 American Lane,Schaumburg,Illinois 60196-1056 Policy No. Eff. Date of Pol. Exp.Date of Pol. Eff.Date of End. Producer No. Add'I.Prem. Return Prem. H BP9140836-02 12/31/2010 12/31/2012 12/31/2010 Named Insured/Mailing Address: Producer: GRANVILLE HOMES,]INC. LOCKTON COMPANIES (PER NAMED INSURED SCHEDULE) 19800 MACARTHUR BLVD.,STE 550 1396 HERNDON AVE,STE 101 IRVINE,CA 92612 FRESNO,CA 93711 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Home Builders Protective Policy BLANKET ADDITIONAL INSURED IT IS AGREED THAT SECTION 11-WHO IS AN INSURED,IS AMENDED TO INCLUDE,AS AN ADDITIONAL INSURED,ANY PERSON OR ORGANIZATION YOU ARE REQUIRED BY WRITTEN CONTRACT TO INCLUDE AS AN ADDITIONAL INSURED.INSURANCE FOR THESE PERSONS OR ORGANIZATIONS SHALL BE LIMITED TO THE EXTENT OF THE COVERAGE AND LIMITS OF LIABILITY REQUIRED BY THE WRITTEN CONTRACT AND ONLY WITH RESPECT TO LIABILITY ARISING OUT OF"YOUR WORK"WHETHER PERFORMED FOR THAT INSURED BY OR FOR YOU.THE WRITTEN CONTRACT MUST BE EXECUTED PRIOR TO THE OCCURRENCE OF ANY LOSS. THE EXTENT OF COVERAGE AND THE LIMITS OF LIABILITY OF THIS CONTRACT SHALL NOT INCREASE THE LIMITS STATED IN SECTION III-LIMITS OF INSURANCE,OF THE EXTENT OF COVERAGE STATED IN THIS POLICY. STF-GL-10096-A-CW(11/06) Page 1 of I Includes copyrighted material of Insurance Services Office,Inc,with its permission. Miscellaneous Attachment: M448453 Certificate ID: 11170477 ARQ, CERTIFICATE OF LIABILITY INSURANCE An oi20 CO PRODUCER (559)436-0833 FAX (559)256-6590 T—THILSYCERTIF[CATEISISSUEDASAMATTEROFINFORMATION Arthur 1. Gallagher & Co. Ins. Brokers of CA Inc, ONAND 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 Granville Homes, Inc. INSURERA American States Insurance 19704 1396 W. Herndon Ave #1101 INSURERS Fresno, CA 93711 INSURER 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 LIMOS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MWnDMI DATE(MMID111'm LINITIS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S CLAIMS MADE ❑OCCUR MED EXP(Any one person) S PERSONAL R ADV INJURY S GENERAL AGGREGATE $ GEML AGGREGATE LIMB APPLIES PER PRODUCTS-COMPIOP AGG S POLICY F J�7 LOC AUTOMOBILE L1AB1LIY 01-CI-321748-1 04/01/2010 04/01/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) A HIRED AUT OS BODILY INJURY S NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LYIB11 TY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S ALTO ONLY. AGG S EXCESSIUMBRELLA LIABILM EACH OCCURRENCE S 1,000,000 X OCCUR CLAIMS MADE OIXSIS637320 04/01/2010 04/01/2011 AGGREGATE S 1,000,wo A s DEDUCTIBLE S RETENTION S r) S WORKERS COMPENSATION AND WMA OTH- EMPWYERSUABIM A p p r ved. ANY PROPRIETORfPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? Appr angel: it E.L.DISEASE-EA EMPLOYE S N ylS,describe under II SPECIAL PROVISIONS belay E.L.DISEASE-POLICY LIMITS OTHER ilP ufip Ten Day Notice of Cancellation Would Apply in Event of Cancellation for NonPayment DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECWL PROVISIONS e- Tract 5838 e City of Fresno, its officers, officials, employees, agents and volunteers are included as dditional insureds per CA7110 0307 attached With primary wording per CA0001 0306 attached s respects auto liability coverage. CERTIFICATE H(XDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Fresno BUT FAILURE TO MAILSUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2600 Fresno Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Fresno, CA 93721 AUTHORIZED REPRESENTATIVE Donna Smith/DONNA >rr��fs-.�` ACORD 25(2001!08) ©ACORD CORPORATION 1989 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) ^•.REPRINTED FROM THE FORMS UPAARY.••• COMMERCIAL AUTO CA 71 10 03 07 THIS ENDORSEMENT CHANGES THE POIJCY. PLEASE READ R CAREFULLY. AUTO PLUS ENDORSEMENT This endorsement modlflas Insuranoe provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED Paragraph 2.b. of the CANCERATION Common SECTION II — LIABILITY COVERAGE — A.I.WHO Poficy Condition is replaced by the following: IS AN INSURED provision is amended by the addition b. 60 days before the effective date r1 cancellation of the following: If we cancel for any other reason. o. Any person or organizatlon for whom you are re- quired by an "Insured contract" to provide Insur- TEMPORARY SUBSTITUTE AUTO — PHYSICAL ance Is an Insured", subjed to the following DAMAGE COVERAGE additional provisions: Under paragraph C. — CERTAIN TRALERS, MO- (1) The "insured contract" must be in effect BILE EQUIPMENT AND TEMPORARY SUBSTITUTE during the dopey period shown In the De rations, and must have been executed prior AUTOS of SECTION 1 — COVERED AUTOS, the to the "bodi following Is added: ly In jury"a property damage (2) This person or organization Is an "Insured" If Physical Damage coverage Is provided by this Cov- only to the extent you are liable due to your erage Form,then you have coverage for: ongoing operations for that Insured,whether the work is performed by you or for you,and Any 'auto" you do not own while used with the per- only to the extent you are heli gable for an mission of Its owner as a temporary sulbstitute for a 'accident"occurring while a covered "auto" covered "auto" you own that is out of service be- Is being driven by you or one of your em- cause of Its breakdown, repair, servicing, loss" or Ploy destruction. (3) There Is no coverage provided to this person BROAD FORM NAMED INSURED or organlma for "bodlly Injury"to Its em- ployees, nor for 'property damage" to Its SECTION p —LIABILITY COVERAGE — A.1.WHO property. IS AN INSURED provision Is amended by the addition (4) Coverage for this person or organization of the following: shall be limited to the extent of your negil- gence or fault according to the applicable d. Any business entity newly acquired or formed by principles of comperattve negllgenoe or fault. you during the policy period provided you own The defense of 50% or more of the business entity and the (� any persclalon r organization must be as business entity Is not separately Insured for tendered practicable this person a orther atlon m Business Auto Coverage. Coverage is extended stun o b all ratter Insurers up to a maximum of 180 days following aoqulsl- which r "sullaily provide Insurance for such tlrn or formation of the bualness entity.Coverage ciaim or auR". under this provision Is afforded only until the end of Line policy period. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Copyright Insurance Services Office, Inc., 1997 CA 71 10 03 07 Pap I d 6 EP ""REPRINTED FROM THE FORMS LIBRARY (5) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE lesser of: A. SECTION III — PHYSICAL DAMAGE COVER- (a) The coverage and/or limits of this policy, AGE, AA. COVERAGE EXTENSIONS, is or amended by adding the following: (b) The coverage and/or limits required by c. Personal Effects Coverage the 'Insured contract". For any Owned 'auto" that Is Involved In a (7) A person's or organization's status as an covered loss". we w11 pay up to $500 for Insured' under this subparagraph d ends 'personal effects" that are lost or damaged when your operations for that 'Insured' are as a result of the covered 'loss", without completed. applying a deductible. EMPLOYEE AS INSURED EXTRA EXPENSE — BROADENED COVERAGE Under Paragraph A.of Section II — LIABILITY COV- Paragraph A. _ COVERAGE of SECTION III — ERAGE Item f. Is added as follows: PHYSICAL DAMAGE COVERAGE Is amended to add: Your "employee"while using his owned 'auto",or an "auto" owned by a member of his or her household, 5. We will pay for the expense of returning a stolen In your business or your personal affairs,provided you covered "auto'to you. do not own,hire or borrow that "auto".This coverage is excess to any other collectible Insurance coverage. AIRBAG,COVERAGE FELLOW EMPLOYEE COVERAGE Under paragraph B. — EXCLUSIONS of SEC11ON III — PHYSICAL DAMAGE COVERAGE, the following is Exckiskm 5. FELLOW EMPLOYEE of SECTION II — added: LIABILITY COVERAGE — B. EXCLUSIONS Is amended by the addition of the following: The excluslon relating to mechanical breakdown does not apply to the accidental discharge of an airbag. However,this exclusion does not apply it the "bodily Injury" results from the use of a covered 'auto"you NEW VEHICLE REPLACEMENT COST own or hire, and provided that any coverage under this provision only applies in excess over any other Under Paragraph C — LIMIT OF INSURANCE of coifeclible Insurance. Section III —PHYSICAL DAMAGE COVERAGE seo- tion 2 Is amended as follows: BLANKET WAIVER OF SUBROGATION 2 An adjustment for depreciation and physical corn We wahre the right of recovery we may have for pay- dMw will be made in determining actual cash menta made for t>xify injury"or "property damage" value In the event of a total loss.However, In the on behalf of the persons or organizations added as event of a total loss to your "new vehicle" to -Insureds"under Section II —LIABILITY COVERAGE which this coverage applies, as shown In the — A.I.D. BROAD FORM NAMED INSURED and declarations,we will pay at your option: A-IA.BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle"purchase price PHYt,ICAL DAMAGE — ADDITIONAL TRANS- cludIng paid for your damaged award, not I - PORTATION EXPENSE COVERAGE chased arty Insurance or warranties pur- chased; The first sentence of paragraph A4, of SECTION III b. The purchase price, as negotiated by us, of — PHYSICAL DAMAGE COVERAGE Is amended as a new vehicle of the same make,model and follows: equipment, not Including any furnishings, parts or equipment not Installed by the We will pay up to $50 per day to a maximum of manufacturer or manufacturers dealership. $1,500 for temporary transportation expense Incurred If the same model Is not available pay the by you because of the total theft of a covered "auto" purchase puce of the most similar model of the private passenger type. available; Pegs 2 d 8 REPRINTED FROM THE FORMS LIBRARY c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen not including any furnishings,parts or equip- property as of the time of the "loss', less an ment not Installed by the manufacturer or adjustment for depredation and physical manufacturer's dealership. condition;or This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or of the private passenger, light truck or medium lease that the damaged covered "auto" la truck type (20,000 Ibs or lose gross vehicle subject to at the time of the "loss", less any weight)and does not apply to Initiation or set up one or all of the folk>wing adjustments: costs associated with loans or leases. (1) Overdue payment and financial TWO OR MORE DEDUCTIBLES perms associated wlfh those payments as of the date of the Under SECTION III — PHYSICAL DAMAGE COV- loss ERAGE, If two or more "company" policies or cover- (2) Financial penalties Imposed under a age forms apply to the same accident, the following lease due to high mileage, exces- applies to paragraph D. Deductible: sNe use or abnonTmd wear and tear. a. If the applicable Business Auto deduct- (3) Costa for extended warranties,Cre- Ible Is the smaller(or smallest) deduct- dict Life Insurance, Health, Accident ible it will be waived;or or Disability Insurance purchased b. If the applicable Business Auto deduct- with the loan or lease. ible is not the smaller(or smallest) de- (4) Transfer or rollover balanus from ductlble it will be reduced by the amount previous bans or leases. of the smaller (or smallest) deductible; or (5) RIM]payment due under a "Balton Loan". c. If the loss involves two or more Busi- (8) The dollar amount of any now Auto coverage fors or policiee un-repaired damage that occurred the smaller(or smallest) deductible will pft to the "toW loss"of a covered be waived. "ajuto. For the purposed this endorsement (7) Securtty deposits not refunded by a "company"moans: lessor. a. Safeco Insurance Company of America (8) All refunds payable or paid to you b. American States Insurance Company as a result of the early termination t. General Insurance Company a lease agreement or any war- ranty or extended service agree- d. American Economy Insurance Company merit on a covered auto". s. Flat National Insurance Company of (9) Any amount representing taxes. Amedu (10) Loan or lease termination fees L American States Insurance Company of Texas GLASS REPAIR —WAIVER OF DEDUCTIBLE g. American States Preferred Insurance Under paragraph D. —DEDUCTIBLE of SECTION III Company —PHYSICAL DAMAGE COVERAGE, the following is h. Safeco Insurance Company of Illinois added: LOANA-EASE GAP COVERAGE No deductible applies to glass damage M the glass Is repaired rather than replaced, Udder paragraph C — LIMIT OF INSURANCE of SEC11ON III — PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI- the following 1s added: DENT, CLAIM,SUIT OR LOSS 4. The most we will pay for a total "loss"In any ane The requirement In LOSS CONDn1ON 2.8. — `accident"is the greater of the following,subject DUTIES IN THE EVENT OF ACCIDENT, CLAIM, to a$1,500 maximum Imlt: SUIT OR LOSS — of SEC11ON IV — BUSINESS AUTO CONDMONS that you must notify us of an CA 71 10 03 07 Page 3 d 6 EP --RE MN7m FROM IHE FORKtS IJBR1RY"" "accident"applies only when the "accident"Is(mown deductible and excess provisions, we will provide to: coverage equal to the broadest coverage applicable to any covered "auto"you own. (1) You, 'rf you are an individual; (2) A partner,If you are a partnership;or HIRED AUTO PHYSICAL DAMAGE COVERAGE — LOSS OF USE (3) An executive officer or Insurance manager,If you are a corporation. SECTION 11 — PHYSICAL DAMAGE AA b. Form does not apply. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Subject to a maximum of$1,000 per accident,we will cover loss of use of a hired "auto" If it results from SECTION N — BUSINESS AUTO CONDITIONS — an accident, you are legally liable and the lessor in- B.2.Is amended by the addition of the blowing: curs an actual financial loss. tf you unintentionally fall to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE [sting at the Inception date of your policy, we will not deny coverage under this Coverage Form because of A We will pay for rental reimbursement expenses such failure. However, this provision does not affect Incurred by you for the rental of an "auto" be- cause of a covered 'loss` to t a covered °auto"- our right to coiled additional premium or exercise our right of cancellation or rwrt-renewal. Payment applies in addition to the otherwise ap- plicable amount of each coverage you have on a HIRED AUTO — LIMITED WORLD WIDE COVER- covered "auto". No deductibles apply to this AGE coverage. Under Section N — Business Conditions, Paragraph B. We will pay only for those expenses incurred gree during the policy period beginning 24 hours after B.7.b.s(1) Is replaced by the following: the '9oss"and endng, regardless of the policy's (1) The 'accident' or 'ions" results explratlon,with the lesser of the following number from the use of an "auto" hired for of days: 30 days or lose. 1. The number of days reasonably required to covered "auto`. If RESULTANT MENTAL ANGUISH COVERAGE repel' or replete the loss' is caused by theft, this number of days is added to the number of days it tabes SECTION V — DEFINITIONS —C.Is repfaoed by the to locate the covered °auto" and return it to following: you. Bodlly Injury" means bodily Injury, slclawm or dls- 2. 30 days. ease sustained by a person Including mental artgulsh C. Our payment Is limited to the teaser of the fol or death resulting from any of these. lowing amourrK HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expeness incurred. H hired 'autos" are covered 'autos"for LJabilty cov- 2. $50 per day. erage and If Comprehensive, Specified Causes of D. This coverage does not apply while there are Loss or Collision coverages are provided under this spare or reserve 'autos"avallableto you for your Coverage Form for any auto" you oven, then the operations. Pfysloal Damage Coverages provided are extended to "autos"you hire or borrow. E. If 'loss" results from the total theft of a covered auto" of ft private passenger type,we win fay The most we will pay for lose to any hired "auto" is under this coverage only that amount of your $50,000 or Actual Cash Vaiue or Cost of Repair, rental reimbursement expeness Which Is not al- whichever is smallest, minus a deductible. The d®- ready provided for under the PHYSICAL DAM- ductible will be equal to the largest deductible appll- AGE COVERAGE Coverage Extension. cable to any owned "auto" of the private passenger F. The Rental Relmburaement Coverage described or light truck type for that coverage. Hired Auto Phy- sical Damage coverage Is excess over any other col- above does not apply to a covered 'auto"that Is lectibie Insurance. Subject to the above Ilmit, described or designated as a covered °auto"on Pegs 4 0 6 REPFeMED FROM THE FORMS LIBRARY Rental Reimbursement Coverage Form the manufacturer for the Installation of a CA 99 23. radio. AUDIO, VISUAL AND DATA ELECTRONIC C. Llmft of Insurance EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN- A. Coverage SURANCE provision of PHYSICAL DAMAGE COVERAGE Is replaced by the following: 1. We will pay with respect to a covered "auto" 1. The most we will pay for loss"to audio,vi- for loss" to any electronic equipment that suel or data electronic equipment and any receives or transmits audlo, visual or data accessories used with this equipment as a signals and that is not designed solely for the result of any one 'accident"Is the lesser of: reproduction of sound.This coverage applies only if the equipment Is permanently Installed a. The actual rash value of the damaged In the covered "auto" at the time of the or stolen property as of the time of the loss"or etre equipment is removable from a 'loss":or housing unit which is permanently installed b. The cost of repairing or replacing the In the covered 'auto" at the time of the loss", and such equipment Is designed to damaged or stolen property with other property of Ike lolmd and quality. be solelyoperated by use of the power from the "auto's"electrical system,In or upon the C. $1,000. covered "auto'. 2. An adjustment for depreciation and physical 2. We will pay with respect to a covered 'auto" condition vrlil be made In determining actual for 'loss" to any accessories used with the cash value at the time of the "loss". electronic equipment described In paragraph g If a repair or replacement results In better A.I.above. than like kind or quality, we will not pay for However, this does not Include tapes, the amount of the betterment records or discs. D. Deductible 3. If Audio, Visual and Data Electronic Equip- meM Coverage form CA 99 80 or CA 99 94 1. if loss" to the audio, visual or data eleo- Is attached to this policy, then the Audio,Yr tronic equipment or accessories used with seal and Data Electronic Equipment Cover- this equipment Is the result of a 'loss"to the age described above does not apply. covered "auto" under the Business Auto Coverage Form's Comprehenalvs or Col+ B. Exclusions sion Coverage,then for each covered "auto" The exclusions that appy to PHYSICAL DAM- our obligation to pay for, repair,return or re- AGE COVERAGE, except for the exclusion relat- plaice damaged or stolen property will be re- Ing to Audio, Visual and Data Electronic duced by ft applicable deductible shown In Equipment, also appy to this coverage. In addl- the Declarations. Any Comprehensive Cov- tion,the following exclusions appy: erage deductible shown In the Declaratlons does not appy to "{oss"to audio,visual or We will not pay for either any electronic equip- data electronic equipment caused by fire or merit or accessories used with such electronic Ilghbft. equipment that Is: 2. If lose" to the audio, visual or data eleo- 1. Necessary for the normal operation of the tronio equipment or accessories used with covered "afro" for the monitofirig of the ft equipment Is ft>a result of a loss'to the covered "auto's"operating system;or covered 'cubo" under the Business Auto 2. Both: Coverage Form's Specified Causes of Loss Coverage, then for each covered 'auto"our a. an integral part of fie same unit housing obligation to pay for, repair,return or replace any sound reproducing equipment de- damaged or stolen property will be reduced signed solely for the reproduction of by a$100 deductible. sound If the sound reproducing 3. If "loss" occurs sofey to the"o,visual or equipment Is permanently Instalied in data elecironic squipment or accessories the covered "auto";and used with this equipment,then for each cov- b. permanenity Installed In the opening of ared "auto" our obligation to pay for, repair, the dash or console normally used by CA 71 10 03 07 Peas 5 of 6 EP REFVJ W ED FROM THE FORAY U MARY return or replace damaged or stolen property SECTION V — DEFINITIONS Is amended by adding will be reduced by a$1DD deductible. the following: 4. In the event that there is more than one ap- Q. 'Personal effects' means your tangible plicable deductible,only the highest deduct- property that Is worn or carried by you, ex- Ible will apply.In no event will more than one cept for tools,Jewelry,money,or securf les. deductible apply. R. `Now vehicle' means any "auto" of which you are the original owner and the `auto" has not bsen previousty titled and Is less than 385 days past the purchase date. Pegs 6 of 6 REPW W Ell FROM THE FORM$UMARY 3. Transfer Of Rights Of Recovery Against (1) Excess whlle it Is connected to a Others To Us motor vehicle you do not own. If any person or organization to or for whom (2) Primary while it Is connected to a we make payment under this Coverage Form covered "auto"you own. has rights to recover damages from another, b. For Hired Auto Physical Damage Cov- those rights are transferred to us. That per- erage, any covered "auto" you lease, son or organlzatian must do everything neo- weary to secure our rights and must do hire, rent or borrow Is deemed to be a nothing after "accident" or "loss" to Irripalr cove � "auto"you own.However, any them. red that Is leased, hired, rented or borrowed with a driver Is not a covered B. Gerwral Conditions 'auto". 1. Bankruptcy c. Regardless of the provisions of Para- graphBanivuptcy or Insolvency of the 'insured" or Liiabili a.�e, this Coverage Form's the lnsured's" estate will not relieve us of h Is primary for any Cd ability assumed under an `Insured any obligations under this Coverage Form. confta'. 2. Concealment, Mtsrepreaant lion Or d. When this Coverage Form and any Fraud other Coverage Form or policy covers Ttft Coverage Form Is void In any case of on the same basis,either excess or prf- fraud by you at any time as it relates to this mary, we will pay only our share. Our Coverage Form. it Is also void K you or any share Is the prafwrtlon that the tJmlt of other 'insured", at arty time, intentionally Insurance of our Coverage Form bears conceal or misrepresent a material fact con- to the total of the IImb of all the Cover- coming: age Fomes and policies covering on the same basis. e. This Coverage Form; b. Promtum Audit b. The covered 'auto"; s. The estimated premium for this Cover- c. Your Intarest In the covered 'auto";or age Form is based on the exposures d. A claim under this Coverage Form. You bold us you would have when this policy began.We will compute the final 3. Uberaltcatlon premlum due when we determine your If we revise this Coverage Form to provide actual exposures. The estimated total more coverage without additional premium premlum will be credited against the 11- charge,your poky will automaticaly provide nal premium due and the first Named the additional coverage as of the day the re- Insured will be billed for the balance, if vision Is effective In your state. arty.The due date for the final premium or retrospective premium Is the date 4. No Benefit To Balles —Physical Damage shown as the due data on the bill.If the coverages estimated total premium exceeds the 1V We will not recognize arty assignment or nal premium due, the first Named In- grant any coverage for the benefit of any eared will get a refund. person or organization holding, storing or b. K tide policy Is issued for more than one transporting property for a fee regardless of year, the premium for this Coverage any other provision of this Coverage Form. Form will be computed annually based !T Other Insurance on our rates or premiums In effect at the beginning of each year of the poky. a. For any covered "auto" you own, this 7. Policy Period,Coverage Territory Coverage Form provides primary Insur- ance.For any covered 'auto"you don't Under this Coverage Form, we cover own, the Insurance provided by this "acddents"and looses'occurring. Coverage Form Is excess over any a. Durk the period shown In the other cdiectble Insurance. However, while a covered 'auto" which Is a Decleratior>s;and "traler is connected to another vehicle, b. Within the coverage territory. the LJablllty Coverage this Coverage Form provides for the "trailer" la The coverage territory Is: a. The United States of America; CA 00 01 03 00 Page 0 of 12 EP CERTHOLDER COPY NE STATECOMPENSATION P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-29-2011 GROUP: POLICY NUMBER: 1901663-2010 CERTIFICATE ID: 49 CERTIFICATE EXPIRES: 12-01-2011 12-01-2010/12-01-2011 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 48 DATED 03-14-2011 CITY OF FRESNO NE JOB:TRACT 5838 DEPT OF PUBLIC WORKS RM 4019 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. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - ASSEMI, DARIUS VICEPRES - EXCLUDED. ENDORSEMENT #1600 - ASSEMI, FARID PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - ASSEMI, FARSHID DIRECTOR - EXCLUDED. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-03-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF FRESNO RISK MAgAGEMENT DIVISION Appr ved: Appro anges: �2 t geed, Date EMPLOYER GRANVILLE HOMES, INC NE 1396 W HERNDON AVE STE 101 FRESNO CA 93711 [B10,NEj PRINTED : 03-29-2011 (REV.8.2010)