Loading...
HomeMy WebLinkAboutT-5932 - Certificate of Insurance - 9/16/2013 AC RDAT BMDQfY YY) CERTIFICATE OF LIABILITY INSURANCE 007 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. u 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). c m PRODUCER CONTACT -p NAME: Aon Risk services central, Inc. PHONE (866) 283-7122 FAX 800-363-0105 `m Southfield M1 office (A1C.No.ExQ: NC.No.: o 3000 Town Center E-MAIL o Suite 3000 ADDRESS: 2 Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAEC# INSURED INSURERA: old Republic Insurance Company 24147 Centex domes, a Nevada INSURER B: General Partnership 6210 Stoneridge Mall or. INSURER C: 5th Floor INSURER D: Pleasanton, CA 94588 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570050959326 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 INSR WVD POLICY NUMBER MM1D LIMITS A GENERAL LIABILITY MwzY MMIDO o Q4/UI/ZU14 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY General Li db (special pro $1,000,000 PREMISES Ea occunenca CLAIMS-MADE FXT OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 N GENERAL AGGREGATE $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'T F , PRODUCTS-COMPIOP AGG $5,000,000 X POLICY PRO X LOC p 0 A AUTOMOBILE LIABILITY MwTB 21514 04/01/20T-3 04 01 2014 COMBINED SINGLE LIMIT $5,000,000 RISK MANAGEIV ENT DIVISION :t­,` a accklenl X ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED Approved BODILY INJURY(Per amidenl) 0 AUTOS AUTOS HIRED AUTOS NON-OWNED ay 1�7 PROPERTY DAMAGE N AUTOS Fu_ ed w han es ,1/. (Peraceidenl) u- r m UMBRELLA LIAa OCCUR EACH OCCURRENCE t (Qn - EXCESS LAB CLAIMS-MADE AGGREGATE DED RETENTION S- ate A WORKERS COMPENSATION AND MWC1I$27400 V 04/01/2013 04/01/2014WC STATU- OTH- EMPLOYERS'LIABILITY YIN X TORY LIMITS ER RI ANY PROPETOR I PARTNER r VVCUnvE NE EACH ACCIOENT $2,000,000 OFFICERIME. HFR EXCI UDF.D? NIA )Mandatory in NH) E.L DISEASE-EA EMPLOYEE S2,000.000 If yns,descnhe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 a� _=3 DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks Schedule,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 W evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance vv— with the policy's provisions. A waiver of subrogation is granted in favor of City of Fresno, its officers, officials, agents, Jr__ employees and volunteers in accordance with the policy provisions of the workers' Compensation policy. 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 REPRESENTATIVL - Attn: Heidi Briggs, Risk Management Division �y Fres Fresno 721 ROOM 1030 Cy/ Fresno CA 93721-3612 USA e-.YJ'a�y cGe�+eO (/�rij� ysa. ©1968.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 0104 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 PRODUCTS/COMPLETED 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 © Insurance Services Office, Inc., 2012 Page 1 of 1 ENDORSEMENT It3 MWZY 60139 AulteGroup,Inc. 0410112013-0410112014 U-40 A ENDORSEMENT Additional Premium: Return Premium: This endorsement, effective 04/01/13 forms a part of Policy No. MWZY 60139 policy effective date 04/01/13 expiration date 04/01/14 issued to PulteGroup, Inc. by OLD REPUBLIC INSURANCE COMPANY, Greensburg, Pennsylvania It is hereby understood and agreed that the following forms are added to the policy as respects the City of Fresno: PIL 028 05 10 Designated Entity-Notice of Cancellation Provided By Us CG 20 01 04 13 Primary and Noncontributory Other Insurance Condition Endorsement#3 Nothing herein contained shall be held to vary, alter,waive or extend any of the terms, conditions,agreements or limitations of the Policy or any Endorsement attached thereto, except as herein set forth. This Endorsement shall not be valid Until countersigned by a duly authorized representative of the Company. Attest: / � ���+ter-► Secretary President Countersigned at Brookfield, Wisconsin this ..est.................. day of.August............... 20.13.._. + Authorized Representative. ENDORSEMENT#3 MWZY 60139 PulteGroup,Inc. 0410112013-0410112014 "This p""').ge intonsConally left blank POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 2600 Fresno Street,Room 1030 Fresno,CA 93721 Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section li — 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 III—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing operations; 2. Available under the applicable Limits of or Insurance shown in the Declarations; 2. In connection with your premises owned by or whichever is less. rented to you. However. This endorsement shall not increase the applicable Limits of Insurance shown in the 1. The insurance afforded to such additional Declarations, insured only applies to the extent permitted by law;and 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 26 0413 O Insurance Services Office, Inc.,2012 Page 1 of 1 ENDORSEMENT#4 MWZY 60139 PulfoGroup,Inc. 0410112093-0410112014 's paq, U-40A ENDORSEMENT Additional Premium: Return Premium: This endorsement, effective 04/01/13 forms a part of Policy No. MWTB 21514 policy effective date 04/01/12 expiration date 04/01/14 issued to PulteGroup, Inc. by OLD REPUBLIC INSURANCE COMPANY, Greensburg, Pennsylvania It is hereby understood and agreed that the following forms are added to the policy as respects the City of Fresno: PIL 028 05 10 Designated Entity- Notice of Cancellation Provided By Us PCA 048 06 07 Additional Insured/Designated Insured Amendment- Primary and Non-Contributory Endorsement#4(13-14) Nothing herein contained shall be held to vary, alter,waive or extend any of the terms, conditions, agreements or limitations of the Policy or any Endorsement attached thereto, except as herein set forth. This Endorsement shall not be valid until countersigned by a duly authorized representative of the Company. Attest: Secretary President Countersigned at Brookfield, Wisconsin this ................. day of.August............... 20.13.._. Authorized Representative. ENDORSEMENT#4(13-14) MINTB 21514 PulteGroup,Inc. 0410112012-0410112014 This page intentionally left blank 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 ENDORSEMENT#4(13-14) MWTB 21514 PutteGroup,Inc. 04101/2012-04/01/2014 This page intentionally left blank 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 organ izations(s). PCA 048 06 07 ENDORSEMENT#4(13-14) MWTB 21514 PulteGroup,Inc. 0410112012-04/0112014 This page intentionally left blank U-40A ENDORSEMENT Additional Premium: Return Premium: This endorsement, effective 04/01/13 forms a part of Policy No. MWTB 21514 policy effective date 04/01/12 expiration date 04/01/14 issued to PulteGroup, Inc. by OLD REPUBLIC INSURANCE COMPANY, Greensburg, Pennsylvania It is hereby understood and agreed that the following forms are added to the policy as respects the City of Fresno: PIL 028 05 10 Designated Entity- Notice of Cancellation Provided By Us PCA 048 08 07 Additional Insured/Designated Insured Amendment-Primary and Non-Contributory Endorsement#4(13-14) Nothing herein contained shall be held to vary, alter,waive or extend any of the terms, conditions, agreements or limitations of the Policy or any Endorsement attached thereto, except as herein set forth. This Endorsement shall not be valid until countersigned by a duly authorized representative of the Company. Attest: 42--� Secretary President Countersigned at Brookfield, Wisconsin this ................. day of,August...............20.13 ................................................................................................................................ Authorized Representative. ENDORSEMENT#4(13-14) M WTB 21514 PulteGroup,Inc. 0410112012-0410112014 This page intentionally left blank 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 ENDORSEMENT#4(13-14) MWTB 21514 PulteGroup,Inc. 04101/2012-04101/2014 This page intentionally left blank 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 organizations(s). PCA 048 06 07 ENDORSEMENT#4(13-14) MWTB 21514 PulteGroup,Inc, 0410112012-04/01/2014 This page intentionally left blank WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 anyone not named in the Schedule. Schedule CITY OF FRESNO ITS OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS 1983 National Council on Compensation Insurance. INSURED COPY Policy Number MWC 118274 00 ENDORSEMENT OLD REPUBLIC INSURANCE COMPANY Insured Name PULTEGROUP, INC. Policy Effective Date: 04-01-2013 12:01 A.M., Standard Time Agent Name AON RISK SOLUTIONS Agent No. 384 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE FOLLOWING RATING PLAN IS AMENDED: INCREASE LIMITS(9816) STATE: IL AMOUNT: 4 .30% TO 1 . 80% THE FOLLOWING RATING PLAN IS AMENDED: INCREASE LIMITS (9816) STATE: IN AMOUNT: 4 . 30% TO 1. 40% THE FOLLOWING FORMS HAVE BEEN ADDED AS RESPECTS THE CITY OF FRESNO: PC 009 05-10 DESIGNATED ENTITY—NOTICE OF CANCELATION WC 00 03 13 04-84 WAIVER OF OUR RIGHT TO RECOVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. All other terms and conditions of this Policy remain unchanged. (The information below is required to be completed only when this endorsement is issued subsequent to the policy effective date.) Endorsement Effective Date:04—01-13 ,this endorsement forms part of Policy Number: MWC 118274 00 Insured Name: PULTEGROUP, INC. TO BE ADJUSTED Policy Effective Date:04-01-2013 AT TIME OF AUDIT NCCf Carrier Code: 11509 Endorsement No: 005 WC 89 06 00 B Page 1 INSURED COPY 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 Cancelation: 30 Person or Organization: CITY OF FRESNO ITS OFFICERS, OFFICIALS, AGENTS, EMPT�OYEES 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. We 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 05 10 INSURED COPY