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HomeMy WebLinkAboutT-5973 - Certificate of Insurance - 1/12/2012 GLENE-1 OP ID: LE CERTIFICATE OF LIABILITY INSURANCE DAT10/24DYYYYJ 10!24111 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). CONTACT PRODUCER 559-233-0123 _NAME: Steve Hertel Agri-Center Insurance Agency 559-266-8855 PHONE 559-256-4502 F°X 1300 W Shaw#1A Arc No.EXt): (arc,Ne}: Fresno,CA 93711 ADDRIESS:GLENE-1 Martin McCubbin -��- - INSURER(S)AFFORDING COVERAGE MAIC# INSURER A:American Safety Indemnity Co. INSURED Gleneagles Homes A California INSURER B:Nautilus Insurance Company Corporation 11326 N.Glencastie Way INSURER C: Fresno, CA 93730-7003 JNSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILT TYPE OF INSURANCE I L POLICY NUMBER MMlDDIYEYYY POLICY EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ESLO12901-11-06 04/01/11 04/01112 dAMAGET RE TED PREMISES Ea occurrence $ 50,000 CLAIMS-MADE J OCCUR MED EXP(Any oneperson) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 R€IDI/ M 1�EEN] 1 ,iSI i NERAL AGGREGATE $ 2,000,000 G£N'LAGGREGATE LIMIT APPLIES PER: Approve PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY PRO JECT F7 LOC $ yi COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY '- Ea accident ANY AUTO ` BODILY INJURY(Per person) $ ALLOWNED SCHEDULEDj AUTOS AUTOS I BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE SE11EXC7256931V 04/01/11 04/01112 AGGREGATE $ 5,000,000 —DED-FX I RETENTION$ $ WORKERS COMPENSATIONWCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN 1. Y ANY PROPRIETORIPARTNER/EXECUTIVE � N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) re: Tract 5973, Fresno,CA. Named Insured reads per attached form#ES 98 065 03 10. The City of Fresno,Its officers,officials,employees,agents and volunteers are Included as additional insured as respects general liability per attached endorsement form CG2037 07 04&CG2033 07 04.General Llabllity CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. C/O Department of Public Works _ Attn: Maryann Lewis AUTHORIZED REP ATIVE 2600 Fresno Street,4th Floor Martin I in >k Fresno,CA 93721 I ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE GLENE-1 PAGE INSUREDS NAME Gleneagles Homes A California OP ID: LE DATE 10/24/19 is rimary per attached endorsement form MAN 05 05 03 05.Excess Liability Is ollow ing form. POLICY NUMBER: ESLO12901-11-06 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 Organlzation(s): Location And Description Of Completed Operations The City of Fresno, Its officers, officials,agents, 2600 Fresno Street employees and volunteers C/O Department of Public Fresno, CA 93721-3623 Works 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 damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule 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 POLICY NUMBER: ESLO12901-11-06 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section It — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to.- organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal added as an additional insured on your policy. Such and advertising injury" arising out of the person or organization is an additional insured only rendering of, or the failure to render, any with respect to liability for "bodily injury", "property professional architectural, engineering or damage" or "personal and advertising injury" surveying services, including: caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, behalf; change orders or drawings and specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional 2, "Bodily injury" or "property damage" occurring insured under this endorsement ends when your after: operations for that additional insured are completed. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project CG 20 33 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ PSI THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, MAN 05 005 03 05 SPECIAL ENDORSEMENT This Endorsement shall not serve to increase our limits of insurance, as described in the LIMITS OF INSURANCE section of the policy. It is agreed that the following changes are Incorporated Into the policy: PRIMARY INSURANCE ENDORSEMENT This Endorsement shall not serve to increase our limits of insurance, as described in SECTION III - LIMITS OF INSURANCE. Name of Person or The City of Fresno, Its officers, officials, agents, employees and Organization; volunteers C/O Department of Public Works 2600 Fresno Street, Fresno, CA 93721-3623 Effective Date. 10/20/2011 In consideration of the payment of premiums, it This Endorsement applies only to: is hereby agreed that the following changes are incorporated into the policy: 1. Operations performed by the Named Insured on or after the effective date of It is agreed that such insurance as is afforded this Endorsement; to the person or organization named above as 2. Liability arising out of or relating to the Additional Insured under the applicable Named Insured's sole negligence; and Additional Insured Endorsement attaching to 3. "Bodily injury" or "property damage" this policy shall be considered primary to such caused by an "occurrence" under person or organization if other valid and Coverage A not otherwise excluded in collectible insurance is available to such the policy to which this Endorsement person or organization for a loss or occurrence applies. we cover for such person or organization, but only as respects liability arising out of "your All other terms, conditions and exclusions under work" performed by the Named Insured for the the policy are applicable to this Endorsement and person or organization named above. remain unchanged. All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. MAN 05 005 03 05` Copyright©2005 Page 1 of 1 www,amsafety.com OP ID: LE '4 CERTIFICATE OF LIABILITY INSURANCE DAT1 lYYYY) 10/124/241 11 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 pollcy(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 Ileu of such endorsement(s). PRODUCER 559-233-0123 NADMEACT Steve Hertel Agri-Center Insurance AgencyPHDNE FAX 559-266-8858 1300 W Shaw#1A we No 559-256-4502 Ext1: Arc No): Fresno,CA 93711 E-MAADDRESS: Martin McCubbin PRODUCER s E •GLENE-1 INSURERS AFFORDING COVERAGE _ NA_I_C# _ INSURED Gleneagles Homes A California wsURERA:DELOS Insurance Co Corporation INSURER B: _ 11326 N. Glencastle Way INSURER C: Fresno,CA 93730-7003 � -- INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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- Iffi­ LT R � � _ TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM1D�YffYYY MMIDbnYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENT �. COMMERCIAL GENERAL LIABILITY REMISES Ea occurrence $ CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ CEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPrOPAGG $ POLICY PRO- J LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ tt 3 (Ea accident) ANY AUTO riV L I i L.i`! s�+�-- BODILY INJURY(Per person) $-- -— ALL OWNED AUTOS LJ 4) SCHEDULEOAUTOS �1t.:��'I'C�VCd /G�iC]C1� BODILY INJURY(Per accident) $es: PROPERTY DAMAGE HIREDAUTOS ^� raccident) $ (P NON-OWNEDAUTOSSigned $ ,— $ UMBRELLALIAF1 —B OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X 7NCYTA IT OTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECUTIVE Yr N 04DKRM12002630 01127/11 01/27/12 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N r A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,040 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) RE:Tract 5973,Fresno}CA. Waiver of subrogation In favor of The City of Fresno is included as respects workers compensation per endorsement WC 04 03 06 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. C/O Department of Public Works Attn: Maryann Lewis AUTHORIZED RESENTATIVE 2600 Fresno St.,4th Floor Martin c bin ' Fresno,CA 93721 ©1988-2009 ACORD CORPORATION. All rights reserved- ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover from 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5%of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of Fresno All Projects c/o Department of Public Works Tract 5973 2600 Fresno St,4th Floor Fresno,CA 93721 Minimum Premium $50 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 9/21/2011 Policy No. 04DKRMl-2002-630 Endorsement No.1 Insured Gleneagles Homes;A California Insurance Company: Delos Insurance Company-35408 Corporation Gary McDonald Homes, Inc Countersigned By: ©1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual©2001. 9/26/2011 cw