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HomeMy WebLinkAboutT-5977 - Certificate of Insurance - 4/18/2011 k DATE ACORP. CERTIFICATE OF LIABILITY INSURANCE 04/14/2011) 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 45 East River Park Place West HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 408 Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURED Bonadelle Homes, Inc INSURER A: United Specialty Ins Co 7030 N. Fruit, Ste 101 INSURERB: Peerless Insurance Company Fresno, CA 93711 INSURER C: 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ,ED DATE(MMIDDNY) GENERAL LIABILITY ISCO00115900 10/30/2010 10/30/2011 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDce, $ 100,000 CLAIMS MADE FX—]OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROECT LOC J AUTOMOBILE LIABILITY CBP 8364480 12/31/2010 12/31/2011 COMBINED SINGLE LIMIT (Ea accident) $ X ANY AUTO 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ B HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) 7n / n /I I , PROPERTY DAMAGE $ !W i +v, H (Per accident) GARAGE LIABILITY Liporove AUTO ONLY-EA ACCIDENT $ ANY AUTO ` W nges. �-�I OTHER THAN EA ACC $ /Ch AUTO ONLY, AGG $ EXCESS/UMBRELLA LIABILITY ,.-' EACH OCCURRENCE $ OCCUR CLAIMS MADE Dc' AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMITS FIR EMPLOYERS'LIABILITY ANY PROPRIETO RlPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ OTHER Ten Day Notice of Cancellation Would Apply in Event of Cancellation for Nonpayment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS e: Early Issuance of Model Home Building Permits for Final Map of Tract 5977 & subordination ity of Fresno, its officers, officials, employees, agents, volunteers are included as additional insured as respects the GL per forms CG 2026 07/04 & CG2037 10/01 attached. rimary wording per endt IL 12 01 11 85. Auto additional insured per CA2048 02/99 attached. eplaces certificate issued 4/8/11 CERTIFICATE HOLDER 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2600 Fresno Street Rm 4019 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Fresno, CA 93721 AUTHORIZED REPRESENTATIVE /1 / Donna Smith/DONNA ACORD 25(2001108) ©ACORD CORPORATION 1988 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(2001/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 05 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE ISC0001159-00 04/06/2011 United Specialty Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Bonadelle Homes Inc Burns&Wilcox Insurance Services 7030 N Fruit,Suite 101 100 Pine Street,23rd Floor Fresno CA 93711 San Francisco,CA 94111 COVERAGE PARTS AFFECTED Commercial 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: Per forms CG 2037 and OG 2026,the City of Fresno is added as an additional insured. This coverage is primary and non contributory with any other insurance available under any other third party liability policy Re: Tract 5977 All other policy terms and conditions remain unchanged. Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 o Copyright, ISO Commercial Risk Services, Inc., 1983 ISC0001159-00 Page 1 POLICY NUMBER ISC0001159-00 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 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 Person or Organization: City of Fresno, its officers,officials,agents,employees and volunteers 2600 Fresno Street, RM 4019 Fresno,CA 93721 Location And Descript ion of Completed Operations: Tract 5977 Additional Premium: (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work'at the location designated and described in the schedule of this endorsement performed for that insured and included in the"products- completed operations hazard" CG 20 37 10 01 ©ISO Properties, Inc.,2000 Page 1 of 1 o ISC0001159-00 Page 2 POLICY NUMBER: ISC0001159-00 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,RM 4019 Fresno,CA 93721 RE. Tract 5977 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 or- ganization(s)shown in the Schedule,but only with respect to liability for"bodily injury',"property dam- age"or"personal and advertising injury'caused, in whole or in part,by your acts or omissions or the acts or omissions of those acting on your be half 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 Pagel of 1 o I SC0001 159-00 Page 3 Forming a part of Policy Number: COP 8364460 Coverage hr Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Named Insured: Agent: BONADELLE DEVELOPMENT ARTHUR J GALLAGHER&CO INS OR CORPORATION REFER TO NAMED INSURED SCHEDULE Agent Code: 4282840 Agent Phone: (558)-436-0633 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"under the Who Is An Insured Provision of the Coverage Form.This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 12131/2010 Each person or organization shown in the Schedule is an'Insured"for Liability Coverage,but only to the extent that person or organization qualifies as an"insured"under the Who Is An Insured Provision contained in Section II of the Coverage Form. SCHEDULE Name of Person(s)or Organization(s): CITY OF FRESNO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS&VOLUNTEERS 2600 FRESNO ST. RM 4019, FRESNO,CA 93721 (if no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) CA 20 48 (02199) Copyright,Iruraance Services Office,Inc.,1998 INSURED COPY 1=12010 835"80 NNIN973 113111 PGDMMD JOSH GCAFPPN 00000442 POP 73 DATE ACORDM CERTIFICATE OF LIABILITY INSURANCE 04/14/2011) 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 45 East River Park Place West HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 408 Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURED Bonadel1e Homes, Inc INSURERA: Oak River Insurance Co INSURER B: 7030 N. Fruit Ave, Suite 100 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 ADDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS am DATE IMMIDD/YYI DATE(MM/DDNYI GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ P_RSE CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROECT LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS ^' •,44< MA AGEMENT DI ON BODILY INJURY $ NON-OWNEDAUTOS r proved: vedCf ;dy( ages. PROPERTY DAMAGE $ �- (1--( � (Per accident) GARAGE LIABILITY D e AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY, AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 2200057680-101 10/01/2010 10/01/2011 X I WC STATU- I JOTH- TORY EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER Ten Day Notice of Cancellation Would Apply in Event of Cancellation for Non-Payment DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS e: Early Issuance of Model Home Building Permits for Final Map of Tract 5977 & subordination Blanket Waiver of Subrogation form WC9904 10A 07/07 attached. CERTIFICATE HOLDER 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2600 Fresno Street Rm 4019 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Fresno, CA 93721 AUTHORIZED REPRESENTATIVE Donna Smith/DONNA � � ACORD 25(2001/08) ©ACORD CORPORATION 1988 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(2001/08) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410A(Ed 07-07) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2.00 %of the total policy premium otherwise due on such remuneration. The minimum premium for this endorsement is$ Asn nn Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED 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 10/01/2010 Policy No. 2200057680-101 Endorsement No, 1 Insured BONADELLE HOMES,INC Premium$ Insurance Company Countersigned by Oak River Insurance Company WC 99 04 10A (Ed 07-07) City of MEMORANDUM DEVELOPMENT AND RESOURCE MANAGEMENT DEPARTMENT•DEVELOPMENT SERVICES DIVISION-2600 FRESNO STREET•FRESNO,CA 93721 DATE: April 13, 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. 5977 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 y , wlo� Jonathan Bartel a � .