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HomeMy WebLinkAboutT-5977 - Certificate of Insurance - 8/10/2011 City F'°' MEMORANDUM "ES_ �. DEVELOPMENT AND RESOURCE MANAGEMENT DEPARTMENT•DEVELOPMENT SERVICES DIVISION-2600 FRESNO STREET-FRESNO,CA 93721 DATE: August 10, 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 THE FINAL MAP OF TRACT NO. 5977 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 August 25, 2011. If you have any questions, please contact me at 621-8076. Thank you, Jonathan Bartel ACORDDATE(MMIDDIYYYY) , CERTIFICATE OF LIABILITY INSURANCE 08/08/2011 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 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 BN Hudson Ranch LP INSURERA: United Specialty Ins Co Bonadelle Homes, Inc. INSURERS: Peerless Insurance Company 7030 N. Fruit, Ste. 101 INSURERC: 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR NSR DATE MMIDDM'VY DATE MMIDD GENERAL LIABILITY ISC000115900 10/30/2010 10/30/2011i EACH OCCURRENCE $ 2,000,000 MAGE TOR X COMMERCIAL GENERAL LIABILITY _PRasurren PREMISES ce $ 100,000 CLAIMS MADE FX I OCCUR MED EXP(Any one person) $ 51000 A PERSONAL&ADV INJURY S 2,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG S 2,000,000 POLICY171 PRO LOC JECT AUTOMOBILE LIABILITY CBP 8364480 12/31/2010 12/31/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 I ALL OWNED AUTOS BODILY INJURY $ B SCHEDULEDAUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS "+ (Per accident) 2K IAAi AGEMI N �f+v l IJI� -- pprved:t PROPERTYDAMAGE s (Per accident) GARAGE LIABILITY Appro ed w/ any Z)- AUTO r I AUTO ONLY-EA ACCIDENT S HANY AUTO - CVL ` OTHER THAN EAACC S qir-i Pri Date AUTOONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR F-1 CLAIMS MADE AGGREGATE S b DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION - AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? --- ---- — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE b If yes,descaioe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I S OTHER 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 SPECIAL PROVISIONS e: Subdivision Agreement, Final Map of Tract 5977, Phase 2 of Vesting Tenative Map 5966/UGM 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. Primary wording per endt IL 12 01 11 85. Auto additional insured per CA2048 02/99 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,BUT FALURE TO DO SO SHALL City of Fresno IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2600 Fresno Street Rm 4019 REPRESENTATIVES. Fresno, CA 937Z1 AUTHORIZED REPRESENTATIVE ✓1 Donna Smith/DONNA >c.C��l -•f' ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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(2009101) THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY- POLICY CHANGES Policy Change Number 05 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE ISC0001159-00 04/U6/2011 UnitedSpecialtylnsurance 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(additionaVreturn)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 Corms CG 2037 and CS 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 t of 1 0 Copyright,ISO Commercial Risk Services,Inc.,1983 ISCOOO1159-00Pagc l POLICYNUMBER 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,RAI 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 endorsementwill 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 0 )SC0001159-00 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 Tract5977 i ._..-------------------------- - -------------------•-------------------------._...._.._..-•--..........-----.........._...._ 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 in- clude as an additional insured the person(s)oror- gamzalion(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 m ISO Properties,Inc.,2004 Page 1 of i c 1500001159-00 Page 3 Forming a part of Policy Number: CEP 8364450 Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Nattwd Insured: Agent BONADELLE DEVELOPMENT ARTHUR J GALLAGHER 6 CO INS 13R CORPORATION REFER TO NAMED INSURED SCHEDULE Apert Code: 4282640 Agent Phone: (558} 3643633 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsemenl modifies insurance provided under the folbwfng: 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 Forth apply unless moddied by this enders eme n t. This endorsement identifies persons)or organization(s)who are insureds'under the Who Is An Insured Provision of the Coverage Form.This endorsement does not after 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. f Endorsement Effective: 12/31/2010 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 11 of the Coverage Form. SCHEDULE Name of Peraon(s)or Orpnization(s): CITY OF FRESNO,ITS OFFICERS,OFFICIALS,EMPLOYEES, AGENTS 6 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) oopyVl,lrwxw w Services Ofte,Inc,1WO 1WIrAlo 535448D NN100M 1311 INSURED COPY poomi 33M OCAFPPN OMOD-W NP 73 GATE(MMID ACORD„ CERTIFICATE OF LIABILITY INSURANCE D/YYYY) os/os/Doll 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 Bonadelle 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. IND' rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P LI ON LIMITS LTR NSR DATE MWDD/YYYY DATE MWDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ GE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE 17 OCCUR MEL)EXP(Any one person) 3 PERSONAL 8 ADV INJURY S GENERALAGGREGATE S GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG j$ POLICY IEC PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALLOW SCHEDULED S A MENTI IVISIOf� BOOILYINJURYSCHEDULED AUTOS (Per person)HIRED AUTOS BODILY INJURYNON-OWNED AUTOS �� (Per accident) $ es. --- a PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY QCa AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $, AUTO ONLY AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION 2200057680-101 10/01/2010 10/01/2011 X AND EMPLOYERS'LIABILITY / / TORY LIMITS ER - AN V PROPRIETOR/PARTNER/EXECUTIVE Y I❑N E.L.EACH ACCIDENT S 1,000,000 A OFFICER/MEMBER EXCLUDED? (Mandatory In NH) El DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 OTHER ITen Day Notice of Cancellation I Would Apply in Event of Cancellation for Non-Payment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS e:Final Map of Tract 5977, Phase 2 of Vesting Tenative Map 5966/UGM 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,BUT FAILURE TO DO SO SHALL City of Fresno IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2600 Fresno Street Rm 4019 REPRESENTATIVES. Fresno, CA 93721 AUTHORIZED REPRESENTATIVE Donna Smith DONNA ACORD 25(2009101) ©1988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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(2009101) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC"174 10A(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 S :u90m_ 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 preparatlon of the policy.) Endorsement Effective 1010V2010 Policy No. 2200057880101 Endorsement W. 1 Insured BONADELLE HOMES,INC Premium S Insurance Company Countersigned by r Oak River Insurance Company WC 99 04 10A (Ed 07-07)