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HomeMy WebLinkAboutT-5983 - Certificate of Insurance - 6/20/2011 PHTH CERTIFICATE OF LIABILITY INSURANCE DAI11612DlY 6!1612011 1 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(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). PRODUCER (559)432-0222 NAAM"E cT DiBuduo Sr DeFendis Insurance Brokers, LLC PHONE FAx License#OE02096 E-MAIL Arc No); P.O.Box 5479 PRODUCER Fresno,CA 93755-5479 CUSTOMER ID S:WILSLEO-01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Wilson Homes,Inc. INSURERA:United Specialty 7550 N Palm Ave,Suite 102 INSURER B:Everest National Insurance Company Fresno, CA 93711 INSURER C INSURER D: INSURER E: INSU ERF: 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, 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPO LTR TYPE OF INSURANCE I DL UBR POLICY NUMBER MM DCY EFF MM!DY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY X ISC000114500 8/23/2010 8/23/2011 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL SADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC A I v l $ AUTOMOBILE LIABILITY =V COMBINED SINGLE UMI $ ANY AUTO I:.� I©Ved• (Ea accident) ALL OWNED AUTO.$ y� oved w1 c1 IQnges' �r f BODILY INJURY(Per person) $ AN 1 I BODILY INJURY(Per accident) $ SCHEDULED AUTOS 4 UG`w PROPERTY DAMAGE $ HIRED AUTOS 'I g (Per accident) NON-OWNED AUTOS $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 B 7187000132101 8/23/2010 8/23/2011 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN 11 FR ANY PROPRIETDRIPARTNEPJEXECUTIVE❑ NIA E.LEACH ACCIDENT Is OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E_L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:Tract 5983,Fresno,CA Certificate Holder Is Named as Additional Insured as respects general liability per CG2010 0704&CG2037 0704 attached Such insurance as is afforded by the policy is primary per company form CG0001 1204 attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. Maryann Lewis c/o Construction Management Division 2600 Fresno Street,Room 4019 AUTHOR ZED REPRESENTATIVE Fresno,CA 93720- ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ISCO001145-00 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY.PL EASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s): The City of Fresno RE: Tract 5983 It's officers,officials,employees,agents &volunteers City of Fresno c/o Construction Management Division 2600 Fresno Street,Room 4019 Fresno,CA 93720 Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section Il -Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) additional insureds,the following additional or organization(s)shown in the Schedule, but exclusions apply: only with respect to liability for"bodily injury", "property damage"or"personal and advertising This insurance does not apply to"bodily injury" injury"caused, in whole or in part, by: or"property damage"occurring after: 1. Your acts or omissions;or 1. All work, including materials, parts or 2. The acts or omission of those acting on equipment furnished in connection with your behalf; such work, on the project(other than service, maintenance or repairs)to be in the performance of your ongoing operations performed by or on behalf of the for the additional insured(s)at the location(s) additional insured(s)at the location of the designated above. covered operations has been completed; or 2. That portion or"your work"out of which the injury or damages arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the principal as part of the same project. CG 2010 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 0 ISC0001145-00 Page 3 POLICY NUMBER: ISC0001145-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PL EASE 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) Location And Description Of Completed Operations Or Organization(s): The City of Fresno RE: Tract 5983. It's officers,officials,employees,agents &volunteers City of Fresno c!o Construction Management Division 2600 Fresno Street,Room 4019 Fresno,CA 93720 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 include as an addltlonal Insured the person(s)or organizatior,(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 Pagel of 1 o ISC0001145-00 Page 2 b. To sue us on this Coverage Part unless all of When this Insurance is excess,we will have no its terms have been fully complied with. duty under Coverages A or B to defend the in- sured against any"suit'if any other insurer has A person or organization may sue us to recover on a duty to defend the insured against that"suit".If an agreed settlement or on a final judgment no other insurer defends,we will undertake to do against an insured; but we will not be liable for so, but we will be entitled to the insureds rights damages that are not payable under the terms of against all those other insurers. this Coverage Part or that are in excess of the ap- plicable limit of Insurance.An agreed settlement When this insurance is excess over other in- means a settlement and release of liability signed surance,we will pay only ourshare of the by us,the insured and the claimant orthe claim- amount of the loss, T any,that exceeds the sum ant's legal representative_ of. 4. Other Insurance (1) The total amountthat all such other If othervalid and collectible Insurance is available insurance would pay forthe loss in the to the insured for a loss we cover under Cover- absence of this insurance;and ages A or B of this Coverage Part, our obligations (2) The total of all deductible and self- are limited as follows: insured amounts under all that other Primary Insurance insurance. We will share the remaining loss, if any,with This insurance is primary except when b.be- any other insurance that is not described in low applies.If this insurance is primary, our ob- this Excess Insurance provision and was not ligations are not affected unless any of the bought specifically to apply in excess of the other insurance is also primary.Then,we will Limits of Insurance shown in the Declarations share with all that other insurance by the of this Coverage Part method described in c.below. c. Method Of Sharing b. Excess Insurance If all of the other insurance permits This insurance is excess over: contribution by equal shares,we will follow this (1) Any of the other insurance,whether pri- method also. Under this approach each mary,excess,contingent or on any other insurer contributes equal amounts until it has paid its applicable limit of insurance or none of basis: the loss remains,whichever comes first. (a) That is l=ire, Extended Coverage, If any of the other insurance does not permit Builder's Risk, Installation Risk or similar contribution by equal shares,we will contribute coverage for your work". by limits. Underthis method,each insurer's (b) That is Fire insurance for premises share is based on the ratio of its applicable rented to you or temporarily occupied by limit of insurance to the total applicable limits you with permission of the owner, of insurance of all insurers. (c) That is insurance purchased by you to 5. Premium Audit cover your liability as a tenant for"prop- erty damage"to premises rented to you a. We will compute all premiums for this Cover- or temporarily occupied by you with age Part in accordance with our rules and permission of the owner or rates. (d) If the loss arises out of the maintenance b. Premium shown in this Coverage Part as ad- or use of aircraft, "autos"or watercraft to vance premium is a deposit premium only.At the extent not subject to Exclusion g.of the close of each audit period we will compute Section I-Coverage A-Bodily Injury the earned premium for that period and send And Property Damage Liability. notice to the first Named Insured.The due date for audit and retrospective premiums is (2) Any other primary insurance available to the date shown asthe due date on the bill. If you covering liability for damages arising the sum of the advance and audit premiu ms out of the premises or operations,or the paid for the policy period is greater than the products and completed operations,for earned premium,we will return the excess to which you have been added as an addi- the first Named Insured. tionaI insured by attachment of an en- dorsement. c. The first Named Insured must keep records of the information we need for premium computa- tion: and send us copies at such times as we may request. CG 00 0112 04 O ISO Properties, Inc., 2003 Page 11 of 15 PHTH CERTIFICATE OF LIABILITY INSURANCE F DAT6!13,13/22DIY011 1 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). ACT PRODUCER (559)432-0222 NAME: DiBuduo&DeFendis Insurance Brokers,LLC PHONE FAX JC_ o A1C,NO License#OE02096 E-MAIL ADDRESS: P.O. Box 5479 PRODDUCERID#:WILSLEO O1 Fresno,CA 93755-5479 INSURER(S)AFFORDING COVERAGE NAICq INSURED Leo Wilson Company Inc- INSURER A:Allstate Insurance Company 5983 Enterprises, LP INSURER e: 7550 N Palm Ave,Suite 102 INSURER C: Fresno,CA 93711 INSURERD: 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. INSR TYPE OF INSURANCE DL UB POLICY EFF POLICY EXP LIMITS POLICYNUMBER MM/DD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ �— NIA E i--iJ COMMERCfAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F7 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY n PRO- LOC $ AUTOMOBILE LIABILITY X (Ed BINEDt)accident) LIMIT $ 1,000,01}0 A X ANY AUTO BAP048584409 10/26/2010 10/26/2019 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS UMBRELLA LAB OCCUR (1i'I roved EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE Apoved /Changes: AGGREGATE $ DEDUCTIBLE RETENTION $ `r ------��� Is WORKERS COMPENSATION I TORY CIMI S OTH- AND EMPLOYERS*LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECLMIIE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-E4 EMPLOYE $ If yes,descibe undez 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:Per Written Contract-Tract 5983 Certificate Holder is Named as Additional Insured as respects auto liability per company form to follow CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Fresno ACCORDANCE WITH HE POLICY PROVISIONS.OF, NOTICE WILL 8E DELIVERED IN Maryann Lewis c/o Construction Management Division 2600 Fresno Street,Roam 4019 AUTHORIZED REPRESENTATIVE Fresno,CA 93720- r ©9988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCE-COMMERCIAL A1101ter You're in goo tends. ALLSTATE INSURANCE COMPANY-NORTHBROOK,IL THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INTERESTED PARTY TYPE:ADDITIONAL INSURED Commerrts: CERTIFICATE HOLDER NAMED INSURED Name and Address of Party to Whom this Certificate Is Issued Name and Address of Insured THE CITY OF FRESNO LEO WILSON COMPANY INC ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS&VOLUNTEERS 7550 N PALM AVENUE C/O CONSTRUCTION MANAGEMENT DIVISION FRESNO,CA 93711 2600 FRESNO ST,RM 4019 FRESNO,CA 93720 This is to certify that policies of insurance listed below have been issued to the insured named above subject to the expiration date indicated below, 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 condilions of such policies. TYPE OF INSURANCE AND LIMITS GENERAL IJABIIJTY Policy Number Effective Date F)iraffon Date Limit Amount GENERAL AGGREGATE LIMIT(Other than Products-Completed Operations) $ PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ PERSONAL AND ADVERTISING INJURY LIMIT $ EACH OCCURRENCE LIMIT $ PHYSICAL DAMAGE LIMIT $ ANY ONE LOSS MEDICAL EXPENSE LIMIT $ ANY ONE PERSON AUTOMOBILE LIABILITY Policy Number 048584409 Effective Date 10/26/10 Expiration Date 10/26/11 Coverage Basis Limits ®ANY AUTO ❑OWNED AUTOS Q HIRED AUTOS Combined Sin Ie IJmft of Liability BODILY INJURY&PROPER TY $ 1,000,000 EACH DAMAGE ACCIDENT Q SPECIFIED AUTOS ❑NON-OWNED AUTOS Split Liability Llmtts Bodlly Injury Property Damage Each ❑OWNED PRIVATE PASSENGER AUTOS $ 1 PERSON Q OWNED AUTOS OTHER THAN PRIVATE PASSENGER 1 $ $ I ACCIDENT UMBRELLA LIABILITY Policy Number Effective Date Expiration Date EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ 1 $ OTHER(Policy Policy Effective Expiration Type) Number Date Date D£SCRIPT30NOF-.OPERATIONS(LaATIONSFVEHIO:E-S/RESTPJMrNSfSPECIALTEMS : :.... :i::: : : :::: '::.: ::::::i i. : RE:5983 ENTERPRISES,LP-TRACT 5983 IT IS AGREED THAT SHOULD THE INSURANCE PROTECTION EVIDENCED HEREIN TERMINATE,THE ISSUING COMPANY Wlll ENDEAVOR TO MAIL NOTICE OF SUCH TERMINATION WITHIN 30 DAYS FOR THE FOLLOWING INTERESTED PARTIES:MORTGAGEE,LIEN HOLDER, ADDITIONAL INSURED AND ADDITIONAL INTERESTED PARTY. DIBUDUO&DEFENDIS 8/17/11 Authorized Representative . f COI 10442 LIABILITY(8105) POLICY NUMBER RAP 048584409 COMMERCIAL AUTO THIS ENDORSEMENTCHANGESTHE POLICY.PLEASEREAD IT CAREFULLY. ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name and Address of Person or Organization: The City of Fresno It's Officers, Officials, Employees, Agents & Volunteers 2600 Fresno St. Rm 4019 Fresno, CA 93720 A. The person or organization shown in the Schedule is included as an insured but only if liable for the conduct of an "insured" and only to the extent of that liability. B. CANCELLATION 1_ If we cancel the policy, we will mail or deliver notice to such person or organization in accordance with the Common Policy Conditions. 2. if you cancel the policy, we will mail or deliver notice to such person or organization. 3. Cancellation ends this agreement. BU1114(1-93) CERTHOLDER COPY NE STATE E.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 FUND 1 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-13-2011 GROUP. POLICY NUMBER: 1935354-20iO CERTIFICATE ID: 18 CERTIFICATE EXPIRES: 10-01-2011 10-01-2010/10-01-2011 CITY OF FRESNO NE JOB:TRACT 5983 - 5983 ENTERPRISES, LP CONSTRUCTION MANAGEMENT DIVISION 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 cr 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 X12570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-08-13 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF FRESNO RISIC M AGEMENT DIVISION Approved: Appr ved Changes: Signe Dia#e=� EMPLOYER WILSON HOMES INC NE 7550 N PALM AVE STE 102 FRESNO CA 93711 [B11,NEj PRINTED : 06-13-2011 (FEV.a-2010)