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HomeMy WebLinkAboutT-5995 - Certificate of Insurance - 8/4/2011 City of MEMORANDUM DEVELOPMENT AND RESOURCE MANAGEMENT DEPARTMENT•DEVELOPMENT SERVICES DIVISION•2600 FRESNO STREET•FRESNO,CA 93721 DATE: August 2, 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. 5995 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 PHTH '4 CERTIFICATE OF LIABILITY INSURANCE F DATE 8/2(202120 1 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 policy(ies)must be endorsed. If SUBROGATION IS WANED, 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 CON DiBuduo&DeFendis Insurance Brokers, LLC I PHONE FAx AIC No Ext• A1C No: License#01702096 EMAIL P.O.Box 5479 PRODUCER Fresno,CA 93755-5479 CUSTCIIER{D A:WILSLEO-01 INSURER(S)AFFORDING COVERAGE _ NAIC# INSURED Leo Wilson Company Inc. INSURER A:Allstate Insurance Company 7550 N Palm Ave,Suite 102 INSURERB: Fresno, CA 93711 INSURER C 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. INSRPOLICTYPE OF INSURANCE DL SUBR POLICY NUMBER MMl p EFF LTMMIDDIY POLICY P LIMITS R GENERAL LIABILITY EACH OCCURRENCE $ IJAMAQE TO RENTE COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO-JEU n LOC $ AUTOMOBILE LIABILITY X (Ea accident) $ 1,000,000 A X ANY AUTO BAP048584409 10126/2010 10/26/2011 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS Per accident) NON-OWNED AUTOS RISK MRNAGE I ENT IVISIG $ $ UMBRELLA LIAB OCCUR _ d W Chan `�1J EACH OCCURRENC EXCESS LIAR HCLAIMS-MADE Appr Ves„ AGGREGATE $ DEDUCTIBLE $$ Date RETENTION $ $ WORKERS COMPENSATION WC STATU- I IOTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS I IF ANY PROPRIETOR'PARTNER/EXECUTIVE❑ N!A E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ It yes,DESCRIPTION O E.L.DISEASE-POLICY LIMIT S er DESCRIP.ION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) RE:Tract 5995,Fresno,CA Certificate Holder is Named as additional insured as repsects auto liability per BU 1114 01-93 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 Construction Management Division 2600 Fresno Street,Room 4019 Fresno,CA 93720- AUTHORIZED REPRESENTATIVE I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD .F . i POLICY NUMBER BAP 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) PHTH CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 812!2011 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)- PRODUCER (559)432-0222 CNAME TACT DiBuduo&De Fendis Insurance Brokers, LLC PHONE FAX A!C No Ext`: A1C No- License 40E02096 E-MAIL P.O. Box 5479 PRODUCER Fresno,CA 93755-5479 CUSTOMER ID#:WILSLEO-01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Wilson Homes, Inc. INSURER A:United Specialty 7550 N Palm Ave,Suite 102 INSURER B:Everest National Insurance Company Fresno, CA 93711 INSURER C INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS-1"0 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 OL UBR POLICYEFF--- POLICY EXP LTR N WVD POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILnY ISC000114500 8123!2010 8/2312011 1 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE FX]OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER! PRODUCTS-COMPIOPAGG $ 2,000,000 X7 POLICY PROJEC- LOC $ AUTOMOBILE LIABILITY EIVIE I , 1 �r COMBINED SINGLE LIMIT $ (Ea acddent) ANY AUTO ppr ved: BODILY INJURY(Per person) $ ALL OWNED AUTOS ppr ve Change ' BODILY INJURY(Per acddent) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS igned Da} (Per accident) NON-OWNED AUTOS 1 $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 2,000,000 B 71R7000132101 8/23/2010 8/23/2011 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONI TOCS ATUS OEH AND EMPLOYERS'LIABILITY ANY PROPRIETOPJPARTNERICX[CUTIVEY!N I E.L EACH ACCIDENT $ OFFICERIMEMSER EXCLUDED? NIA (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If�/es,describe under DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required) RE:Tract 5995,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 SHOULDANYOF 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 Construction Management Division 2600 Fresno Street,Room 4019 Fresno,CA 93720- AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD PCLICY NUMBER: ISC0001145-00 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: COM Iv1ERCIAL 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 5995 its officers,officials,employees;agents &volunteers City of Fresno c/o Comstraction 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 a W rth respect to the insurance afforded to these include as an additional insured the person(s) additional insureds,the following additional or organizations)shown in the Schedule, but exclusions apply: only with respectto 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'yourwork"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 suboontractor engaged in performing operations for the principal as part of the same project. CG 2010 07 04 D ISO Properties, Inc.,2004 Page 1 of 1 ISC0001145-00 Page 3 POLICY NUMBER: ISCQCC1145-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY.PL FRSE 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 5995 It's officers,officials,employees,agerus 3c volunteers City of Fresno coo Constructianivlanagement 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 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 pa;formed for that additional insured and included in the"products- completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Pagel of 1 ISC0001145-00 Page 2 b. To sue us on this Coverage Part unless all of When this insurance is excess,vve will have no its terms have been fully complied with, duty under Coverages A or B to defend the in- A person or organization may sue us to recover on sured against any 'suit!'if any other insurer has an agreed settlement or on a final judgment e duty to defend the insured against that"suit". If no other insurer defends,we will u ndertake to do against an insured;but we will not be liable for so,but we will be entitled to the insured's 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,ve will pay only ourshare of the by us,the insured and the claimant or the claim- amount of the loss, if ary,that exceeds the sum ant's legal representative. or 4- Other Insurance (1) The total amountthat alt such other If othervalld and collectible insurance is available insurance would payforthe loss in the to the insured for a loss we cover u rider Cover- absence of this insurance;and ages or B of this Coverage Part, our obfigations (2) The total of all deductible and self- are limited as follows: insured amounts under all that other cV Primary Insurance insurance. We will share the remaining loss, if any,with This insurance is primary except when b.be- any other insurancethat is not described in lowapplies,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,%-_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,wewill follrnvthis (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 basis: paid its applicable limit of insurance or none of the loss remains,whichever comes first. (a) That is Fire,Extended Coverage, If any of the other insurance does not permit BuildefsRisk,Installation Risk orsimilar cpntribution coverage for"your work"; by equal shares,we will contribute by limits.Underthis rrrethod,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 forthis Caver- 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 retrospectne premiums is (2) Any other primary insurance available to the date shown as the due date on the bill-If you covering liability for damages arising the sum of the advance and audit premiums out of the premises or ope ratio ns,or the paid for the policy period is greaterthan 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. tonal 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 CERTHOLDER COPY NE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-02-2011 GROUP: POLICY NUMBER: 1935354-2010 CERTIFICATE Ill 17 CERTIFICATE EXPIRES: 10-01-2011 10-01-2010110-01-2011 CITY OF FRESNO NE JOB:TRACT 5998 CONSTRUCTION MANAGEMENT DIVISION 1721 VAN NESS AVE FRESNO CA 93721-1130 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 suaject 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 emend, extend or 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. tAuth.,,z,d 3epresentative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-06-13 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF FRESNO RISK MAN GE lveL;4 a Appr ed:l ` Appro ed v+y Changes: 1 Signed 1 EMPLOYER WILSON DOMES INC NE 7550 N PALM AVE STE 102 FRESNO CA 93711 [B11,NE] PRINTED 09-02-2011 !R E V.3.2010) ENDORSEMENT AGREEMENT BROKER COPY STATE- WAIVER OF SUBROGATION REP 02 - 1935354-10 RENEWAL NE HOME OFFICE 1-56-87-87 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12.01 AM PACIFIC EFFECTIVE JUNE 13, 2011 AT 12.01 A.M. STANDARD TIME 'f HE TIME INDICATED ATT AND EXPIRING OCTOBER 1 2011 AT 12.01 A.M. PACIFIC STANDARD TIME WILSON HOMES INC 7550 N PALM AVE STE 102 FRESNO, CA 93711 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF FRESNO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, WILSON HOMES INC IT IS FURTHER AGREED TRA.T THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO= JUNE 15, 2011 2570 I'`VINBa L A HORIZED REPRESENTATIVO PRESIDENT AND CEO SCIF FORM 10217 (REV_8-20 OLD DP 217