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HomeMy WebLinkAboutT-5997 - Certificate of Insurance - 1/12/2012 A �® CERTIFICATE OF LIABILITY INSURANCE12/20/20111 _ DIDDV 12/20 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 1-559-436-0833 CONTACT NAME: Donna Smith Arthur J. Gallagher & Co. PHONE FAX Insurance Brokers of California, Inc. . 559-256-6541 AIC No: 559-256-6590 45 E. River Park Place West, #408 E-MAIL donna smith@ajg.com ADDRESS: j g Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURER A: UNITED SPECIALTY INS CO 12537 INSURED INSURER B: Team 5 Properties, Inc. INSURER C 2109 W. Bullard Ave, Ste #101 INSURERD: Fresno, CA 93711 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 24557946 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 ADDLITYPE OF INSURANCE INSR SUER POLICY NUMBER MM DIDY EFF POLICY EXP � LTR /YYYY MMIDD/YYYY LIMITS A GENERALLIABILITY ISC000222400 10/30/1 10/30/121 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE �OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X JE POLICYIRO- 7 CT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY BODILY INJURY(Per person) $ ALL OS SCHEDULED ;;� /qG,1, .V i-. l v l L.J Y f. :ON AUTOS AUTOS - BODILY INJURY(Per accident) $ NON-OWNED .fOVed: PRPERTY DAMAGE $ HIRED AUTOS AUTOS .L.� (Pero accident / i r Gl $ UMBRELLA LIAB OCCUR v r �i EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE �_ f, , AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NER TQLMTANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 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 5997, The City of Fresno, its officers, officials, employees, agents and volunteers included as additional insureds per CG2037 07/04 and CG2026 07/04, primary/noncontributory wording per IL1201 11/85, Named Insured includes: Deyoung Properties 5581 LP. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o Construction Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 1721 Van Ness Avenue AUTHORIZED REPRESENTATIVE Fresno , CA 93721 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD jabezfres 24557946 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 01 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE ISC0002224-00 10/30/2011 United Specialty Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE DeYoung Communities Inc Burns&Wilcox Insurance Services 2109 W Bullard Ave#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: The coverage provided for the City of Fresno, perform CG 2026 and CG 2037, is primary and non contributory with any other insurance available under any other third party liability policy. Re: 1. Tract 5997 2. Tract 5553 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 0 Copyright, ISO Commercial Risk Services, Inc., 1983 ISC0002224-00 Policy Page I POLICY NUMBER: ISCO002224-00 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) The City of Fresno It's officers, officials, employees,agents I &volunteers I City of Fresno c/o Construction Management Division j 2600 Fresno Street, Room 4019 j Fresno,CA 93721 { f He, i i1. Tract 5997 1 i 2. Tract 5553 I Information required to completthis Schedule, if not.......................... -------- _..._................._..---------._-..._.__..------- Section .---._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 Page 1 of 1 o ISCO002224-00 Policy Page 2 POLICY NUMBER: ISC0002224-00 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): -rhe City of Fresno Re: 1. Tract 5997 It's officers, officials, employees,agents 2• Tract 5553 &volunteers City of Fresno c/o Construction Management Division 2600 Fresno Street, Room 4019 Fresno, CA 93721 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 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", ISCO002224-00 Policy Page 3 AC"R" CERTIFICATE OF LIABILITY INSURANCE D1ATE 2/20lDD/Y 12/20/20111 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(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 1-559-436-0833 CONTACT NAME: Donna Smith Arthur J. Gallagher & Co. PHONE 559 256-6541 FAx 559 256-6590 Insurance Brokers of California, Inc. AIC No: 45 E. River Park Place West, #408 E-MAIL donna_smith@ajg.com smith®a' com ADDRESS: j Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# Donna Smith INSURERA: GOLDEN EAGLE INS CORP 10836 INSURED INSURER 8: NATIONAL UNION FIRE INS CO OF PITTS 19445 Team 5 Properties, Inc. INSURER C 2109 W. Bullard Ave, Ste #101 INSURER D: Fresno, CA 93711 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24558675 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE E OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY F PEC0j 171 LOC $ A AUTOMOBILE LIABILITY BA8851637 05/31/12 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ B UMBRELLA LIAB X OCCUR BE6542709 0 5/31/13 05/31/12 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ .e- IX ! ' $ WORKERS COMPENSATION .+.✓L I,J I�p 1 6 V h�.t WC STATUTORY - OPT TH- AND EMPLOYERS'LIABILITY YIN Lved., ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N1A '"� E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEDI(Mandatory in NH) ^+r Chan 'P.CJ: y E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1 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) Excess Liability shown is Excess Auto Liability only Re: Tract 5997. Named insured includes DeYoung Properties 5581 LP. Blanket Additional Insured per form GECA 701 01/07 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o Construction Management Division AUTHORIZED REPRESENTATIVE 1721 Van Nese Avenue Fresno, CA 93721 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD jabezfres 74gq AA7q COMMERCIAL AUTO GOLD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SECTION II -LIABILITY COVERAGE A. COVERAGE 1. WHO IS AN INSURED The following is added: d. Any organization, other than a partnership or joint venture, over which you maintain ownership or a majority interest on the effective date of this Coverage Form, if there is no similar insurance available to that organization. e. Any organization you newly acquire or form other than a partnership or joint venture, and over which you maintain ownership of a majority interest. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization;or (2) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. f. Any volunteer or employee of yours while using a covered "auto"you do not own, hire or borrow in your business or your personal affairs. Insurance provided by this endorsement is excess over any other insurance available to any volunteer or employee. g. Any person, organization, trustee, estate or governmental entity with respect to the operation, maintenance or use of a covered"auto" by an insured, if: (1) You are obligated to add that person,organization, trustee, estate or governmental entity as an additional insured to this policy by: (a)an expressed provision of an "insured contract", or written agreement; or (b)an expressed condition of a written permit issued to you by a governmental or public authority. (2) The"bodily injury"or"property damage"is caused by an "accident"which takes place after: (a)You executed the"insured contract"or written agreement; or (b)the permit has been issued to you. GECA 701(01/07) Includes copyrighted material of Insurance Services Offices,Inc.with its permission Page I of 4 2. COVERAGE EXTENSIONS a. Supplementary Payments. Subparagraphs (2)and (4)are amended as follows: (2)Up to $2500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident'we cover. We do not have to furnish these bonds. (4)All reasonable expenses incurred by the"Insured"at our request, including actual loss of earning up to$500 a day because of time off from work. SECTION III -PHYSICAL DAMAGE COVERAGE A. COVERAGE The following is added: 5. Hired Auto Physical Damage a. Any "auto" you lease, hire, rent or borrow from someone other than your employees or partners or members of their household is a covered"auto"for each of your physical damage coverages. b. The most we will pay for"loss" in any one"accident'is the smallest of: (1) $50,000 (2) The actual cash value of the damaged or stolen property as of the time of the"loss";or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. If you are liable for the"accident', we will also pay up to$500 per"accident'for the actual loss of use to the owner of the covered"auto". c. Our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by an amount that is equal to the amount of the largest deductible shown for any owned "auto" for that coverage. However, any Comprehensive Coverage deductible shown in the Declarations does not apply to'loss"caused by fire or lightning. d. For this coverage, the insurance provided is primary for any covered "auto' you hire without a driver and excess over any other collectible insurance for any covered "auto"that you hire with a driver. 6. Rental Reimbursement Coverage We will pay up to$75 per day for up to 30 days,for rental reimbursement expenses incurred by you for the rental of an "auto' because of 'loss" to a covered "auto'. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for a period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your materials and equipment from the covered "auto'. GECA 701(01/07) Includes copyrighted material of Insurance Services Offices,Inc.with its permission Page 2 of 4 If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under paragraph 4.Coverage Extension. 7. Lease Gap Coverage If a long-term leased "auto" is a covered "auto" and the lessor is named as an Additional Insured - Lessor, In the event of a total loss, we will pay your additional legal obligation to the lessor for any difference between the actual cash value of the "auto" at the time of the loss and the "outstanding balance"of the lease. "Outstanding balance"means the amount you owe on the lease at the time of loss less any amounts representing taxes;overdue payments; penalties, interest or charges resulting from overdue payments; additional mileage charges; excess wear and tear charges; and lease termination fees. B. EXCLUSIONS The following is added to Paragraph 3 The exclusion for "loss" caused by or resulting from mechanical or electrical breakdown does not apply to the accidental discharge of an airbag. Paragraph 4 is replaced with the following: 4. We will not pay for"loss"to any of the following: a. Tapes, records, disks or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment. b. Equipment designed or used for the detection or location of radar. c.Any electronic equipment that receives or transmits audio,visual or data signals. Exclusion 4.c does not apply to: (1) Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto"at the time of the"loss"and such equipment is designed to be solely operated by use of the power from the"auto's"electrical system, in or upon the covered "auto';or (2)Any other electronic equipment that is: (a) Necessary for the normal operation of the covered"auto" or the monitoring of the covered "auto's"operating system; or (b)An integral part of the same unit housing any sound reproducing equipment described in (1) above and permanently installed in the opening of the dash or console of the covered "auto" normally used by the manufacturer for installation of a radio. D. DEDUCTIBLE The following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. GECA 701(01/07) Includes copyrighted material of Insurance Services Offices,Inc.with its permission Page 3 of 4 SECTION IV. BUSINESS AUTO CONDITIONS A. LOSS CONDITIONS Item 2.a.and b.are replaced with: 2. Duties In The Event of Accident, Claim,Suit,or Loss a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the accident, claim, "suit', or loss. Knowledge of an accident, claim, "suit', or loss, by other employee(s) does not imply you also have such knowledge. b. To the extent possible, notice to us should include: (1) How,when and where the accident or loss took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the accident or loss. The following is added to 5. We waive any right of recovery we may have against any additional insured under Coverage A. 1. Who Is An Insured g., but only as respects loss arising out of the operation, maintenance or use of a covered"auto"pursuant to the provisions of the"insured contract',written agreement,or permit. B. GENERAL CONDITIONS 9. is added 9. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Your unintentional failure to disclose any hazards existing at the effective date of your policy will not prejudice the coverage afforded. However, we have the right to collect additional premium for any such hazard. COMMON POLICY CONDITIONS 2.b. is replaced by the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. GECA 701(01/07) Includes copyrighted material of Insurance Services Offices,Inc.with its permission Page 4 of 4 Aco CERTIFICATE OF LIABILITY INSURANCE DATE20/2 Y011 12/20/21 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 CONSTITU'rE 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). PRODl10ER 1-559-436-0833 CONTACT NAME: Donna Smith Arthur J. Gallagher & Co. PHONE 559-256-6541 FAX 559-256-6590 Insurance Brokers of California, Inc. Ex); A/C No: 45 E. River Park Place West, #408 E-MAIL onna 8mit@a ADDRESS: dhjgCOm Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC0 INSURER A: OAR RIVER INS CO 34630 INSURED INSURER B: Team 5 Properties, Inc. INSURER C: 2109 W. Bullard Ave, Ste #101 INSURER D: INSURER E: Fresno, CA 93711 INSURER F I COVERAGES CERTIFICATE NUMBER: 24558136 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 ISSUEC 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. EFF POLICY EXP INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDY ANCE NYYY D MM DfYYYY LIMITS LTR2L5&AUDL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENT D COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC I'�f �.T - i�I $ AUTOMOBILE LIABILITY -- OMBINED SINGLE LIMIT y i1� QVed; Ea accident ANY AUTO L•i BODILY INJURY(Per person) $ ALL OWNED SCHEDULED :r ved I. " ..7 h' `„5, BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED r PROPERTY DAMAGE $ HIRED AUTOS AUTOS - - �- -1- P acci nt UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION 2200058457-111 02/01/1 02/01/12 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN N OR,LIMITS I —L-EEL ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (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$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Blanket Waiver of Subrogation applies per form WC9904 10A 07/07 attached. Re: Tract 5997. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o Construction Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 1721 Van Ness Avenue AUTHORIZED REPRESENTATIVE Fresno, CA 93721 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD jabezfres 24558136 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 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$�,0 nn Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 02/01/2011 Policy No. 2200058457-111 Endorsement No. 1 Insured TEAM 5 PROPERTIES, INC. Premium$ Insurance Company Countersigned by Oak River Insurance Company WC 99 0410A (Ed 07-07)