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HomeMy WebLinkAboutT-6000 - Certificate of Insurance - 6/25/2012 A4 06/11 CERTIFICATE OF LIABILITY INSURANCE DIDD/Y 06!11/2ol2 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 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. Ne: 45 E. River Park Place West, #408 ADDE-MAIL RE... J 4 donna smith®a' com Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURERA: UNITED SPECIALTY INS CO 12537 INSURED INSURER B: Team 5 Properties, Inc. INSURER C 2109 W. Bullard Ave, Ste #101 INSURER D: Fresno, CA 93711 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 27604873 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 ADOL SUBR POLICY NUMBER IMM LPOLICIMITS MM DD EFF POLICY EXP LIMITS LTRWVD A GENERAL LIABILITY ISC000222400 10/30/1 10/30/12 EACH OCCURRENCE $ 2,000,000 X DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PRE 'ES Ea occurrence $ CLAIMS-MADE T OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PePROPERTY DAMAGE $ I HIRED AUTOS AUTOS ,.,.d.. $ UMBRELLA LAB OCCUR R�- �, MA APEMEN D1Vl 1 EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ A roved. $ WORKERS COMPENSATION AP rQV • r WC STAT U- OTH- AND EMPLOYERS'LIABILITY ER Y/N ■ _ _ � TORY LIMITS ANY PRO PRIETOR/PARTN ER/EX ECUTIVE❑ NIA G'~' l E.L.EACH ACCIDENT $ (MandatoryF / in NHR EXCLUDED? C i ed Date J E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Subdivision Agreement, Final Map of Tract No. 6000 Additional Insured Endorsements CG2016 07/04, CG2037 07/04 and Primary/Noncontributory IL1201 11/85 in favor of the City of Fresno, its officers, officials, employees, agents and volunteers attached. Named insured includes: DeYoung Willow & Nees 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 r, Fresno , CA 93721 [I� ~ USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD dsmith THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 12 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE ISC0002224-00 5/29/2012 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 additional insured status 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. All other policy terms and conditions remain unchanged. Authorized Representative Signature IL 12 0111 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 o Copyright, ISO Commercial Risk Services, Inc., 1983 POLICY NUMBER: ISC0002224-00 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, its officers, officials, employees, agents&volunteers 2600 Fresno St., Rm 4019 Fresno, CA 93721 Re: Final Map of Tract No. 6000 .......................................... ..�..r., ,... .�.,_.,_..�..._..�._,_...�... ._, 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) oror- 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 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): The City of Fresno, its officers, officials, Re: Final Map of Tract No. 6000 employees, agents&volunteers 2600 Fresno St., Rm 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". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 o Axco_ CERTIFICATE OF LIABILITY INSURANCE DATE /Y 06/11/211/201 22 V. 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 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 ADDRE-MAILESS: J donna smith@a'g com Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURER A: GOLDEN EAGLE INS CORP 10836 INSURED INSURER B: EVANSTON INS CO 35378 Team 5 Properties, Inc. INSURER C 2109 W. Bullard Ave, Ste #101 INSURER D: Fresno, CA 93711 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 27604940 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 ADDLSUBRPOLICTYPE OF INSURANCE INSR WVD POLICY NUMBER Y MMIDDMM/DDf EXP POLIY LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F7OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY BA8851637 05/31/12 05/31/13 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 XOBW3960512 05/31/1 05/31/13 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' 4000vv�e AN,A(3EMENT DIVISI NY/N TORY LIMITS FIRANY PROPRIETOR/PARTNER/EXECUTIVE N I E.L.EACH ACCIDENT $ OFFICER/ME MBER EXCLUDED? d.(Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe underDESCRIPTION OF OPERATIONS below Wf an g eS• E.L.DISEASE-POLICY LIMIT $ Date DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Excess Liability shown is Excess Auto Liability only. Blanket Additional Insured per form GECA 701 01/07. Named Insured includes DeYoung Willow & Ness 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 1` ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD dsmith 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 ACo�° CERTIFICATE OF LIABILITY INSURANCE DATE /Y 06/11/211/2 0122 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 1-559-436-0833 CONTACT NAME: Donna Smith Arthur J. Gallagher & Co. PNE HO559-256-6541 FAX 559-256-6590 Insurance Brokers of California, Inc. AIC No: 45 E. River Park Place West, #408 E-MAILESS: donnaADDRsmith�aJ gcom Fresno, CA 93720 INSURERS AFFORDING COVERAGE NAIC# INSURER A: OAK RIVER INS CO 34630 INSURED INSURER B Team 5 Properties, Inc. INS'RERC: 2109 W. Bullard Ave, Ste #101 INSURER D: Fresno, CA 93711 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 27604999 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. INSRTYPE OF INSURANCE ADDL SUER YEFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MWDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence)$ CLAIMS-MADE r-�OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ r}��., pp�� GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: I K MAS � .EME Y DIVISION PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY N r V� 'W/4 COPABINED SINGLE LIMIT 4 !1 eS� Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED r / �,�t`L— BODILY INJURY(Per accident) $ AUTOS AUTOS ��yy NON-OWNED 317 - 5 Dict{{ePROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 2200058457-121 02/01/102/01/137x7= TH- OIR AND EMPLOYERS'LIABILITY ANY PRO PRIETOR/PART N ER/EXECUTIVEF—] N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED'? (Mandatory In NH) ELL -EA EMPLOYEE $ 1,000,000 If yes,describe under 11000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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. Tract 6000 - Final Map 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 c�• ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD dsmith 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$_350 On 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 04 10A (Ed 07-07)