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HomeMy WebLinkAboutT-6185 - Certificate of Insurance - 8/22/2018 GLENE-1 DATE WAIDiONYYY) CERTIFICATE OF LIABILITY INSURANCE 08121/2618 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: H the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 end s. PRODUCER 559-233-0123 Kim Cameron Agri-Center Insurance Agency PHONE 559-233-0123 559-266-8858 2650 W.Shaw Lane.Suite 102 E fag cente� it rtsurartce.corti Fresno,CA 93711 Martin flMcCubbin fNStIRERtA)AFFoRPNIN0 � _ nsuRmA:First Mercury Insurance Co _ INSURED Gleneagles Homes,A CA Corp „�„�a,State Compensation Ins.Fund 35076 Gary McDonald Homes, U RERc_Navigators Insurance Company !,42307 Copper River Ranch West American Insurance Co 44393 Villages.LLC R15uRERD: _ _ — 11861 N_Alicante Drive INSURER E: _- Fresno,CA 93730-8867 -- - INSURER F COVE GES CERTIFIC T£NUMBER: REVISION NUMBER: INDICATED, NOTWITHSTPOLICIESTHIS IS TO CERTIFY TT THE ANDING ANYREQUIREMENT. TERM OR CONDITBNAMEDEEN ISSUED TO THE INSURED ION OFANY CONTRACTT OR OTHER DOCUMABOVE ENT WIITH OPOLICYR THE REO SPECT WHICHTIHIS 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. --POLICY EFF-``;POLICY EXP"� INSR TYPE OF DNSURANCE TADDL SUBR POLICY NUMBER IMMIDMnm � A X COMMERCIAL GENERAL LIABILITY EACH pCCURRENCE 1,000,004 CLAIMS-MADE OCCUR Y CAGGLOO0006802502 10101/2017 10/01/2018 DAMAGE TO RENTED 200,464 P�hit&ESc>:a.v�S EXCLUDED MED EXP_[Any om — - — a ADV l 1,000,006 PEM GENERAL AGGREGATE S 2,666,406 GEN'L AGGREGA-T-E LIMIT APPLIES PER: 210001600 POLICY rJ PRO- D LOC PRODUCTS-COMPIDPA S 4 RETENTION — i0,OQ0 OTHER: CCdrIBiNED SINGLE LIMIT 1,664,444 D AUTOMOBILE LIABILITY -_ --- ANY AUTO Y SAWS7052803 1210812017 1210812018 BODILY I=,P."= UR.Y t�ar.persor+ .. OWNED rx _W,0_0_D_,0_00 SCHEDULED Dil. 1NJ ,Parecriderll _ AUTOS ONLY AIN yy PE AMAGE S HURTT oden AUT S ONLY C UMBRELLA LIAB XOCCUR H DC URRENCE $ _ X EXCESS LIAB CLAIMS-MADE SFI7EXCT256931C 10/01/2017 10/01/2018 AGGREGATE 9,006,406 DED RETENTION$ B WORKERS COMPENSATION �( PTR 0TH• AND EMPLOYERS I.i�461LITY YIN 9QQ471918 0112712018 01/27/2019 t 1,000,400 AHY PROPREIET�O�R�IPARTNERIEXECUTIVE E.L.EACH ACCIDENT S _ inrlfCdatRory iMHH]EXCLUDED? NIA Y E.L-DIS •EA EMPLOYE S 1,000,000 If '�rD6fl,666 Irdescribe wader � E.L.DiS E• L Y I IT DM RIPTION OF OPERATIONS below 1 � i DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SEE NOTES RISK MANAGEME T PIVISION Approve Approved,wlqbalnges o 74TH D f CANCELLATION Signet! Dace SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y OF FRESNO ACCORDANCE WITH THE POLICY PROVISIONS, 0 FRESNO STREET FLOOR AUTHORIZED REPRESENTATIVE FRESNO,CA 93721 Martin MCCubbin �Q���_ ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GLENE-1 PAGE 2 NOTEPAD INSURED'S NAME Gleneagles Homes,A CA Corp OP ID: KC W Data 08/21/2018 The City of Fresno, its officers, officials, agents, employees, and volunteers are included as additional insured as respects to general liability per attached form CG 20 12 04 13 and the auto policy per forms CA 20 48 02 99 & CA 88 66 05 13 attached. Primary and Noncontibutory applies to General Liabilty per attached form CG 2001 0413. In regards to the Excess Liability, Primary and Noncontributory applies per attached form NAV-EXC-348A (01/11) . Worker's Compensation Waiver of Subrogation applies per attached form 30 Day Notice of Cancellation, 10 Day Notice for non-payment COMMERCIAL GENERAL LIABILITY CG20120413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READIT CAREFULLY. ADDITIONAL INSURED -- STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under thefdbwing: OOMNI£RCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: City of Fresno Public Works Department 2600 Fresno St Rm 4064 Fresno,CA 93721 fnformatfon r2quIted to complete this Schedule if not sh ons above-,will be shown In the Declarations, A. Section II -Who Is An Insured is amended to 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury; "prop" damage or governmental agency, or subdivision or political 'personal and advertising injury"arising out subdivision shown in the Schedule,subject tothe idlowing provisions: of operations performed for the federal government,state or municipality;or 1. This insurance applies only with respect to b. "Bodliy injury" or „property damage.oporalions performed by you or on our behalf included Alhin the "products-completed for which the state or governmental agency or operations hazard." subdivision or political subdivision has issued a permit or authorization. B Wth respect to the Insurance afforded to these However: additional insureds, the follcvding is added to Section IA-Limits Of Insurance: a. The insurance afforded to such additional if coverage provided to the additional insurod is insured only applies to the extent permilled requiredy a contract or agreement,the mast ver: by law,and will pay on behalf of the additional insured is the b. If coverage provided to the additional amount of insurance: insured is required by a contract or 1. Required by the contract or agreement,or agreement, the insurance afforded to such 2 Available under the applicable Limits of addit'sonal insured will not be broader than pp that which you are required by the contract Insurance shown in the Declarations; or agreement to provide for such additional whichever is less. insured. This endorsement shall not increase the applicable Limits of Insuranceshown in the Declarations. CG 2012 0413 ©Insurance Services Office,Inc.,2012 Page 1 of 1 CACGL00000680250i COMMGROJAL GUNfff7111.LIAW14ITY 1:1417.0 010499 Tr11,11 VINDOR VIVIViI TONAn101-u'll-M I-2al_10Y. PI-MAal.Itl:11u IT oA1ZC:F"uJ..)_.Y. PRIMARY AND 111ONCONTRIBU I URY— O T'6 PER INSURANCE CAOIND1`[10111 '1'hte ondN'ealtWn!Itlur1111as U;aurtlnoe iwavldecl tutder ilia foltowta [X]lulMl.'[tGllll,C]� IO�W.L LlAOILITY GOVM-- A I P6�11.1T 1 I'ROIDUOTS100 I I_I:MD 0135RA7 ONZI LIAWLI'lYMVERAWC;I', lv' ThefollowlvIsgclrtnr110III aONlot,111uu;illiaa► uldwipersadoecu►yl3uvtslai tolhocolilmly. Pl'llrnorynndMrrrlr;on(rll)tltory IIIRlN'Ed1Cu! (9) Ynu IIAVO eIrra 4 111 W111119 h1 F1 oo;llrtnl of T(;ls Nat11'411(n is In11ir-�1Y In Fuld Wit 1104 Qaafc• w3m.01ne111 IIIaI IIIN 111'stfre;;ae YYaM I)G 00114 We)11 I'Mr nit y011wr III attrunce rivaVa II;910 l*hlnty RnrlwrAM 1101 soak rt olrAiNlall rrom An adrlllINICI Instred midul.Yow poll<:Y prnvklecl e;1y 01116 61911UR1tCO Avnl10110 tolhet;ddRlo:lzI 11101: Insured. (1) Tile wfqlopal 11Is11p(I Is-.1 N med Insured kill dol'Stich alherIuvr�nce;�n(I ca 2p 0I bn't'8 Illsl4'E11100SQruInaR Of(loe,NO.,9.0.12 liege 1 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 48 02 99 DESIGNATED INSURED ENDORSEMENT The endorsement modifies insurance provided under the following: 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 Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the WHO IS AN IN- SURED provision of the Coverage Form. This endorsement does not alter coverage provided in the Cov- erage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective Policy Number Named Insured Countersi ned b (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s) City of Fresno 2600 Fresno St Room 4064 Fresno, CA 93721 (If no entry appears above, information required to complete this endorsement will be shown in the Declare- tions as applicable to this endorsement.) 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 II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 COMMERCIAL AUTO CA 88 66 05 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - NONCONTRIBUTING This endorsement modifies insurance provided under the following: 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 Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. Schedule Name of Person(s)or Organization(s): City of Fresno 2600 Fresno St Room 4064 Fresno, CA 93721 Regarding Designated Contract or Project: City of Fresno Each person or organization shown in the Schedule of this endorsement is an "insured" for Liability Cov- erage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The following is added to the Other Insurance Condition: If you have agreed in a written agreement that this policy will be primary and without right of contribu- tion from any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement was executed prior to the "bodily injury" or "property damage", then this insurance will be primary and we will not seek contribution from such insurance. N © 2013 Liberty Mutual Insurance.All rights reserved. CA 88 66 05 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 C MERCIAL EXCESS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS OTHER INSURANCE PRIMARY AND NON-CONTRIBUTING This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART SCHEDULE When required by written contract executed before the "loss." A. Section IV-Conditions, 9. Other Insurance is deleted and replaced by the following: 9. This insurance is excess over any other insurance available to the insured except: a. insurance that is purchased specifically to apply in excess of this policy; or b. insurance available to the person or organization shown in the Schedule of this endorsement as an additional insured on the"controlling underlying insurance." B. When this insurance applies on a primary and non-contributing basis,the Limits of Insurance available for the additional insured will be the lesser of: 1. the amounts shown in item 3 of the Declarations of this policy; or 2. the amount of insurance you are required to provide the additional insured in the written contract or agreement. All other terms of the policy remain unchanged NAV-EXC-348A(01/11) Navigators Specialty Insurance Company Page 1 of 1 Contains copyrighted material of the Inci iranra�Prvin.PS Offir.c' Inn with its nermission ENDORSEMENT AGREEMENT BROKER COPY STATE SAT I ON WAIVER OF SUBROGATION 9004719-18 FUND RENEWAL NF HOME OFFICE 2-78-20-50 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE FEBRUARY 10, 2018 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING JANUARY 27, 2019 AT 12.01 A.M. PACIFIC STANDARD TIME GARY MCDONALD HOMES 11861 N ALICANTE DR FRESNO, CA 93730 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, GARY MCDONALD HOMES IT IS FURTHER AGREED THAT 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: FEBRUARY 13, 2018 2570 u1, AUTHORIZED REPRESENT IVF PRESIDENT AND CEO SCIF FORM 10217 IREV.7-20141 OLD OP 217