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HomeMy WebLinkAboutPM 2017-05 - Certificate of Insurance - 8/2/2018 DDYSI-1 OP 107 GW ACORO DATE(MMIDDrYYYY) CERTIFICATE OF LIABILITY INSURANCE 08102/2018 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 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 endorsement(s). PRODUCER 559-272-2023 W.CT Gayle D.Williams CISR CIIP Valley Regional Insurance Svcs PHONE 559-272-2023 FAX 559-446-0911 Fresno Office-Main Office (A1C,No,Ext): (AIC,No): 7576 N Ingram Ave Ste 102 X&Nhss:gayle@valleyregional..com Fresno, CA 93711 Valley Regional Insurance INSURERS AFFORDING COVERAGE NAZCA INSURERA:Evanston Insurance Co. ,35378 INSURED DDYS Investments,LLC INSURERB:National Union Fire Insurance 7151 N Cedar Ave Ste 104 Fresno,CA 93720 INSURER c: INSURER D INSURER E INSURER F- COVERAGE$ 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS, INTR ADDL 1 UB POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER IIYyyyi LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ 8 1,000,000 CLAIMS-MADE FX]OCCUR Y Y 3EN4048 07111/2018 07/11/2019 ❑AMA�aE O RENTED $ 100,000 MED EXP i Any Qn e perrspn) 51000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER R1 'K MANAGEMENT QEVIc)ION GENERAL AGGREGATE $ 2,000,000 X POLICY E PRef EILOC Approved 4 PRODUCTS-CMPIOP AQ G 2,000,000 OTHER $ AUTOMOBILE LIABILITY En�N DStNGLE LIMIT $ ANY AUTO BODILY INJURY tPeuersonJ OWNED SCHEDULED AUTOS ONLY AUTOS yy p �%'� � BODILY INJURY P accident) .$ AUTO ONLY AlFTO59N 4 Signed Dat19 PPR�aERJYrI AMAGE $ 41 B X UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ 9,000,000 EXCESS LIAB CLAIMS-MADE •IEBU015803527 07111/2018 07/1112019 AGGREGATE $ 9,000,000 DED RETENTION$ WORKERS COMPENSATION PSTATU ER OTH- AND EMPLOYERS'LIABILITY Y I N OFFICERIMEMTERIEXCLUDEDXECUTIVE NIA E.L.EACH ACCJDENT $ (Mandatory in H) EL DISEASE-EA EMPLOYEE $ If yes,describe under [PTION OF OPERATIONS belo-w E L DISEASE.POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Holder shall read City of Fresno its officers,officials,agents,employees and volunteers and is additional insured per written contract and CG2012 (05-09)attached.Primary and Non-contributory applies per CG2001 04-13 and 105515(05-10)attached.Waiver of Subrogation applies per ME L024 01 (05-16). CERTIFICATE HOLDER CANCELLATION CITY O 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. Room 4064 2600 Fresno St AUTHORIZED REPRESENTATIVE Fresno,CA 93721 ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 3EN4048 COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE lState Or Governmental Agency Or Subdivision Or Political Subdivision: City of Fresno, its officers, officials,agents, employees and volunteers 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- 2. This insurance does not apply to: clude 6s an insured any state or governmental agen- a. "Bodily injury", "property damage" or "personal cy'or subdivision or political subdivision shown in the and advertising injury" arising out of operations Schedule, subject to the following provisions: performed for the federal government, state or 1. This insurance applies only with respect to opera- municipality; or tions performed by you or on your behalf for which b. "Bodily injury" or "property damage" included the state or governmental agency or subdivision or political subdivision has issued a permit or author- within the 'products-completed operations hazard". ization. CG 2012 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 3EN4048 MARKEL' EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s)with whom the Named Insured agrees, in a written contract executed prior to the'occurrence", to waive rights of recovery Additional Premium: $ Included The following is added to Condition 8.Transfer Of Rights Of Recovery Against Others To Us under Section IV—Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-0105 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENDORSEMENT No. 17 This endorsement, effective 12:01 AM: July 11, 2018 Forms a part of policy no: EBU 015803527 Issued to: DDYS INVESTMENTS LLC By: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. Prime Expresssm Additional Insured(s) Endorsement- Specified Entities and Primary Non-Contributory This policy is amended as follows: Section VII. DEFINITIONS, Paragraph N. is amended to include the following additional provision: Insured means the following entity(ies) listed below. Such entity(ies) is included as an additional Insured, solely as respects liability arising out of any operations or activities performed by or on behalf of the Named Insured: City of Fresno, its officers, officials, employees, agents and volunteers Coverage afforded to these entity(ies) will be primary to, and non-contributory with, any other insurance available to such entity(ies). All other terms, definitions, conditions, and exclusions of this policy remain unchanged. Authorized Representative or Countersignature (Where Applicable) 105515 (5/10) AH 2895 DDYS Investment, LLC 7151 N. Cedar Ave.,#104 Fresno, CA 93720 July 25, 2018 Heather Haupt Risk Analysis City of Fresno 2600 Fresno Street, RM 1030 Fresno,CA 93721 Re: DDYS Investments Parcel Map No, 2017-05-Insurance Dear Heather; Please be advised that DDYS Investments, LLC does not own any automobiles and does not have any employees. �icer � Brad Morris Duly authorized as the Agent for ownership