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T-5626 - Certificate of Insurance - 8/26/2015 HAMIL12 OP ID:JI CERTIFICATE OF LIABILITY INSURANCE DATE 08/19/201 YY) 08/19/2015 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 CONTACT Julie In IlBhart BUCKMAN MITCHELL,INC. P.O.BOX 629 P o •559-635-3536 FAX o 559-750-5463 500 North Santa Fe Street EMAIL VISALIA, CA 93279 ADDRESS:juliei@bminc.com Richard L.Nunes,Jr.,AFIS INSURERI$ AFFORDING COVERAGE NAIC# INSURER A:Rockhill Insurance Company INSURED Hamilton Estates,LLC INSURER B- dba:Bernard Alan Te Velde& Rebecca D.Te Velde of the INSURER C: 2000 Te Velde Family Trust INSURER D: 4128 A South Demaree Visalia,CA 93277 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, 1118-N5R OLICYIEXP TYPE OF INSURANCE I A POLICY NUMBER MM DD/YYYY P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X X GENLO10664-01 10/18/2014 10/18/2015 AGE 7DAERTE �� PREMISES Fren Fa occurce $ 100,00 CLAIMS-MADE OCCUR MED EXP(Any oneperson) $ Exclude PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 7 POUCY 7XI M4 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E,,,p ecddent $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NONNOSWNED PROPERTY DAMAGE f11� MANAORMW ® KION IPERANTS $ UMBRELLA LIAR OCCURApprpVot{ 6 EACH OCCURRENCE $ FilEXCESS LIAB CLAIMS-MADE AGGREGATE $ DEP RETENTION$ pprovetl wl riga L] T$ WORKERS COMPENSATION WC STATU- p OTH- AND EMPLOYERS'LIABILITY Y/N +{� - QRY L)MITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L,EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑fff NIA ned at _ (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - 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) The City of Fresno, its officers, officials, employees, agents S volunteers are Additional Insured under the General Liability. The insurance is primary, and our obligations are not affected by any other insurance carried by such additional insured whether primary, excess, contingent, or on any other basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Fresno THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Dept 2600 Fresno St.,RM 4016N AUTHORIZED REPRESENTATIVE Fresno,CA 93721 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GENLO10664-01 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE 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) Or Or anization s : Location And Description Of Completed Operations City of Fresno, Public Works NE corner of Fowler&California Avenue 2600 Fresno Street, Room 4016N Fresno, CA 93702 Fresno, CA 93721 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section If — 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 ❑ POLICY NUMBER: GENLO10664-01 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s): Location(s)Of Covered Operations City of Fresno, Public Works NE corner of Fowler& California Avenue 2600 Fresno Street, Room 4016N Fresno,CA 93702 Fresno, CA 93721 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does nota l "bodily apply to Y �in ju rY" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above, 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 13 Hamilton Estates, LLC Bernard Alan Te Velde & Rebecca D. Te Velde of the 2000 Te Velde Family Trust POLICY NUMBER: GENLO10664-01 COMMERCIAL GENERAL LIABILITY Effective 10/18/14 CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF-TRANSFER OF RIGHTS-OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Fresno 2600 Fresno Street Room 4016N Fresno,CA 93721 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the"products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement forms a part of the Policy to which attached,effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Insured: Hamilton Estates LLC Policy No. GENLO10664-01 Endorsement Effective Date:10/18/2014 Endorsement No. 1 GENERAL CHANGE ENDORSEMENT Changes: ❑Additional Premium $ ❑ Return Premium $ Non-Premium $ $0.00 Total $ $0.00 Endorsement for the following reason: ❑ Audit ❑ Named Insured Change ❑ Mid-term change ❑ Address ❑ Limits Change ❑ Inception Date Change ❑ Expiration Date Change ❑ Coverage cancelled ❑ Short Rate ❑ Pro Rate ❑ Flat ❑ Minimum Premium Applies ❑Q the following form(s) (copy attached)is added to the policy: RHIC1098 08/12-Primary/Non-Contributory Coverage' ❑ the following form(s)are deleted from the policy: ❑X policy is amended as follows: The following Named Insured is addled to the policy: Bernard Alan Te Velde&Rebecca D.Te Velde of the 2000 Te Velde Family Trust All other Terms and Conditions remain unchanged. RHIC 1079(1/13) "Includes copyrighted material of Insurance Services Office,Inc.with its permission" Page 1 of 1 Policy#GENLO10664-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED INSURED ENDORSEMENT This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS AND COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART The Named Insured on the Declarations page is amended to read as follows: Bernard Alan Te Velde&Rebecca D.Te Velde of the 2000 Te Velde Fami1v Trust Hamilton Estates LLC All Other Terms and Conditions Remain Unchanged. RHIC 1080(1/07) "Includes copyrighted material of Insurance Services Office,Inc.with its permission" Page 1 of 1 Policy# GENLO10664-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY/NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRIMARY/NON-CONTRIBUTORY-Any person or organization where required by written contract or agreement, effected prior to the date your operations for that person or organization commenced,such insurance as is afforded by this policy to any additional insureds under this policy shall be primary insurance, and any insurance or self-insurance maintained by such additional insured(s)shall not contribute to the insurance afforded to the named insured. All other terms and conditions remain unchanged. RHIC 1098(8/12) Includes copyrighted material of Insurance Services Office, Inc.with its permission" Page 1 of 1 LONEOAK-04 CVLIETSTRA ­DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/20/2015 _ 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 License#0757776 CONTACT Visalia,CA-HUB International California NAME: Colby VlletstraPHONE - FAX 4128 S.Demaree A/C No Ext,:(559)713-1570 ( ;t;,�, (559)713-1574 Suite A E-M IREss: Visalia,CA 93277 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Nationwide Mutual Insurance Company :23787 INSURED INSURER B:Zenith Insurance Company •13269 Bernard Alan Te Velde and Rebecca D.Te Velde of the 2000 INSURER C: Te Velde Family Trust 13866 4th Avenue INSURER D: Hanford,CA 93230 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. INSR 'ADDL Sl1DR POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY RISK MANAGEMENT S`I EACH OCCURRENCE $ CLAIMS-MADE F-1 OCCUR AApproVeed Pre�,Ml E3,_[ ppcwr�we� $ rip rand W/GItU96l; Ll MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ` r 'GENERAL AGGREGATE $ POLICY❑JECr C LRE PRODUCTS-COMP/OP AGG $ OTHER: Si d` ate $ AUTOMOBILE LIABILITY �MINNEDD INGLE LIMJT $ 1,000,000 A X1 ANYAUTO X IFPK7860614851 05/15/2015 05/15/2016 BODILY INJURY(Per person) $ ALL OWNED f SCHEDULED BODILY INJURY Per accident $ N -OAUTOS AUTOS ( ) X HIRED AUTOS X AO O WNED I pRy Op $ f Per accdden UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ f DED RETENTIONS -- $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITYMUTE ER L B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X M1162301 01/01/2015 01/01/2016 E, EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE. $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Fresno,its officers,officials,employees,agents and volunteers are Additional Insured as respects to Auto Liability.This insurance is primary,and our obligations are not affected by any other insurance carried by such Additional Insured whether primary,excess,contingent,or on any other basis. Waiver of Subrogation for Workers Compensation insurance as respects to the City of Fresno,its officers, officials,employees,agents and volunteers. 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 Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 2600 Fresno Street Room 4016N AUTHORIZED REPRESENTATIVE Fresno,CA 93721 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CA 20 48 (02-99) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE igRM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGIRM_; 1&QQKF.)f.,5.Q4]GZiA EEQR With_res_pect to_coverage provided y t bhis endorsement, the provisions_of the Cove_r_ag_e_F_orm appl_y_unle_ss_mo_dified 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): THE CITY OF FRESNO, ITS OFFICERS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS(PUBLIC W6RKS DEPT) (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the 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. Copyright, Insurance Services Office, Inc., 1998 CA 20 48 (02-99) FPK BAN 78-6-0614851 740R 15140 AGENT COPY CA2048029900 0240 78 0000913 The nithe WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 any person or organization named in the Schedule. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5% of the California workers compensation premium otherwise due on such remuneration. Minimum Premium: $ 0 Schedule Person or Organization City of Fresno, Its Officers, Officials, Employees, Agents and Volunteers Public Works Department 2600 Fresno Street, Room 4016N Fresno, CA 93721-3615 RE: Bernard Alan Te Velde and Rebecca D. Te Velde of the 2000 Te Velde Family Trust This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective 01/01/2015 ZENITH INSURANCE COMPANY- 13145 Insured LONE OAK FARMS Policy No. M1162301 CA Policy Period 01/01/2015-01/01/2016 Issued On 01/01/15 L� Countersigned by PRESIDEN Endorsement No. 33 WC 04 03 06 B (Ed.10-07) At Fresno, CA