Loading...
Turley & Associates - Insurance Certificate (2019)AC40R " CERTIFICATE OF LIABILITY INSURANCE P ATE /4/2018 Y) 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 Dealey, Renton &Associates P. 0. Box 12675 CONTACT NAME: Doris A Chambers PHONE FAX c • 510- 465 -3090 we No : 510- 452 -2193 Oakland CA 94604 -2675 ADDRESS: dchambers@dealeyrenton.com INSURER (S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Co. of Connecticut 25682 4/23/2019 INSURED TURLEASSO Turley & Associates, Inc. 2431 Capitol Avenue INSURER B: Travelers Property Casualty Co of Ameri 25674 INSURER c :Arch Insurance Company 11150 INSURER D: MED EXP (Any one person) Sacramento CA 95816 -6818 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1460608210 REVISION NUMRFR- 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. ILTR TYPE OF INSURANCE INSD SUER POLICY NUMBER MM /DDY /YYYY MMIDD/YYYY LIMITS A X COMMERCIALGENERALLIABILITY CLAIMS -MADE � OCCUR 6806HO67151 4/23/2018 4/23/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ] PE0 � LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ B X UMBRELLALIAB X OCCUR CUP8127Y454 4/23/2018 4/23/2019 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN UB3K274148 4/23/2018 4/23/2019 X PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N /A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I I E.L. DISEASE - .POLICY LIMIT $ 1,000,000 C Professional Liability PAAEP0024501 4/23/2018 4/23/2019 $2,000,000 $2,000,000 per Claim Annl Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) REF: Project #18- RFP -PW -409, City of Gilroy City Hall HVAC Assessment. The City of Gilroy, its elected and appointed officers, officials, employees and volunteers are named as additional insureds as respects General Liability for claims arising from the operations of the named insured. 30 Days Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Dav Notice of CannAintinn © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 /�— ---3— c - -- © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD PoliCy # 6806HO67151 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) Additional Insured: The City of Gilroy, its elected and appointed officers, officials, employees and volunteers This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury'; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of 'your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services ". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance ". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by 'your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non - contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance ". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission TRA Y ELERSA WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00) — 001 POLICY NUMBER: UB3K274148 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (BLANKET WAIVER) 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. 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 3.00 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization City of Gilroy 7351 Rosanna Street Gilroy CA 95020 Schedule Job Description HVAC /Mechanical Engineering Waiver of Subrogation in favor of.- The City of Gilroy, its elected and appointed officers, officials, employees and volunteers DATE OF ISSUE: 5/4/2018 017106 ST ASSIGN: CA Certificate of Insurance Certificate Holder ............. I .................................................................................... ............................................................................................... Additional Insured THE CITY GILROY 7351 ROSANNA ST GILROY, CA 95020 !nsured A ............ ......... ...... ...... ............ ............................ 1.11T� ............................. ................................. ........... BRIAN PROVENCAL DIVIDE INSURANCE AGY DBA TURLEY & ASSOC 10235 FAIR OAKS #202 2431 CAPITOL AVE FAIR OAKS, CA 95628 SACRAMENTO, CA 95816 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated, This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. .......................... ..... ........ ' ............................................... ' ................ *** ............... .......................... Policy Effective Date: Oct 2, 2017 Policy Expiration Date: Oct 2, 2018 Insurance coverage(s) Limits Bodily '' '"I'n' Ju''r'y'/'P­ro­p'e Injury /Property ... D'a'rn­a­g'e' ................................. $­1','0"0­0','0­0­0 ... Combined ''"'* "''"S' Single ............................. * .......... �m'­p'(o'y­e'r`s ... Non -Owned *66''n'e'd ... Auto ... B'I'P'D' ... ' ........................ $­1','0­0­0','0"D­0 ... Co'm­ 'b'in"e'd'''S' Single ...................................... ­ .................. Hired Auto Bodily In j ury/P r o pe r ty Damage $ 1 0 0 0, 0 0 0 Combined Sin gle Limit Description of LocationNehicies/Special Items Scheduled autos only ............................. * .................. * .......... * ..................... * ......... ' ....... 2007 DODGE RAM 15001 D7HA182475195648 ....'..."....'.'....'.'.'. 'I '.'.".."..'.'.'.'.'.'.'..'.'.".."..'.'.'.'.'.*.'.'.. " I ''"" ....... * .......... ' ................. * .... * ........................... *­ ............ * ..i6l6 LEX�SRX350JTJBK1BA8A241016O ............................. ...... I.. I ..... .............. I .......... ....... ....... I ....... I .................... ........ I ........... 2013 MERCEDES-BENZ E350 WDDKJ5KBODF1 94328 CITY OF GILROY, CITY HALL, HVAC ASSESSMENT PROJECT #; 18-RFP-PW-409. CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS & EMPLOYEES. In Continued PR99REIIIYE DIVIDE INSURANCE AGY COWMERCIAL 10235 FAIR OAKS #202 FAIR OAKS, CA 95628 1-916-96.1-0553 Policy number: 04377418-6 Underwritten by: United Financial Cas Co March 29, 2018 Page 1 of 2 Certificate of Insurance Certificate Holder ............. I .................................................................................... ............................................................................................... Additional Insured THE CITY GILROY 7351 ROSANNA ST GILROY, CA 95020 !nsured A ............ ......... ...... ...... ............ ............................ 1.11T� ............................. ................................. ........... BRIAN PROVENCAL DIVIDE INSURANCE AGY DBA TURLEY & ASSOC 10235 FAIR OAKS #202 2431 CAPITOL AVE FAIR OAKS, CA 95628 SACRAMENTO, CA 95816 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated, This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. .......................... ..... ........ ' ............................................... ' ................ *** ............... .......................... Policy Effective Date: Oct 2, 2017 Policy Expiration Date: Oct 2, 2018 Insurance coverage(s) Limits Bodily '' '"I'n' Ju''r'y'/'P­ro­p'e Injury /Property ... D'a'rn­a­g'e' ................................. $­1','0"0­0','0­0­0 ... Combined ''"'* "''"S' Single ............................. * .......... �m'­p'(o'y­e'r`s ... Non -Owned *66''n'e'd ... Auto ... B'I'P'D' ... ' ........................ $­1','0­0­0','0"D­0 ... Co'm­ 'b'in"e'd'''S' Single ...................................... ­ .................. Hired Auto Bodily In j ury/P r o pe r ty Damage $ 1 0 0 0, 0 0 0 Combined Sin gle Limit Description of LocationNehicies/Special Items Scheduled autos only ............................. * .................. * .......... * ..................... * ......... ' ....... 2007 DODGE RAM 15001 D7HA182475195648 ....'..."....'.'....'.'.'. 'I '.'.".."..'.'.'.'.'.'.'..'.'.".."..'.'.'.'.'.*.'.'.. " I ''"" ....... * .......... ' ................. * .... * ........................... *­ ............ * ..i6l6 LEX�SRX350JTJBK1BA8A241016O ............................. ...... I.. I ..... .............. I .......... ....... ....... I ....... I .................... ........ I ........... 2013 MERCEDES-BENZ E350 WDDKJ5KBODF1 94328 CITY OF GILROY, CITY HALL, HVAC ASSESSMENT PROJECT #; 18-RFP-PW-409. CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS & EMPLOYEES. In Continued PRL%GREMif%Ei. Additional Insured Endorsement Name of Person or Organization The City Gilroy The city of Gilroy, its officers, representatives, agents & employees. 7351 Rosanna St. Gilroy, CA 95020 The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury each person/ each accident Property Damage each accident Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 043774186 Issued to (Name of Insured): BRIAN PROVENCAL DBA TURLEY & ASSOCIATES Effective date of endorsement: 03/29/2018 Policy expiration date: 10/02/2018 Form 1198(01/04) DIVIDE INSURANCE AGY 10235 FAIR OAKS #202 FAIR OAKS, CA 95628 THE CITY GILROY 7351 ROSANNA ST GILROY, CA 95020 Additional insured endorsement Name of Person or Organization THE CITY GILROY 7351 ROSANNA ST GILROY, CA 95020 PR674GRE111YE° COMMERC /AL Policy number: 04377418 -6 Underwritten by: United Financial Cas Co Insured: BRIAN PROVENCAL March 30, 2018 Policy Period: Oct 2, 2017 - Oct 2, 2018 Mailing Address United Financial Cas Co PO Box 94739 Cleveland, OH 44101 1- 800 - 444 -4487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 04377418 -6 Issued to (Name of Insured): BRIAN PROVENCAL DBA TURLEY & ASSOC Effective date of endorsement: 03/29/2018 Form 1198 (01104) Policy expiration date: 10/02/2018 DIVIDE INSURANCE AGY 10235 FAIR OAKS #202 FAIR OAKS, CA 95628 THE CITY GILROY 7351 ROSANNA ST GILROY, CA 95020 Additional insured endorsement Name of Person or Organization THE CITY GILROY 7351 ROSANNA ST GILROY, CA 95020 P4'A94 , 7MI1/,� COMMERCIAL Policy number: 04377418 -6 Underwritten by: United Financial Cas Co Insured: BRIAN PROVENCAL March 31, 2018 Policy Period: Oct 2, 2017 - Oct 2, 2018 Mailing Address United Financial Cas Co PO Box 94739 Cleveland, OH 44101 1 -800- 444 -4487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 04377418 -6 Issued to (Name of Insured): BRIAN PROVENCAL DBA TURLEY & ASSOC Effective date of endorsement: 03/30/2018 Fonn 1 198 (01/04) Policy expiration date: 1010212018