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HomeMy WebLinkAboutRBF Consulting - Insurance Certificate` ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 10/05/2012 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 Aon Risk Services Central, Inc. Pittsburgh PA office CONTACT NAME: PHONE (866) 283 -7122 FAX (847) 953 -5390 AIC. No. Ext): ac. No.): Dominion Tower, 10th Floor 625 Liberty Avenue E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# Pittsburgh PA 15222-3110 USA INSURED INSURER A: Liberty Mutual Fire Ins co 23035 RBF Consulting PO Box 57057 Irvine CA 92619 -7057 USA INSURER B: Liberty Insurance Corporation 42404 INSURER C: Lloyds Syndicate No. 2623 1128623 INSURER D: PREMISES Ea occurrence) INSURER E: CLAIMS -MADE ❑X OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: 570047831637 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDDt MWDD LIMITS A GENERAL LIABILITY TB EACH OCCURRENCE 2 , 000, 000 $2,000,000' X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $1,000,000 CLAIMS -MADE ❑X OCCUR MED EXP (Any one person) $5,000 X Contractual PERSONAL & ADV INJURY $2,000,000 X BFPD, XCU GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $4,000,000 POLICY X PRO X LOC A AUTOMOBILE LIABILITY AS2- 681 - 004145 -722 06/30/2012 06/30/2013 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HI IRED AUTOS X NON -OWNED X AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) B X UMBRELLA LIAB X OCCUR TH7681004145682 06/30/2012 06/30/2013 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $10,000,000 DED RETENTION 410,000 B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR /PARTNER EXECUTIVE OFFICEILTIEMBEREXCLUDED? F9 NIA WA768DO04145692 A05 WC7681004145702 06/30/2012 06/30/2012 06/30/2013 06/30/2013 TO SITS OTH- X TORY LIMM ITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory In NH) WI If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $1,000,000 C E &O -PL- Primary QC1202675 06/30/2012 06/30/2013 Per Claim $5,000,000 Professional & Pollution Aggregate $5,000,000 SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: City of Gilroy Housing Element Implementation Projects. City of Gilroy, its officers, officials and employees are included as Additional Insured on the General Liability, but only with respect to work performed by or on behalf of the insured as required by written contract. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy GA 95020 USA c_xXo�a c��cJaL�aed !4 �./na ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD `m w c m d a 0 N Cl) i+r v °o r- Ln O Z 0) A O w d U �-i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE TREAD IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COi\i�1LRCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED is amended to include as an insured any person or orpi-dzation for whom you have agreed in writing to provide liability insurance. But The insurance provided by this amendment: 1. Applies only to "bodily injury" or "property damage" arising out of (a) "your work" or (b) premises or other property owned by or rented to you; 2. Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the Emits of insurance provided by this policy, and 3. Does not apply to any person or organization for whom you have procured separate liability insurance while such insurance is in effect, regardless of whether the scope of coverage or limits of insurance of this policy exceed those of such other insurance or whether such other insurance is valid and collectible. The following provisions also apply: 1. adhere the applicable written agreement requires the insured to provide liability insurance on a primary, excess, contingent, or any other basis, this policy will apply solely on the basis required by such written agreement and Item 4. Other Insurance of SECTION IV of this policy will not apply. 2. Wlhere. the applicable written agreement does not specfE, on what basis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern. 3 This endorsement shall not apply to any person or organization for any "bodily injury" or "property damage" if any other additional insured endorsement on this policy applies to that person or organization with regard to the "bodily injury" or "property damage". 4. If any other additional insured endorsement applies to any person or organization and you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for that additional insured, this policy will apply solely on the basis required by such written agreement and Item 4. Other Insurance of SECTION IV of this policy will not apply, regardless of whether the person or organization has available other valid and collectible insurance, If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern. This endorsement iS executed by the LIBERTY MUTUAL FIRE INSURANCE COMPANY Pren- um S Effective Date E.\ptration Date For attachment to Policy No. TB2 -681- 004145 -712 Audit Ba.is Issued To Cow::crsi,cjj ed bV huchorized Rry?,eseon6- Issued Sales Office and No. End, Se,:al No. LN 20 0106 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) or organization(s): Location(s) of Covered Operations Any owner, lessee, or contractor for whom you have agreed in writing prior to a loss to provide liability insurance including City of Gilroy its officers, officials and employees Information required to complete this Schedule if no# shown above will be shav<m in the Declarations. A. Section It — 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. a. With respect to the insurance afforded to these additional Insureds, the following additlonal exclu- sions apply: This insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 2010 07 04 Q ISO Properties, Inc., 2001 Page 1 of 2 2. That portion of 'dour 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. This endorsement is executed by the LIBERTY MUTUAL FIRS INSURANCE COMPANY Premium $ Effective Pate For attachment to Policy No. Audit Basis Issued To fssued ExpWation Date TB2- 681 - 004145 -712 o Countersigned by Authorized Representative Sales Office and No. End. Serial No. Page 2 of 2 © ISO Properties, Inc., 2004 CG 20 10 07 04