Loading...
HomeMy WebLinkAboutPMC - Insurance Certificate�1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 06/2512015 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 Dominion Tower, 10th Floor 625 Liberty Avenue CONTACT NAME: A!C No. Et): (866) 283 -7122 FAX No : (800) 363 -0105 E -MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # Pittsburgh PA 15222 -3110 USA INSURED INSURER A: Liberty Mutual_ Fire Ins Co 23035 Michael Baker International. Inc_ Formerly Pacific Municipal Consultants (PMC) INSURERS: LlOyd's Syndicate -No. 2623 AA1128623 -- iNsukkk c: Liberty Insurance Corporation 42404 INSURER D: National union Fire Ins Co of Pittsburgh 19445 2729 ,Prospect Park Drive, Suite 220 Rancho Cordova CA 95670 USA INSURER E: INSURER F: $1,.000,000 COVERAGES CERTIFICATE NUMBER: 570058423927 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 CONTRACTOR 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 INISR LTR - TYPE O INSURANCE NSD SUSIR WVD POLICY NUMBER MypDp NOD LIMITS A X COMMERCIAL GENERAL LIABILITY TB - - - - - - _EACH OCCURRENCE _ _ _ $2,000,000 CLAIMS -MADE X❑DCCUR PREMISES Ea occurrence) $1,.000,000 MEDEXP (Any one, person) S5,000 PERSONAL& ADV INJURY _ $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4.,000,000 POLICY �.� JECT PRO- � LOC PRODUCTS - COMP /OPAGG - $4,000,.000 _ _ - - - -_ - -- -_ OTHER: A AUTOMOBILE LIABILITY As2- 681 - 004145 -724 06/30/2014 08%30/2015', COMBINED SINGLE LIMIT - Ea accident $1,000,000 .BODILY INJURY (Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS N NON -OWNED AUTOS - PROPERTY DAMAGE Per. accident D X UMBRELLA LIAB X OCCUR BE018742918 08/30/2014 08/30/2015 EACH OCCURRENCE $10,.000,000 LtAB CLAIMS -MADE AGGREGATE $10, 000, 000 4CESS D!E! D X RETENTION $10, 000 c _-WORKERS COMPENSATION oN AND N ANY PROPRIETOR/ PARTNER /EXECUTIVE OFAFCERR PARTNER/ ❑',N (Mandatory In NH) /A ADS AC7681004145704 wi 06/30/2014 08/30 2015 .08/30/2015 PER 0TH - X STATUTE = Ei EACH ACCIDENT ' ' . _. _ -- Sl, 000 , 000 _ - --- - E.L. DISEASE-EA EMPLOYEE $1,000,000 - H yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT S1,000,000 B E8O -PL- Primary QC1402675 06/30/2014 08/31/2015 Per Claim $5,000,000 I TI Professional & Pollution Aggregate $5,000,000 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Projects as on file with the insured including but not limited to Environmental Services. City of Gilroy, its officers, officials, employees and designated volunteers art: named as additional insureds on the general liability policy. 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 Attn: Risk Manager 7351 Rosanna St. Gilroy CA. 95020 USA ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD LL U G) G) c Of 9 d O x N V) N 0 0 n O Z w R V Ot t) B 233201101446oms THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This eadorsedieni modifies insurance provided under cite fogdlowittg: C0N5IERCLAL GENEPLU.. U.NBILIn CCOVM- -xGE Pohlst SECTION 11 - WHO IS AN INSURED is amended to include as an insured any person or organization for. wdiom you have agreed in writing io provide liability insuran cc. But: The insurance provided by this amendment: 1. Applies only to "bodily injury ".or "properm- damagc" arising out.of (a) "your work" or (b) prernises or oiherproperiy owned by or rented to you; 2. Applies only:.to coverage and mtinrrturn limits of rnsuranee required by the tit.•ritten agre=ent. but in no eive tt exceeds either the scope of corerage or tiie ]hilts of insuiaece'protided by this policy; and 3. Does not apply to any person or organzation for whom you have procured separate liability insurance %vhile such insurance is in effect, regardless of whether the scope o f crn -erage or limits o f insurance of this policy exceed those of such other insurance or whether such other insurance is vatid and collectible. The following provisions also apply: I. Where. the applicablc.vnitten a�#ieement requires the insured to provide fiat ty insurance on ,a primary, excess, contingent, or any other basis, thi% policy Vill apply.solely on the lsasis required by such written agrectrteni and Item 4.-Other Insurance of SECTION IV of this policy will not apply. ? Where the applicable written agrement,does not specify on what basis the lialtilify insurance will apply, the p"isioas of Item 4. Other. Imurance of SECTION IV of this policy will,govcm. 3 This endorsement shall not apply to any person or organization for any " botdily injury" oz 'property damage" if anyotfter additional insured endorsement on this policy applies to that person or orgrrtivation with regard to the "bodily injury" or °property damage", 4. If any other additional insured endorsement applies to any person or orgaaizauon and you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, ovany other basis for that additional insured, this policy will apply solely on the basis requited by such written agreement.and Item-4. 01her Insurance of SECTION W of this policy Will not apply, regardless of a-heihcr the person or organization his a-miilabic odter caGd avid collectible insurance. If the applicable written agreement does not specify on what basis the lialary insuonce will apply, the provisions of Item 4. Other Insurance of SECTION IV of this pofiq trill govem. '1Nvc: d(nr m=irmccvrccibythe LIBERTYMUTUALFIREINSURANCE COMPANY t'rc-nvium S l3ffcctnc chic Fns sinachrrtmi to Policy Nu. Audit R:t+in lswLd To txxucd LN 20 0106 05 Evi.'Wian Date TB2- 681 - 004145 -714 . . t ifticc anJ N0. _ Au�simcrd tk, tcacwnit-c hnd. Sctisi Nn. 014201300366700004 Policy Number TB2- 681 - 004145 -714 issued. by LIBERTY NIUTUAL FIRE UNSURAINCE Ct}i',II'xNY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY [NDEMNITY COVERAGE PART SELF - INSURED TRACKER EXCESS `LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY, COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS1COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY =VERAGE PART `COMMERCIAL LIABILITY- UMBRELLA COVERAGE FORM A. If we cancel this policy for any reason other than nonpayment of premium, we %ili notify the persons or organizations shown in the Schedule above. We will send notice to -the email or mailing address fisted abovee at least 10 days, or the number of days listed above 0 any, before the cancellation becomes e%ctive. in,no eventdoPs the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is Intended as a courtesy only. Our failure to provide such .advance noilftation will not extend the policy cancellation date nor negate cancellat'ran of ttie policy_ Ali other terms and conditions of this policy remain unchanged. LIM N 41 0611 C9) 2011 Liberty. Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of insurance Services Office, lnc, with its permission. PoiicyNumber: AS2 -681- 004145 -724 Issued By: Liberty DKutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE L.tABiLITY INDEMNITY COVERAGE PART SELF- INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS' LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person (s)1 Organization(s): Email Address or mailirig address: Number Days Notibw. Per schedule on file with the company 30 i A. If we cancel this policy for any reason other than nonpayment of premium, we oath notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, it any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance nofi ication will not extend the policy cancellation date :nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 3$ 0105 11 0 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of tnsurance Sarvices Office, Inc. with Its permission. NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effecdive. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification win not extend the policy cancellation date nor negate cancellation of the policy. Name of Other Person(s) Organization(s): Per schedule.on file with the company Schedule Email Address or mailing address, Number Days Notice: All other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. W A 7— 6 8 D— 0 0 414 5 — 6 9 4 Issued to Michael Baker Corporation 30 Premium $ WM 90 18106 11 © 2011, Liberty Mutual Group. All Rights Reserved. Page 1 of 1. Ed. 06/01/2011 Pollcy Number.-OC1402675* w. LIMITED AUTHORITY TO; ISSUE CERTIRCAWS,OF DMIRANCE ENDORSEMENT In consideration of the premium dW.Med, A'b-hereby understood and agreeid as:fbkmiw. (1) Underwriters authorize Aon thw (Terbfta* Isspen to issue Verlift ates of Insutance at the request ex diractiort of the- It 'is. ex uh pres,*T ulersto6g &W agreed that, subjectlb (2) below dwfffic� Ini :96 4iimAa SMY shall not confer anyfi­hli1jp_oh thebertiffidOW Hbldprj dftto ­ oblipjaboh on-ft rights: ally, part of the Underwiteis, or ­ ­ I _7 ,porl: to, 'or be constnJed, lo. alter; extend, nvxfify,, amend, or otherwise change tto terms or conditionat of this To in any. manner !r ICY whatsoever. In the, case of- any. conflict between the de i s&' on"buthe teams and ­ . conditions of this PofrcY' oonhairied in -arty, COrtifidate,01" bourance,*on the'.one !W;ndi and the terms and=ndifions of this-Policy. as'set,fbrth herein on the %othK-ft.*rms .asset Iorth herein and conditions. of this. Policy control. (2) Notwithstanding Paragraph (1) aW* such .Certificates df Ineuranbe, as ' :are authorized under tbls.�endorseiTtent may provide that In the evert "Ainderwriters cancel or non-renew this fi-is Policy, or in the event of a Mate" Change -to ;this , p pbli;Y, )01 � - r Matmiall nderwrftrs shall mail notice 4, sudi ***� iiot� 'a' Change to such d4idicate Holder '3_0 day- 6`0' ' - -'to date of cellabb-n, W 11167effe�, -,,.Can non-renewal. or a, Material Orange. 64 �16 date. of OPYS* prior 119. ef!"- red 1W 1101" to . � � cancellation in the event 09 Apuri pe The Y w- !4p when y a, Assured Shall PUVide Wiftn h*fi6e. to the UndEwritaiS, such . Cer in Holders, if specified each 61; Ini&fthee inib6- b WS any. SIX at' Otim Policy, (il) 90 days prior'to_e)q3Lratioh*df this Polic', acrd withIAL jb,dayS`of.:reoeIOt.Of Y a written . request from Underwriters. Und'erwMmrs'. obligation to rhail P90qe of cancellation non-re I newai, or a Mai"l as vWd din _d fi-this. O.ro a , pply solely to those Ce I rtificat e Holders With rt*p6d'to whom the sssured. has provided the lbregoing.written, notice to the Un-derwritem and, agreed that UnderWffterVauthdriiatidn' of the :OWN (3) it is further undersib.ocid d - at m -1i '4. Cis re Issuer under Oft en6ii�miid is li ited ioii� to 7tlii' 6 lu3nice Insufanm and does not authorize., empower, 'o . r appoint, the* ! *O * afa-Issuar to as an agent for the Uhderwnters:or bind the other Purpose: Certificate issuer shall tae solely shall 'resp any e" rm­m' - or omissions in bonnet with the issuance of any -Cditfidde cif Insurance pursuaht,t6thi endorsemen t .i (4) As used in this endorsement (1) CeAfficate pf If"MMm means a d=xnent-, issued -for in1mmationel this xrpo.ses only. -is: eyWqnqR of- the. existence and,term of _Itc in satisfy a;=6WW 6 '09'" O'li of the Assured (ii) Material Change means, an endorsement to � or amendment of this Pobqy, after issuance &,this , .!,)6fiC_ by,ftie Onder,writers, that �eithcts 'y attar afforded to the AsOred. All other teffns, clauses and conditions: remain unchanged. Maricet Submission - Supplemental PapP48, of 54 Plauses