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HomeMy WebLinkAboutFlowers & Associates - Insurance CertificateAGOR ®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/24/2017 _ 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 Dealey, Renton & Associates 199 S. Los Robles Ave #540 Pasadena, CA 91101 CONTACT - NAME Marie Swaney PHONE.) 626- 844 -3070 FAX ,moo) E-MAIL . mswane deale renton.com DRESS Y@ Y - INSURERS AFFORDING COVERAGE NAIC # Lic #0020739 INSURER A Hartford Ins. Co of Midwest - J37478 INSURED FLOWEASSO INSURER B :Travelers Propwty Casualty Co of A 125674 Flowers 8r Associates, Inc. INSURER C Wesco Insurance Co. 125011 201 North Calle Cesar Chavez, Suite 100 Santa Barbara, CA 93103 < INSURER D $10,000 Contractual Liab 805- 966 -2224 INSURER E INSURER F: PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER: 773441536 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 ILTR TYPE OF INSURANCE IINSD SWVD I POLICY NUMBER MMIDDY/YYYY MMroD/Yl'YY LIMITS B GENERAL LIABILITY Y Y 68011-1980764 9/1/2017 9/1/2018 I EACH OCCURRENCE I $1,000,000 �JCOMMERCIAL CLAIMS -MADE X I OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) I $1,000,000 X MED EXP (Any one person) $10,000 Contractual Liab PERSONAL & ADV INJURY 1 $1,000,000 I x XCU Included GEEN'L AGGREGATE LIMIT APPLIES PER POLICY I x I PRO- LOC OTHER GENERAL-AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 I Ded I $0 AUTOMOBILE LIABILITY LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO AUT OWNED AUTOS HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ Pe Peoa cdentDAMAGE $ $ UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DIED 1 1 RETENTION $ I $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F NIA (Mandatory in NH) y 72WEGPI0126 9/1/2017 9/1/2018 I X I PER I OTH- I STATUTE ER E L EACH ACCIDENT I $1,000,000 E L DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below 1 E L DISEASE - POLICY.LIMIT 1 $1,000.000 _ C Professional Liability Y ARA125588801 812612017 812612018 $2,000,000 per claim Contractor's Pollution Liab $4,000,000 Annual Aggregate Retro Date 10/1/1977 $25,000 Deductible DESCRIPTION,OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AM Best's Rating on all policies above: A/XII or greater. WC officers & directors excluded: Robert Flowers, Stephen Flowers, & Vernon Williams. RE: WO #1623, Pavement Maintenance — City of Gilroy, its officials, officers and employees are named as additional Insured as respects general liability for claims arising from the operations of the named insured as required per written contractor agreement: General Liability is Primary/Non- Contributory per policy form wording'. Insurance coverage includes waiver of subrogation per the attached endorsement(s). lafa:all�lfG \Ia:N1�9a: +hGlaya��_�Il�1.Em.ry �. City of Gilroy, Its officials, officers and employees Attn: David Stubchaer 7351 Rosanna St Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @,1988-2014 ACORD(CORPORATION. All;rights,reserved. ACORD 25 (2014/01) The ACORD name and logo are registered imarks of ACORD Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured:Flowers & Associates, Inc. Producer: Dealey, Renton & Associates Schedule Person or Organization City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna St Gilroy CA 95020 Additional Premium % We have the right to recover our payments from any- one liable for an injury- covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) Authorized Representative WC040306 Policy Number 72WEGPI0126 Effective Date -9/1/2017 Job Description City of Gilroy, its officials, officers and employees -- RE: WO 41623, Pavement Maintenance You must maintain payroll records accurately segre- gating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement shall be the percentage, as shown in the Schedule applicable to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. POLICY NUMBER: 6801x980764 COMMERICAL GENERAL LIABILITY ISSUE DATE: 8/24/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .0 -9 e ► ► ,IZ1:4 � (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna St Gilroy CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: City of Gilroy, its officials, officers and employees -- RE: WO #1623, Pavement Maintenance PROVISIONS A The following is added to WHO IS AN INSURED The insurance provided to such additional (Section II): insured is limited as follows: The person or organization shown in the Sched- ule above is an additional insured on this Cover- d. This insurance does not apply to the render - age Part, but only with respect to liability for bod- ing of or failure to render any "professional ily injury", 'property damage" or 'personal injury services ". caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on e. The limits of insurance afforded to the addi- your behalf: tional insured shall be the limits which you agreed in that 'contract or agreement requir- a. In the performance of your ongoing oper- ing insurance" to provide for that additional ations; insured, or the limits shown in the Declarations for this Coverage Part, b. In connection with premises owned by or whichever are less. This endorsement does rented to you; or not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for C. In connection with your work and included this Coverage Part within the "products- completed operations hazard." B. The following is added to Paragraph a. of 4. - - Other Insurance in COMMERCIAL GENERAL Such person or organization does not qualify as LIABILITY CONDITIONS (Section IV): an additional insured for "bodily injury", "property However, if you specifically agree in a contract or damage" or "personal injury' for which that person agreement requiring insurance that, for the addi- or organization has assumed liability in a contract tional insured shown n the Schedule, the insur- or agreement. ance provided to that additional insured under this CG D3 82 09 07 Page 1 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc, with its permission COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, 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 entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance 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 the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we' make for "bodily injury", "property damage" or "personal CG D3 82 09 07 injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): ' "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule 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 entered into that contract or agreement; b. While that part of the contract or agreement is in effect, and c. Before the end of the policy period. © 2007 The Travelers Companies, Inc Includes the copyrighted material of Insurance Services Office Inc., with its permission Page 2 CERTIFICATE OF LIABILITY INSURANCE DATE(YMDDYYYIT 8/25/2016 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: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION CIS 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 endorseme s . PRODUCER Dealey, Renton & Associates 199 S. Los Robles Ave #540 Pasadena, CA 91101 ON ACT NAME: Mang Swaney PHONE FAX Ear: Nn End 626- 844 -3070 IMC noDAiESS. mswaney @dealeyrenton.com INSURER {S AFFORDING COVERAGE NAIL M Lic #0020739 $1,000.000 INSURER A:Hartforddns.CoofMidwest 137478 INSURED FLOWEASSO INSURER B:Travelers Prop ejy Casualty CoofA 125674 Flowers & Associates, Inc. INSURERC:Wesco Insurance Co. 125011 201 North Calle Cesar Chavez, Suite 100 Santa Barbara, CA 93103 NsuRERD: 1so AUTOMOBILE 605-966 -2224 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 502788224 _ 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. ILTSRR TYPE OF INSURANCE INRp $UBR POLICY NUMBER PMM/DDY EFF PMDOY FJ(P LIMITS B X I COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR X-1 CQnlractual Llab Y Y 6801H980764 9/1/2016 9/1/2017 EACH OCCURRENCE DAMAGETORENTED PREMI$ES_(Ea occurranw) MED EXP (An one person) $1,000.000 $1,000,000 $10,000 X IXCLIIncllded GEN'L AGGREGATE LIMIT APPLIES PER. 117 POLICY I X I J'ECT F1 LOC I7 OTHER PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS. COMP(OP AGG $2,000.000 Oed 1so AUTOMOBILE DASILITY ANY AUTO ALL AWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS �(Es dent $ BODILY INJURY (Per person) $ BODILY INJURY (Per acoden0 $ PROPERTY AMA— Par ac Id I $ UMBRELLA UAS u OCCUR EXCESS UAB CLAIMS4MADE, EACH OCCURRENCE S AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIE%ECUTIVE Y / N OFFICER/MEMSER EXCLUDED? n1N (Myyaaanssdatory In NH) DESCRIPTION OF OPERATIONS oelow y /A 72WEGPI0126 19/112016 1 9/1/2017 L STERI EH E.L. EACH ACCIDENT III $1,000,000 1 E.I. DISEASE - EA EMPLOYEE $1,000,000 I E.L DISEASE -POLICY LIMB $1,000,000 C Professional Liabilfry, Contractor's' Pollution List, Retro Date: 1011/1977 I Y 1 ARA125588800 1 8/2612016 8/2612017 $2,000,000 per claim $4,000,000 Annual Aggregate $25,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) Cancellation Notice: 30 day /10 day for non -pay or premium will be mailed to the certificate holder. AM Best's Rating on all policies above: A/XII or greater. RE: WO #1445, 201512016 Pavement Design/Construction — City of Gilroy, its officials, officers and employees are named as additional insured awrespects general' liability for claims arising from the operations of the named insured as required per written contractor agreement. SEE CANCELLATION SECTION of Certificate for 30 Day Notice of Cancellation /10 Day for Non - Payment of Premium. See Attached... City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 Ov vav IYVw Iv Uov lul nul]Puy vl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE riahts reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY Dealey, Renton & Associates POLICY NUMBER CARRIER AGENCY CUSTOMER ID: FLOWEASSO LOC #: ADDITIONAL REMARKS SCHEDULE NAMED INSURED Flowers & Associates, Inc. 201 North Calle Cesar Chavez, Suite 100 ,Santa Barbara, CA 93103 NAIC CODE EFFECTIVE DATE: Page 1 of 1_ ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Coverage afforded the additional insured is primary and non - contributory as respects to general liability coverage. Insurance coverage includes waiver of subrogation per the attached endorsement(s). SEE CANCELLATION SECTION of Certificate for 30 Day Notice of Cancellation !10 Day for Non - Payment of Premium. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured:Flowers & Associates, Inc. Producer: Dealey, Renton & Associates Schedule Person or Organization City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 Additional Premium % We have the right to recover our payments from any- one liable for au injury- covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) Authorized Representative WC040306 Policy Number 72WEGPI0126 Effective Date 9/1/2016 Job Description City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement Design /Construction You trust maintain payroll records accurately segre- gating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement shall be the percentage, as shown in the Schedule applicable to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. POLICY NUMBER: 680111980764 COMMERICAL GENERAL LIABILITY ISSUE DATE: 6/25/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 PROJECTILOCATION OF COVERED OPERATIONS: City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement Design /Construction PROVISIONS A The following is added to WHO IS AN INSURED (Section 11): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for bod- ily injury", 'property damage" or 'personal injury caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing oper- ations; b. In connection with premises owned by or rented to you; or Ci': In connection with your work and included within the "products- completed operations hazard." Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury' for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services ". e. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in, that 'contract or agreement requir- ing Insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a contract or agreement requiring insurance that, for the addi- tional insured shown in the Schedule, She insur- ance provided to that additional insured under this CG D3 82 09 07 Page t 012007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, 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 entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance 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 the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", 'property damage" or "personal CG D3 82 09 07 injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed., D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule 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 entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. m 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission Page 2