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HomeMy WebLinkAboutGranite Rock - Insurance Certificate (2018)303844 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (M YY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, /2018 2!12/2018 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(les) 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 CONTACT NAME: Commercial Lines - (628) 201 -9001 PHONE FAX 610.537.2393 No, Elrt): (A/C, No): USI Insurance Services National, Inc. - CA Lic#: OD08408 (A/C, CertRequests GL17A00056 -ADDRESS: : @usi.com 201 Mission St, 11th Floor EACHOCCURRENCE S 5,000,000 INSURER(S) AFFORDING COVERAGE NAIC A San Francisco, CA 94105 INSURERA: •American Contractors Ins Co RRG 12300 INSURED INSURER B: Zurich American Insurance CO 16535 Granite Rock Company ACIG I Company INSURER C : nsurance om Pa Y 19984 PO BOX 50001 A X INSURER D: GL17B00056 INSURER E: 06/01 /2018 Watsonville, CA 95077 INSURER F: 5 5,000,000 COVERAGES CERTIFICATE NUMBER: 126671133 REVISION NUMBER: See below 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. TR TYPE OF INSURANCE ADDL U R POLICY NUMBER POLICY DIYYYY AMr IODfYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X GL17A00056 06/01/2017 06/01/2018 EACHOCCURRENCE S 5,000,000 / Ei0 PREMISES Ea occurrence) S 100,000 CLAIMS -MADE �X OCCUR (primary) MED EXP (Any one person) S 5,000 A X GL17B00056 06/01/2017 06/01 /2018 PERSONAL & ADV INJURY 5 5,000,000 (Excess Follow Form 1) GENERAL AGGREGATE $ 5,000,000 A GEN'L AGGREGATE LIMIT APPLIES PER PRO - POLICY n JECT jLOC OTHER X GL17C00056 (Excess Follow Form 2) 06/01/2017 06/01/2018 PRODUCTS - COMP /OPAGG S 5,000,000 S B AUTOMOBILE LIABILITY BAP347266916 06/01 /2017 06(01 /2018 COMBINED 51 GLE LIMIT Ea aBINED S 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per acadent) $ S UMBRELLALIAS OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N ANYPROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? C (Mandatory in NH) NIA WCA000019017 06/01/2017 06/01/2018 X STATUTE ERH E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE S 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 B Builders Risk MBR938471608 06101/2017 06/01/2018 $1,814,859 Any One Occ I DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Re: Granite Job #6274; West Branch Llagas Creek Trail Project No. 15 -PW -228, STPL- 5034(023). City of Gilroy, its officers, officials and employees is named as additional insured as respects general liability per endorsement attached. CERTIFICATE HOLDER CANCELLATION City of Gilroy Public Works Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ge -1, The ACORD name and logo are registered marks of ACORD ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) ITh. cruf -npls.e c«W:aW 12941379 —dw 1 N2.18) ADDITIONAL INSURED - AUTOMATIC STATUS AS REQUIRED BY CONTRACT - SPECIFIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE City of Gilroy, its officers, officials, and employees. A. Who is an Insured (Section II) is amended to include as an insured any person or organization shown in the above SCHEDULE (called additional insured), but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of your premises or your operations for the additional insured, and only to the extent and for the minimum limits required in the written contract. B. The insurance provided to the additional insured is subject to the following limitations: 1. Unless required by written contract, this insurance does not apply to "bodily injury" or "property damage" occurring after "your work" for the additional insured has been completed or after that portion of "your work" out of which the "bodily injury" or "property damage" arises has been put to its intended use by any person or organization, whichever occurs first. 2. Unless specifically required by written contract, this insurance does not apply to "bodily injury" or "property damage" arising out of the sole negligence, act or omission of the additional insured. 3. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" for which the additional insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement except to the extent that the additional insured would have been obligated to pay such damages in the absence of the contract or agreement. 4. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional services by any insured or on any insured's behalf, including: a) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, drawings or specifications; and b) Supervisory, inspection, architectural or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 5. The insurance afforded herein only applies to the extent permitted by applicable state law, including statutes governing additional insured coverage in the construction industry. 6. The insurance afforded to the additional insured shall not exceed the minimum limits required in the written contract. C. In no event shall the insurance provided to the additional insured exceed the scope of coverage, including minimum limits, required by the contract. If a written contract or agreement requires that additional insured status be provided by the use of specified edition dates of the ISO CG2010 and /or CG2037, then the terms of that endorsement are incorporated into this endorsement as respects such additional insured and shall supersede the coverage grant and limitations in Sections A. and B. of this endorsement. In the event that CG2010 and /or CG2037 are required but no edition dates are specified, the 04113 editions shall apply. D. This insurance is excess to any other insurance, whether primary, excess, contingent or on any other basis, available to the additional insured unless a written contract requires that this insurance be primary or primary and non - contributing. However, this insurance is always excess to other insurance, whether primary, excess, contingent or on any other basis, when the additional insured has been added to the other insurance as an additional insured. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the mentioned Policy, other than as above stated. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/06/2017 Policy No.: GL17A00056 Endorsement No.: Policy Effective: 06/01/2017 Premium $ Insured: Granite Rock Company Insurance Company: American Contractors Insurance Company Risk Retention Group