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HomeMy WebLinkAboutRJF Construction - Insurance Certificate (2018).acoR °® CERTIFICATE OF LIABILITY INSURANCE OA7E(MMIDDIYYYY) `� 05/15/2018 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(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 CONTACT Angie Phillips .C_ Pacific Coast Benefits Insurance s Ne.ExN ;408 -847 -1000 _ lA%.Noi :408 -848 -2314 P.O. 1749 E-MAIL ADDRESS: angieQpacbenins.com Gilroy, CA 95021 INSURERS AFFORDING COVERAGE NAfCC INSURED Robert Fiscalini DBA: RJF Concrete Construction PO Box 2728 Gilroy, CA 95021 I,NSURERA - .Progressive Insurance INSURER B First Comp Insurance INSURER C: INSURER D: INSURER E: CAVFRAnFR CFRTIFICATF NIIMRFR7 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. ILT R' TYPE OF INSURANCE ',ADDL.SUBRI POLICY NUMBER MM DD YYYY MMIDD YY EXP LTR Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE __ I S CLAIMS -MADE OCCUR DAMAGE REMISES Ea occurrence $ MED EXP (Any one person S PERSONAL & ADV INJURY _ $ GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I POLICY ❑ PRO- JECT D LOC I PRODUCTS-- COMPIOPAGG S $ OTHER A AUTOMOBILE LIABILITY 03127368 -3 0512312018 05/23/2019 COMBINED SINGLE LIMIT Ea accident $100,000 BODILY INJURY (Per person) S ANY AUTO X OWNED r AUTOS ONLY X AUTOSULED HIRED X NOWOWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accidenU $ PROPERTY DAMAGE fPer accident _ $ UninsuredMotorists $100,000 j UMBRELLA LIAB HCLAIM3-MADE! OCCUR EA CH OCCURRENCE $ 4, EXCESS uAB AGGREGATE $ - - -- ED RETENTIONS $ BANDEMPLOYOERS'LABILOI WORKERS Y ANY PROPRIETORIPARTNERlEXECUTIVE Y❑ I IV1WC0095149-01 05/18/2018 05/18/2019 I X STATUTE ERH EL EACH ACCIDENT $1,000,000 OFFICER /MEMBER EXCLUDED.) �(Mandatory In NH) NIA - - -" $1,000,000_ - E.L. DISEASE -EA EMPLOYEE if desc ibe under DESCRIPTI N OF OPERATIONS below ICI $1,000,000 E.L DISEASE - POLICY LIMIT I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 701, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as Additional Insured as per written agreement. City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 VMINUCLLN I IVIV 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 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by ARP on May 31, 2018 at 10:41AM ACORN® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD /YYYY) 05/17/2018 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(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 - CONTACT Sherylea J Jenkins A C. N E , (916) 967 -7715 FqC No): (916) 967 -1591 Lions and Coventry Insurance Services, Inc. E -MAIL ADDRESS: CL@Iionsandcoventry.com 7816 Uplands Way, Suite #B INSURERS AFFORDING COVERAGE NAIC # INSURER A: ATAIN SPECIALTY INSURANCE COMPANY 17159 Citrus Heights CA 95610 INSURED INSURER B CLAIMS -MADE X OCCUR INSURER C RJF Concrete Construction INSURER D 7700 Princevalle Street INSURER E: $ 100,000 INSURER F $ 5,000 Gilroy CA 95020- COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE INSD SUER POLICY NUMBER MM /DDIYYYY MM /DD/YYYY LIMITS Gilroy CA 95020 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occu «ence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A X X CIP326827 09/25/2017 09/25/2018 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY � JECT PRO RO- F—] LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Deductible $ 1,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ F—] OFFICER /MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Police Department Personnel, City of Gilroy, its Officers, Officials and Employees are hereby included as Additional Insured per attached Blanket Endorsement. Primary and Non - Contributory wording and Waiver of subrogation applies per attached blanket endorsements. CERTIFICATE HOLDER CANCELLATION ©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 City of Gilroy, its Officers, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Officials and Employees AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy CA 95020 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section If - Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with re- spect to liability for "bodily injury ", "property dam- age" 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are re- quired by the contract or agreement to provide for such additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these ad- ditional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury ", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 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 "occur- rence" which caused the "bodily injury" or "prop- erty damage ", or the offense which caused the "personal and advertising injury ", involved the ren- dering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 04 13 Copyrig ht, Insurance Services Office, Inc., 2012 Page 1 of 2 2. 'Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than serv- ice, maintenance or repairs) to be per- formed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion III - Limits Of Insurance: The most we will pay on behalf of the additional in- sured is the amount of insurance: Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insur- ance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Copyright, Insurance Services Office, Inc., 2012 CG 20 33 04 13 POLICY NUMBER: CIP326827 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): LOCATIONS AS REQUIRED BY SPECIFIC WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggre- gate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "pro- ducts- completed operations hazard ", and for medical expenses under Coverage C regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. CG 25 03 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 2 B. For all sums which the insured becomes legally C obligated to pay as damages caused by "occur- rences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attrib- uted only to ongoing operations at a single desig- nated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D expenses shall reduce the amount available under the General Aggregate Limit or the Products - completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. When coverage for liability arising out of the "products- completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard" will reduce the Products - completed Operations Aggregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, Insurance Services Office, Inc., 2008 CG 25 03 05 09 ENDORSEMENT This Endorsement Changes the Policy - Please Read it Carefully PRIMARYAND NON - CONTRIBUTING INSURANCE (Sole Negligence) This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AN D CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Section IV — Commercial General Liability Conditions, Paragraph 4: Section IV: Commercial General Liability Conditions 4. Otherinsurance: Specifically and solely for the Third -Party shown below, notwithstanding the provisions of sub - paragraphs a, b, and c of this paragraph, it is hereby agreed that in the event of any "suit "where the damages are caused by the insured§ sole negligence, this insurance shall be primary and any other insurance maintained by the additional insured named as the Third Party below shall be excess and non - contributory. The Third -Party to whom this endorsement applies is: ANY PARTY FOR WHOM THE INSURED IS PERFORMING SERVICES, AT A SPECIFIED PROJECT SET FORTH IN A WRITTEN CONTRACT, THAT: (1) HAS BEEN SIGNED BY ALL PARTIES, INCLUDING THE NAMED INSURED AND THE PARTY SEEKING COVERAGE UNDER THIS ENDORSEMENT; AND (2) HAS BEEN ENTERED INTO BEFORE ANY LOSS HAS OCCURRED. Any coverage provided pursuant to this endorsement shall be subject to all other terms, conditions, exclusions and endorsements of the policy to which this form is attached. The endorsement is effective on the inception date of the policy unless otherwise stated below. Policy Number: CIP326827 Named Insured: RJF CONCRETE CONSTRUCTION Endorsement Effective Date: 09/25/2017 AF001397 07116 Page 1 of 1 POLICY NUMBER: CIP326827 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COM M ERCIAL G EN ERAL LIABILITY COVERAGE PART PRODUCTS/ COM PLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS W The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 Insurance Services Office, Inc., 2008 Page 1 of 1