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HomeMy WebLinkAboutPlaceworks - Insurance Certificate (2019)ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 06/26//2018 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 NAME: Marsh Risk & Insurance Services PHONE FAX 17901 Von Karman Avenue, Suite 1100 A/C No Ext : A/C No): (949) 399 -5800; License #0437153 E -MAIL Irvine, CA 92614 ADDRESS: $ 5,000,000 Attn: NewportBeach .CertRequest @marsh.com /F: 212- 948 -4323 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Crum & Forster Specialty Insurance Co 44520 CN115158923- 01- 01 -18 -19 INSURED PlaceWorks, Inc INSURER B : Travelers Property Casual Company Of America 25674 INSURER C : MED EXP (Any one person) Dba: The Planning Center Design Community & Enviornment BI & PD Ded. $5,000 3 MacArthur Place, Suite 1100 INSURER D: Santa Ana, CA 92707 INSURER E: $ 5.000.000 INSURER F: COVERAGES CERTIFICATE NUMBER: LOS- 002211906 -16 REVISION NUMBER: 6 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 DDY1 MM DD /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X EPK122995 07/01/2018 07/01/2019 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTIFD PREMISES Ea occurrence $ 50,000 X MED EXP (Any one person) $ 5,000 BI & PD Ded. $5,000 PERSONAL & ADV INJURY $ 5.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 JECT X PRO - POLICY El PRO ❑ LOC PRODUCTS - COMP /OP AGG $ 5,000,000 Contractors Pollution $ 5,000,000 OTHER: B AUTOMOBILE LIABILITY X X BA7E37616718CAG 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X L_ 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 L Comp /Coll Deductibles $ $1,000 UMBRELLA LIAB X OCCUR EX6J3287561843 07/01/2018 07/01/2019 EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N / A UB7K7286761843G 07/01/2019 X PER OTH- STATUTE I JER E L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Errors & Omissions - Claims Made EPK122995 07/01/2018 07/01/2019 Each Claim /Aggregate 5,000,000 Retro Dates: See 2nd Page DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Job #1036, Gilroy High Speed Train Visioning Project The City of Gilroy, officers, representatives, agents, and employees are included as additional insured where required by written contract with respect to General and Auto Liability. This insurance is primary and non- contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to General Liability. Waiver of subrogation is applicable where required by written contract with respect to General and Auto Liability. CERTIFICATE HOLDER CANCELLATION The City of Gilroy Attn: Rick Smelser, City Engineer 7351 Rosanna St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Rosalynda Martinez © 1988 -2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD BA7E37616718CAG Effective 07/01/2018 COMMERCIAL AUTO THIS N R EM T CHANGES THE POLICY, ICY, PLEA E READ ITICAREFULLY, BUSINESS AU TO EXTENSION ENDORSEMENT This endorsement modifies insurance providers' under the following :. BUSINESS ALITO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage, However, coverage for any injury, darnage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions, do .toot apply to the extent that :average is exCltrded or limited by such an endorsement. The fallowing listing is a general cover- age description, only. Limitations and exciusions may apply to these coverages. Read all the provisions of this en- doarsernent and the rest of your policy carefully to determine rights, duties, and what is and is not covered, i M. BLANKET ADDITIONAL � � INSURED C. EMPLOYEE HIRED 1/ D. P AS E. SUPPLEMENTARY PAYMENTS «- INCREASED LIMITS F. HIRED AUTO — LIMITED 40RL D IDE COV- ERAGE _.. INDEMNITY BASIS L"RIVIBITIA ! ;I! �; _ M _1 0� 1. !r A. BROAD FORM NAMED INSURED The foi<owing is added to paragraph A.t,, Who Is An Insured, of SECT1O J it — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or fora dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage, Coverage under this provision is afforded onfy un- til the I 801 day after you acquire or form the or- ganization or the tend of the policy period, which- ever is earlier. AwIlIk t til ► W rw he following is added to Paragraph c. in A "1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE, Any person or organisation who is required under, a written contract or agreement between you and that person or otganizat,on, that is Signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "Insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured„ ;.artdtir the Who Is An Insured provision contained in Section It, 1. The following is added to paragraph AJ,, Who Is An Insured, of SECTION 11 — CGV, FRED AUTOS LIABILITY COVERAGE: An "employee'° of Your,'; is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee' s" name, with your permission, while performing duties related to the conduct of your busi- ness.. 2, The fallowing replace, Paragraph b. in 13.5., Other Insurance, of SECTION IV — BUSI. LESS AUTO CONDITIONS- b. For Hired ,Auto Physical Damage Cover - Age, the following are deemed to be cov- ered "a =utos " you own (1) Any covered "au o" you lease, hire, rent or barrow; and (2) Any covered "arito" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 02435 The Traa;e€ers rnr9arnmiy Company. All rrgl it.ti reserved. Page t of 4 includes Copyrighted material of €nsuranc6: Se` icas Office, Inc. Wth its Permission, BA7E37616717CAG Effective 07/01/2017 COMMERCIAL AUTO perrnission, while performing duties related to the conduct of your busi- t°ess. However, any "auto " that is leased, hired, rented or borrowed with a driver is not a covered "auto ". The following is added to Paragraph A.I., Who is An insured, of SECTION 11 – COVERED AUTOS LIABILITY COVERAGE. Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs, E. SUPPLEMENTARY PAYMENTS --a INCREASED LIMITS 1. The following replaces Paragraph .A.2.a.(2), of SECTION 11 -- COVERED AUTOS L,IABIL._ ITT COVERAGE: (2) Up to $3,000 fur cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we Craver, We do not have to furnish these brands. 2. The following replaces Paragraph A.2,a.(4), sat SECTION 11 �- COVERED AUTOS LIABIL- ITY COVERAGE.- (a) 'With respect to any clalm made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arra=tge to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us q�yadvised of all proceedings and ac- tion s. (hi) neither you nor any other involved "insurers" will make~ any settlement without our consent,. (iii) We rnay, at our discretion, participate in defending 4he "insured" against. or in thtt settiernent of, any claim or "suit ", (iv) lftere will reimburse the "insured" for sums that the "insured" legaily must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para - graph C., Urnits Of Insurance, of SECTION 11 – COVERED AUTOS LIABILITY COVERAGE. "= (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at OUr request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for year inves:iga« cause of time off from work. Lion of such claims and your defense F. t°IIR,Et9 AUTO �. L.1�il1TE Ik�L1�iF�110E +��lii- of the ` "insured'" against any such "suit' , but only up to and included E A E – INDEMNITY BASIS within the lirinit described in Para - " The following replaces Subparaoraph (S) in Para- graph C„ Limits Of Insurance, of graph .7., Policy Period, Coverage Territory, SECTIn 11 C¢IEFEt AUTOS of SECTION I – BUSINESS AUTO CONDI- LIABILITY COVERAGM, and not in TIONS, addition to such limit., Our dtity 10 0== (�� ACly�JVh�1'� IIl the word, except �Irty Gtairntry or snake such payments ends when we � �" jurisdiction: while any trade sanction, Poi- have used up the applicable limit of ,= bargo, or similar regulation imposed by the insurance in payments far damages, =--- United States of America applies to and pro- settlements at' defense expenses. hibits the transaction of business with or (b) This Insurance is excess over any valid within such country or jurisdiction, for 'caw}- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, 'auto" that you lease, hire, rent or borrow contingent or on any rather basis, without a driver for a period of 30 days or less (o) This insurance Is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any — or barrow from any of your ernpioyees , country outside the United States, its ter - parkners (if you are a partnership), rlrterrtbers ritodes and possessions, Puerto Nitro and (if you are a limited H ability company) or Canada. Members of their households. Page 2 of 4 Q 2015 The Trewlers indemnity Company. API rights reserYed. CA T3 53 02 15 Includes copyrighted material of Insurance Services office, Inc. with its permission, (7O3337 BA7E37616 71 t'C AG Effective 07/01/2017 YOU 2gf8e to maintain all required or cornpulsony insurance' in any such c.Oun_ try Up to the Minimum limits required by local lave. Your failure to corn'ily with cr�r�� invalidate re([Lfllre^�ryr(rJ$.n� $ will not invalidate the coverage afforded by this Policy, but we will Po' only lie liable to tl~s same extent we would have Deer liable had you cornplied with the r omPulsory In- surance requirements. (d) it is understood that we are not an admit- ted or authorized insurer outside the United Statati of America, its territories and possessions, Pl €erto Mica and Can - ada, We assume no responsilaility for the furnishing of certificates of insurance, or for cornpliiance in any dray with the laws of other coun-tries relating to insurance.. G, WAIVER OF DEDUCTIBLE — GLASS The following Is added to Paragraph 0,, Vect$.rcfi. tale, of SECTION III —. PMYSICAL DAMAGE COVERAGE -, No deductible for a covered "auto" will apply to Wass CIM89e if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — t�033 OF USE —INCREASED LIMIT The following replaces the last sentence of Para, graph AA.b., Lass Of Use Expenses, of aEC TION III -- PHYSICAL DAMAGE COVERAGE However, the Most we will pay for any expenses f,Dr loss of use is 65 per day, to a rr-taximurn of 50 for any one " C,olde'nt ". I. PHYSICAL DAMAGE m TRANSPORTATION EXPENSES INCREASED LIMIT The following replaces the first sentence iri para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE OVER SAGE: pay r' per t3 n �4q L5 �f1y�+��e �y V isle will pay up the $+�0 per day to a ,A ILt.+.imurn o 1,500 for ternporafy transportation expense In- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY COMNIIERC✓IAL AUTO (2) In or on your covered "au W'. This coverage applies only in the event of a total theft of your covered "auto ". No deductibles apply to this personal properly coverage, K. AIRBAGS The following is adde a to Piaracgraph 8.3., Exclu- sions, of S CCTIt' N Ill — PHYSICAL DAMAGE COVERAGE: Exclusion 3 „a, does not apply tc, "doss,” to one or snore airbags in a covered "auto" you own that in- flate due to a cause ether than a caLrse Of "loss„ set forth In Paragraphs A;A,b. and A.1.c., but only: a, it that "auto" is a covered `auto" for cornpre- herisive Coverage uaader this policy; . The airbags are not covered under any war- ranty; and c. The airbags were riot intentionally inflated. We wsil pay i.rp to a maximum Of $11,000 for any one "loss ". L, NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The folIO'Ning is added t.3 Paragraph A.2,a., of SECTION IV— BUSINESS AUTO CONDITIONS Your duty to glt�e Lis or oUr authorized representa- tive prompt notice of the "accident" or "loss" ap -. plies only when the "accicl <vrrt" or "loss" is known to. (a) You (if you are an individual); (b) a partner (if ycu are to ,'partnership); (c) A member (if you are:: limited liability com- Dany,; (d) An executive officer, director or insurance Manager (if yOtA are a Corporation or other or- gan7zation); or (e) Any "employee" authorized by you to glvo no- E r,0 of the `accident" ni. 431o.M9cs", M. BLANKET WAIVER OF SLlSt° OGAT°ION The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Cutters To Lis, of SECTION IV .m 13USI ESS AUTO CONDI- TIONS: The fallowing is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against ago- Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right Of re:oovsry we may have Personal Property against any person or to the ex- We will pay up to $400 for "loss" to wearing ap.- tent required of you toy a written contract signed and executed prior to any " accident" pares and other personas ;property which is: or "loss", provided that the 'accident" or "IoSs" (1) Owned by an "insured'; and arises out of operations contemplated by CA T3 53 02 15 V 201 5 The Travefers inciermaity r�r gu sty. All oughts fe$erve;dt, Page 5 of 4 Includes copyrighted material of insurance sevvirres Corfce, Inc. with lip t7Orf lfiiriitm. ra 00113M BA'M1616717C AG EfTecitive07101/2017 COMMERCIAL AUTO such contract. The waiver applies orjjy to the Person of oiganizetion designated in Such Contract. N. UNINTENTIONAL ERRORS OR OWSSIONS The I`WovAng is added to Paragraph 9.2,, Con- cealment, Misrepresentation, Or Frakid, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional ornission of; or unintentional error in, any 103rMation given by You shall not prejudicl your fights unde( this insurance, Hoyj- ever this PIRWISIDn does not affect our right to col- lect additional premium or exefcjse our right of canc,ollation Of non-renewel, Page 4 of 4 ui The 'ffaWA'efs indCenrlity Compaoy. Ali rights rvsanve,', CA 1-3 83 02 is sion, EPK122995 Effective 07/01/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILFI-Y f---OVERAGE PART SCHEDULE IName Of Additional Insured Person s) or Organization(s) ere Required By Written Contract. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the parson(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability caused, in whole or in part, by "your work" for that insured which is performed by you or by those acting on your behalf. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN 011`ImO2111 Page 1 of I EPK122995 Effective 07/0112018 PRIMARY AND N ON-CO NTR.IBU ADDITIONAL SUBROGATION WITH WAIVER OF This endorse tent modifies insurance provided under the following: [.. �.. +� E re required By Written Contract. A, SECTION III -- WHO 15 AN INSURED within the Common Previsions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability arising out of "your work" for that person or organization performed by you, or by these acting on your behalf. B, As respects additional insureds as defined above, this insurance also applies to "bodily injury, ", or "property damage" arising out of your negligence when the following written contract requirements are applicable,. 1. Coverage available Linder this coverage part shall apply as primary insurance. Any ether insurance available to these additional insureds shall .apply as excess and not contribute as primary to the insurance afforded by this endorsement. . We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for injury or damage arising out of "your work" performed under a written contract with that person(s) or organization(s). 3, The terns "additional insured" is used separately and not collectively, but the inclusion of more than one "additional insured" shall not increase the limits or coverage provided by this insurance. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies: vig 1 -ND14i -1111 Page 1 of 'i