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HomeMy WebLinkAboutDrake Haglan - Insurance Certificate (2019)AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I 10/24/2018 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 INSURERS), 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 Doris A Chambers Dealey, Renton & Associates I PHONE FAX Attn: David C. Eckman I (A/C. No. Extl: 510-465-3090 (A/C. No): 510-452-2193 P. O. Box 12675 I E-MAIL ADDREss: dchambers@dealeyrenton.com Oakland CA 94604-2675 I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Associated Indemnity Corp. 21865 INSURED DRAKEHAGL INSURER B: American Automobile Ins. CO. 21849 Drake, Haglan & Associates, Inc. I 11060 White Rock Road, #200 INSURER C: XL Specialty Insurance Co. 37885 Rancho Cordova CA 95670 I INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:947543270 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y AZC80923931 10/23/2018 10/23/2019 EACH OCCURR CLAIMS -MADE 1XI OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC JECT OTHER: B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB OCCUR X EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROP RI ETOR/PARTNE R/EXECUTI V E OFFICER/MEMBER EXCLUDED? IN I N/A (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below C Professional Liability Claims Made Y Y MZA80334191 ENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $ 4.000,000 10/23/2018 10/23/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) Y AZCB0923931 10/23/2018 10/23/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 2,000,000 Y SCW0046431801 10/23/2018 10/23/2019 X I PER STATUTE I OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DPR9933592 10/23/2018 10/23/2019 $2,000,000 per Claim $4,000,000 Annl Aggr DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Lions Creek Trails Project Construction Services - Lions Creek Trails Project Construction Services: Kern to Wren; Wren to Farrell, Gilroy, CA GENERAL LIABILITY ADDITIONAL INSUREDS: City of Gilroy, its officers, representatives, agents and employees CERTIFICATE HOLDER CANCELLATION 30 Day NOC/10 Day for NonPay of Prem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. Attn: David Stubchaer 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I 10/24/2018 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 INSURERS), 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: Doris A Chambers Dealey, Renton & Associates PHONE FAX Attn: David C. Eckman (A/C. No. Ext): 510-465-3090 (A/C. No): 510-452-2193 P. O. Box 12675 ADDRESS: dchambers@dealeyrenton.com Oakland CA 94604-2675 I INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Associated Indemnity Corp. 21865 INSURED DRAKEHAGL INSURER B: American Automobile Ins. Co. 21849 Drake, Haglan & Associates, Inc. I 11060 White Rock Road, #200 INSURER C: XL Specialty Insurance Co. 37885 Rancho Cordova CA 95670 I INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1291240119 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 SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y AZC80923931 10/23/2018 10/23/2019 EACH OCCURRENCE X $ 2,000,000 DAMAGE TO RENTED CLAIMS -MADE OCCUR ( PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X❑ PRO - ❑ POLICY LOC PRODUCTS - COMP/OPAGG $4,000,000 OTHER, OTHER: $ B AUTOMOBILE LIABILITY Y Y MZA80334191 10/23/2018 10/23/2019 COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A UMBRELLA LIAB X OCCUR Y H AZC80923931 10/23/2018 10/23/2019 EACH OCCURRENCE $ 1.000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION Y SCW0046431801 10/23/2018 10/23/2019 X I PER OERH AND EMPLOYERS' LIABILITY Y / N STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? NI NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000.000 C Professional DPR9933592 10/23/2018 10/23/2019 $2,000,000 per Claim Liability $4,000,000 Annl Aggr Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Ronan Channel and Lions Creek Trails Project in the City of Gilroy Proposal No. 12-RFP-PW-356 GENERAL LIABILITY ADDITIONAL INSUREDS: City of Gilroy, its officers, representatives, agents and employees CERTIFICATE HOLDER CANCELLATION 30 Day NOC/10 Day for NonPay of Prem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy: Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Inga Alonzo 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD