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HomeMy WebLinkAboutScharffenberger Land Planning & Design - Insurance Certificate (2020)ACC> R'D® �' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmrYY) 02/26/2019 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 I CONTACT K B CorRisk Solutions 225 W. Washington St. Suite 1560 Chicago, IL 60606 INSURED Tom Scharffenberger D/B/A Scharffenberger Land Planning & Design 523 17th Avenue San Francisco, CA 94121 NAME: aren ronson PHONE FAX (A/c, No, Ext): 312 - 6 3 7- 8 7 5 5 I (A/C, No, Ext): E-MAIL kbronson@corrisksolutions.com INSURER(S) AFFORDING COVERAGE INSURERA: New Hampshire Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: NAIC # 23841 INSURER F: 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. IN5R TYPE OF INSURANCE ADWL 5UBR POLICY NUMBER POLICY EFF POLICY EXP I LIMITS LTR INSRD WVD (MMIDD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY ' EACH OCCURANCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I CLAIMS MADE � PREMISES (Ea occurance) OCCUR I MED EXP (Any one person) . DOES NOT APPLY PERSONAL & AND INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 7 POLICY n PROJECT n LOC AUTOMOBILE LIABILITY UUMBINED SINGLE LIMIT (Ea _ accident) ANY AUTO I BODILY INJURY (Per person) ALL OWNED SCHEDULED DOES NOT APPLY AUTOS _ AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON -OWNED Al ITn.q PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR I EACH OCCURANCE EXCESS LIAB CLAIMS MADE DOES NOT APPLY I AGGREGATE DED I I RETENTION $ WORKERS COMPENSATION I TWC ORY LIMITS I I OTHER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? E.L. EACH ACCIDENT Y/N NIA DOES NOT APPLY I L.L. DISLSAL - LA (Mandatory in NH) El It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 064991197- Per Occurrence: $1, 000,000 A Professional Liability 03 01/22/19 01/22/20 Annual Aggregate: $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACCORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Gilro its officers officials and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Y Y� r THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. employees AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy, CA 95020�� ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. Allrights reserved. The ACORD name and logo are registered marks of ACORD ®' DATE (MM/DD/YYYY) A o CERTIFICATE OF LIABILITY INSURANCE 02/21/2019 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 CS&S/BB&T INS SVCS OF CA NAME: PO BOX 958489 PHONE FAX (AIC, No, Ext): I (A/C, No): LAKE MARY, FL 32746-8989 I E-MAIL Phone - 866-524-3090 ADDRESS: Fax - 877-763-5122 I INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Continental Casualty Company 20443 INSURED I INSURER B : SCHARFFENBERGER LAND PLANNING & DESIGN 523 17TH AVE I INSURER C SAN FRANCISCO, CA 94121 I INSURER D : INSURER E : I INSURER F : 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS 1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 CLAIMS -MADE ® OCCUR DAMAGE TO RENTED 300,000 PREMISES E ( a occurrence) MED EXP (Any one person) $ 10,0001 A Y N 1075206345 01/15/2019 01/15/2020 PERSONAL & ADV INJURY $ 1,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ® PRO JECT ❑ LOC GENERAL AGGREGATE $ I PRODUCTS - COMP/OP AGG $ 2,000,000 2,000,000 OTHER $ 1 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000,0001 ANY AUTO I BODILY INJURY (Per person) $ OWNED SCHEDULED A AUTOS ONLY AUTOS N N 1075206345 01 /15/2019 01 /15/2020 I BODILY INJURY (Per accident) $ XHIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident) i $ 1 OCCUR UMBRELLA LIAB HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB I AGGREGATE $ DED 1 I RETENTION $ $ J WORKERS COMPENSATION I I OTH- ANDD EMPLOYERS' LIABILITY SPER TATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A .. I ELEACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? in NH) $ (Mandatory E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, officials and employees are added as an additional insured as provided in the blanket additional insured endorsement as it pertains to work being performed by the named insured under written contract. CERTIFICATE HOLDER City of Gilroy Attn: Community Development Dept. 7351 Rosanna Street Gilroy, CA 95020 CANCELLATION 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD cado526 ---1111111 ACC ® DATE (MM/DD/YYYY) L� CERTIFICATE OF LIABILITY INSURANCE 0MM/2019 DD 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 CONTACT NAME Karen Bronson CorRisk Solutions PHONE PA% 225 W. Washington St. Suite 1560 IEMA L°E"" 312-637-8755 to p.N°. Erp. Chicago, IL 60606 IAnnRESS kbronson@corrisksolutions.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Insurance Company 23841 INSURED I INSURER B: Tom Scharffenberger D/B/A Scharffenberger Land IINsuRERc: Planning & Design 523 17th Avenue IINSURERD: San Francisco, CA 94121 I INSURERE: INSURER F: 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 TYPE OF INSURANCE ADD'L SUER POLICY NUMBER POLICY EFF POLICY EXP I LIMITS LTR INSRD WVD (MMIDDIYYYY) (MMIDDIYYYY) GENERAL LIABILITY I EACH OCCURANCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I CLAIMS MADE OCCUR PREMISES (Ea occurance) I MED EXP (Any one person) DOES NOT APPLY PERSONAL & AND INJURY -- GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG POLICY n PROJECT n LOC AUTOMOBILE LIABILITY DUMBINED SINGLE LIMI I (Ea _ accident) ANY AUTO I BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS DOES NOT APPLY IBODILY INJURY (Par accident) HIRED AUTOS NON -OWNED PRUPER I Y DAMAGE (Per AI ITnft accident) UMBRELLA LAB OCCUR EACH OCCURANCE EXCESS LAB CLAIMS MADE DOES NOT APPLY (AGGREGATE DED I I RETENTION $ WORKERS COMPENSATION STATU_ AND EMPLOYERS' LIABILITY I OWC RY LIMITSI OTHER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT (Mandatory in NH) YIN DOES NOT APPLY I E.L. UISESAE - EA It describe UESGRIPI IUN OF EMPLOYEE yes, under OPERATIONS below E.L. DISEASE - POLICY LIMIT A Professional Liability 064991197- 01/22/19 01/22/20 Per Occurrence: $1,000,000 03 Annual Aggregate: $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACCORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City Of Gilroy, its officers officials and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE y yr THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. employees AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. Allrights reserved. The ACORD name and logo are registered marks of ACORD SCHARFFENBERGER Land Planning & Design March 11, 2019 Mr. Trevin W. Barber City of Gilroy Senior Management Analyst 7351 Rosanna Street Gilroy, CA 95020 Re: Workers' Compensation Insurance Dear Mr. Barber, This letter is to certify that Scharffenberger Land Planning & Design is solely owned and operated by Thomas J. Scharffenberger. Neither Scharffenberger Land Planning & Design, nor I, Thomas J. Scharffenberger, have any employees, and I certify that I am not required by law to carry workers' compensation insurance and have therefore opted not to purchase workers' compensation coverage. Further, I certify that I will ensure all hired subcontractors carry appropriate workers' compensation insurance as required by law. Should I, either individually or dba Scharffenberger Land Planning & Design hire employees in the future, I will immediately notify the City of Gilroy and provide evidence of appropriate workers' compensation insurance. Sincerely, Thoi as J. charffenberger 523 17th Avenue San Francisco, California 94121 TEL/ FAX 415.387.3077 tscharf@pacbell.net CLA # 3487