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HomeMy WebLinkAboutBKF Engineers - Insurance Certificate (2019)AC"R" ® CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD9 ) 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 Dealey, Renton & Associates I PHONE Nancy Ferrick FAX P. O. Box 12675 (A/c. r- Exn: 510-465-3090 I (A.IC. No): 510-452-2193 Oakland CA 94604-2675 ADDRESS: nferrick@dealeyrenton.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Co of Ameri 25674 INSURED BKFENGINE INSURERB: XL Specialty Insurance Co. 37885 BKF Engineers 255 Shoreline Drive, Suite 200 I INSURERC: Redwood City CA 94065-1428 I INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 169937431 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 nic,n wvn POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6808J585363 9/1/2018 9/1/2019 EACH OCCURRENCE cinnnnnn CLAIMS -MADE 1K OCCUR X Cross Liability GEN'L AGGREGATE LIMIT APPLIES PER: POLICYFX] PRO- JECT LOC OTHER: A AUTOMOBILE LIABILITY Y Y BA8J591007 X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED N NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LAB H OCCUR Y Y CUPBJ595006 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION Y UB9K584739 AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below B Professional Liability DPR9927800 DAMAGE TO RENTED I PREMISES (Ea occurrence) $ 1.000,000 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 9/1/2018 9/1/2019 COMBINED SINGLE LIMIT (Ea accident) g 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) 9/1/2018 9/1/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 7/1/2019 9/1/2019 X STATUTE I EERH I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000.000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 7/1/2018 9/1/2019 $5.000,000 per Claim $7,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Monterey Rehabilitation Project. City of Gilroy, its officers, officials and employees are named as Additional Insured for General and Auto Liability as required per written contract or agreement. Insurance is primary per policy form. A Waiver of Subrogation applies to General Liability and Workers' Compensation. 30 Days Notice of Cancellation. The Professional Liability policy is Claims -Made. Professional Liability Retroactive Date: 01/01/1916. 30 Days Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy, Its officers, ACCORDANCE WITH THE POLICY PROVISIONS. officials and employees 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 POLICY NUMBER: 6808J585363 COMMERCIAL GENERAL LIABILITY ISSUED DATE: 7/2/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy„ CA 95020 Location And Description Of Completed Operations Re: Monterey Rehabilitation Project. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional in- sured and included in the "products -completed opera- tions hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 6808J585363 ISSUED DATE: 7/2/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Gilroy, its officers, officials and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 hazards." This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 TRAVELERS) WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00) — 001 POLICY NUMBER: UB9K584739 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 3.00 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization City of Gilroy, its officers, officials and employees DATE OF ISSUE: 7/2/2019 017106 Schedule Job Description THAT ARE PARTIE TO A CONTRACT THIS AGREEMENT, PROVIDED YOU THE LOSS. ST ASSIGN: CA