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HomeMy WebLinkAboutSCVTA - Clear Channel - Insurance Certificate (2020)CcOTt ® CERTIFICATE OF LIABILITY INSURANCE DATE 03125/2019 /YYYY) �,,,,,.• 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 MARSH USA Inc. NAME: PHONE FAX 4400 Comerica Bank Center (A/C, No. Extl: (A/C. No): 1717 Main Street E-MAIL Dallas, TX 75201 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 318-GAWU-GAWU-19-20 GAW 1 INSURER A: National Union Fire Insurance Co 19445 INSURED Clear Channel Outdoor, Inc. INSURER B : The Insurance Company of The State of Pennsylvania 19429 & its subsidiaries INSURER C : New Hampshire Ins Company 23841 20880 Stone Oak Parkway INSURER D : Illinois National Insurance Company 23817 San Antonio, TX 78258 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: HOU-003498622-05 REVISION NUMBER: 7 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 LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL5425923 03/31/2019 03/31/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TED CLAIMS -MADE � OCCUR PREM SESO(Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ Excluded _ PERSONAL & ADV INJURY $ 1,000,000 I 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT a LOC I PRODUCTS - COMP/OP AGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY CA4993124 (AOS) 03/31/2019 03/31/2020 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 - A X ANY AUTO CA4993126 (MA) 03/31/2019 03/31/2020 BODILY INJURY (Per person) $ B X OWNED SCHEDULED CA4993125 (PA) 03/31/2019 03/31/2020 I BODILY INJURY (Per accident) $ _ AUTOS ONLY AUTOS X HIRED NON -OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE I AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION WC012717211 (MA ND OH WA WI WY) 03/31/2019 03/31/2020 X I PER I 1OTH- AND EMPLOYERS' LIABILITY D Y / N WC012717213 (FL) 03/3112019 03I31/2020 STATUTE ER 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ if yes, describe under DESCRIPTION OF OPERATIONS below Continued On Next Page E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) REFERENCE: Bus Shelters Certificate Holder is an additional insured for General Liability and Auto Liability, but only to the extent of the liability assumed under written contract. Workers' Compensation coverage is evidenced for employees of the Named Insured only. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Randall Amberg ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 318 LOC #: San Antonio i ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA Inc. Clear Channel Outdoor, Inc. & its subsidiaries POLICY NUMBER 20880 Stone Oak Parkway San Antonio, TX 78258 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation Continued: Carrier: American Home Assurance Company Policy Number: WC012717212 (CA) Effective Date: 03/31/19 Expiration Date: 03/31/20 Carrier: New Hampshire Insurance Company Policy Number: WC012717210 (AZ IL KY NC NH NJ PA VA) Effective Date: 03/31/19 Expiration Date: 03/31/20 Carrier: New Hampshire Insurance Company Policy Number: WC012717209 (CO DE GA MD MI MN NE NM NV NY OR TX) Effective Date: 03/31/19 Expiration Date: 03/31/20 Page 2 of 2 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A`` CO 031252019 ® CERTIFICATE OF LIABILITY INSURANCE DATE /2019 /YYYY) , ' 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 MARSH USA Inc. NAME: 4400 Comerica Bank Center (A/C, No. ,No. Ext): I FAX Noll: 1717 Main Street E-MAIL Dallas, TX 75201 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 318-GAWU-GAWU-19-20 GAW 521 INSURER A: National Union Fire Insurance Co 19445 INSURED Clear Channel Outdoor, Inc. INSURER B : The Insurance Company of The State of Pennsylvania 19429 & its subsidiaries INSURER C : New Hampshire Ins Company 23841 20880 Stone Oak Parkway INSURER D : Illinois National Insurance Company 23817 San Antonio, TX 78258 - INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: HOU-003498745-05 REVISION NUMBER: 9 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 LIMITS LTR IN$D WVD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY GL5425923 03/31/2019 03/31/2020 EACH OCCURRENCE $ 5 000 000 M DAMAGE RETED I $ f 5,000,000 CLAIMS -MADE OCCUR PREM SESO(Ea occurrence) $ MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 5,000,000 PRO- I 5,000,000 POLICY JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY CA4993124 (AOS) 03/31/2019 03/31/2020 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 A X ANY AUTO CA4993126 (MA) 03/31/2019 03/31/2020 I BODILY INJURY (Per person) $ B X OWNED SCHEDULED CA4993125 (PA) 03/31/2019 03/31/2020 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DIED I I RETENTION $ $ C WORKERS COMPENSATION WC012717211 (MA ND OH WA WI WY) 0313112019 03/31/2020 X I PER I 1OTH- AND EMPLOYERSLIABILITY ' p Y / N WC012717213 (FL) 03/31l2019 03131/2020 STATUTE ER 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below Continued On Next Page E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) REFERENCE: Bus Shelters Certificate Holder is an additional insured for General Liability and Auto Liability, but only to the extent of the liability assumed underwritten contract, Workers' Compensation coverage is evidenced for employees of the Named Insured only. Workers' Compensation coverage is evidenced for employees of the Named Insured only. Workers' Compensation coverage is evidenced for employees of the Named Insured only, RE: CCO-OAKLAND, CA - TRANSIT SHELTERS AT VARIOUS LOCATIONS IN THE CITY OF GILROY CERTIFICATE HOLDER City of Gilroy 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 of Marsh USA Inc. ACORD 25 (2016/03) Randall Amberg--- ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 318 LOC #: San Antonio A4 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA Inc. Clear Channel Outdoor, Inc. & its subsidiaries POLICY NUMBER 20880 Stone Oak Parkway San Antonio, TX 78258 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation Continued: Carrier: American Home Assurance Company Policy Number: WC012717212 (CA) Effective Date: 03131/19 Expiration Date: 03/31/20 Carrier: New Hampshire Insurance Company Policy Number: WC012717210 (AZ IL KY NC NH NJ PA VA) Effective Date: 03/31/19 Expiration Date: 03131/20 Carrier: New Hampshire Insurance Company Policy Number: WC012717209 (CO DE GA MD MI MN NE NM NV NY OR TX) Effective Date: 03/31/19 Expiration Date: 03/31/20 Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AoC" 03125/2019 ® CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 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 MARSH USA Inc. NAME: PHONE FAX 4400 Comerica Bank Center (A/C. No. Ext1: (A/C, No): 1717 Main Street E-MAIL Dallas, TX 75201 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 318-GAWU-GAWU-19-20 GAW 1 INSURER A: National Union Fire Insurance Co 19445 INSURED Clear Channel Outdoor, Inc. INSURER B : The Insurance Company of The State of Pennsylvania 19429 & its subsidiaries INSURER C : New Hampshire Ins Company 23841 20880 Stone Oak Parkway INSURER D : Illinois National Insurance Company 23817 San Antonio, TX 78258 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: HOU-003499002-05 REVISION NUMBER: 7 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 LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL5425923 03/31/2019 03/31/2020 I EACH OCCURRENCE $ 1,000,000 FX1 DAMAGE RETE I 1,000,000 CLAIMS -MADE OCCUR PREM SESO(Ea occurrence) $ MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY PRO- [-X ] LOC JECT PRODUCTS - COMP/OP AGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY CA4993124 (AOS) 03/31/2019 03/31/2020 Ea BINEDtSINGLE LIMIT $ 1,000,000 A X ANY AUTO CA4993126 (MA) 03/31/2019 03/31/2020 I BODILY INJURY (Per person) $ B X OWNED SCHEDULED CA4993125 (PA) 03/31/2019 03/31/2020 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION WC012717211 MA ND OH WA WI WY ( ) 03/31/2019 03/31/2020 PER OTH- X I I I AND EMPLOYERS' LIABILITY D Y / N WC012717213 (FL) 03/3112019 0313112020 STATUTE ER 1,000,000 I N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXC EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below Continued On Next Page E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: CCO-OAKLAND, CA - TRANSIT SHELTERS AT VARIOUS LOCATIONS IN THE CITY OF GILROY City of Gilroy, its City Council, comissions, officers, employees, agents and volunteers are additional insured for General Liability and Auto Liability, and such insurance is primary and non-contributory, but only to the extent of the liability assumed underwritten contract, Workers' Compensation coverage is evidenced for employees of the Named Insured only. Workers Compensation is evidenced for employees of the Named Insured Only. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Randall Amberg-- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 318 LOC #: San Antonio I ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA Inc. Clear Channel Outdoor, Inc, & its subsidiaries POLICY NUMBER 20880 Stone Oak Parkway San Antonio, TX 78258 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation Continued: Carrier: American Home Assurance Company Policy Number: WC012717212 (CA) Effective Date: 03/31/19 Expiration Date: 03/31/20 Carrier: New Hampshire Insurance Company Policy Number: WC012717210 (AZ IL KY NC NH NJ PA VA) Effective Date: 03/31/19 Expiration Date: 03/31/20 Carrier: New Hampshire Insurance Company Policy Number: WC012717209 (CO DE GA MD MI MN NE NM NV NY OR TX) Effective Date: 03/31/19 Expiration Date: 03/31/20 In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity (ies) according to the notification schedule shown below: Per the most current schedule maintained by Marsh USA, Inc. and furnished to XL Catlin Insurance no less than 45 days prior to the effective date of cancellation. Number of Days Notice of Cancellation: 30. Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD