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HomeMy WebLinkAboutOdin Construction Solutions - Insurance Certificate (2020)A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) s/17/2i. 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: Denise Tuck InterWest Insurance Services, LLC I PHONE FAX. -979-7536PO BOX 255188 �1oExt): 916-609-8376 No): 916 L Sacramento CA 95865-5188 I ADDRESS: dtuc4d)iwins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nautilus Insurance Company 17370 INSURED ODINCON-01 INSURER B: Great Divide Insurance Company 25224 Odin Construction Solutions, Inc. dba Odin Engineering I INSURERC: 4740 Rocklin Road I INSURER D : Rocklin CA 95677 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER:1226348519 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 LIMITS LTR Ify$D WVD POLICYNUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y ECP202815210 1/22/2019 1/22/2020 EACH OCCURRENCE It 1 000 000 DAMAGE TO RENTED CLAIMS -MADE F OCCUR I PREMISES (Ea occurrence) $ 300,000 _ I MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 PE0 PRODUCTS COMP/OP 2,000,000 POLICY LOC - AGG $ OTHER: $ B AUTOMOBILE LIABILITY Y _ Y BAP202815410 1/22/2019 1/22/2020 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X CompDed$1000 X CollDed$1000 Hired Auto PhysDamage $ $65,000 A UMBRELLA LIAB OCCUR FFX202815310 1/22/2019 1/22/2020 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $4,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION Y WCA202815510 1/22/2019 1/22/2020 PER I OERH AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE STATUTE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A ❑ (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 A Pollution Liability ECP202815210 1/22/2019 1/22/2020 Pollution Liability $1,000,000 Professional Liability Deductible $25,000 Policy Agg $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) 30 day notice of cancellation and 10 day for non payment of premium per policy provisions RE: (WARP) UVAS Creek Levee Rehabilitation Project Phase 2 Project No 62084001 Contract No. C0648 Certificate holder is Additional Insured as respects Liability per the attached policy forms. The Santa Clara Valley Water District, Its Directors, officers, employees and agents, individually and collectively, City of Gilroy, Pacific Gas and Electric Company, and South County Regional Wastewater Authority CERTIFICATE HOLDER 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. Santa Clara Valley Water District 5750 Almaden Expressway AUTHORIZED REPRESENTATIVE San Jose CA 95118 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 06 07 14 NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS A. If we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or in accordance with the "Number of Days' Notice" indicated in the Schedule below, whichever is longer. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) or Organization(s): Number of Days' Notice Santa Clara Valley Water District 30 5750 Almaden Expressway San Jose, CA 95118 All other terms and conditions of this policy remain unchanged. WC 99 06 06 07 14 Page 1 of 1 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. BUSINESS AUTO — EARLIER NOTICE OF CANCELLATION OR NONRENEWAL SCHEDULE Number of Days Notice: 30 Enter the name and address here: Santa Clara Valley Water District 5750 Almaden Expressway San Jose, CA, 95118 CANCELLATION AND NONRENEWAL For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation or nonrenewal, as provided for in this policy or as amended by an applicable state cancellation or nonrenewal endorsement, is increased to the number of days shown in the Schedule above. Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 BSUM CA 02 02 13 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. NOTICE OF CANCELLATION TO DESIGNATED ENTITIES SCHEDULE Name of Person(s) or Orcianization(s) Santa Clara Valley Water District 5750 Almaden Expressway San Jose, CA 95118 In consideration of an additional premium of $0 and notwithstanding anything contained in the policy to the contrary, it is hereby agreed and understood if the Company cancels this policy on or before the expiration date of the policy, the Company will mail or deliver to the person(s) or organization(s) shown in the schedule above, written notice of cancellation to the address included above not less than 30 days prior to the effective date of cancellation. Proof of mailing of notice shall be sufficient proof of notice. The effective date and hour of cancellation stated in the notice shall be the end of the policy period. This endorsement shall not apply for the following reasons: non-payment of premium, or b. the policy is non -renewed for any reason. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ENV 2217 06 18 Page 1 of 1 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. NOTICE OF CANCELLATION TO DESIGNATED ENTITIES SCHEDULE Name of Person(s) or Oraanization(s) Santa Clara Valley Water District 5750 Almaden Expressway San Jose, CA 95118 In consideration of an additional premium of $0 and notwithstanding anything contained in the policy to the contrary, it is hereby agreed and understood if the Company cancels this policy on or before the expiration date of the policy, the Company will mail or deliver to the person(s) or organization(s) shown in the schedule above, written notice of cancellation to the address included above not less than 30 days prior to the effective date of cancellation. Proof of mailing of notice shall be sufficient proof of notice. The effective date and hour of cancellation stated in the notice shall be the end of the policy period. This endorsement shall not apply for the following reasons: non-payment of premium, or b. the policy is non -renewed for any reason. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ENV 2217 06 18 Page 1 of 1 POLICY# BAP2028154-10 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. BUSINESS AUTO — ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section II — Liability Coverage A. — Coverage, 1. Who is an Insured, is amended to add: d. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into, excluding contracts or agreements for professional services, which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: 1. The coverage and/or limits of this policy; or 2. The coverage and/or limits required by said contract or agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission BSUM CA 06 02 13 Page 1 of 1 POLICY NUMBER: BAP2028154-10 COMMERCIAL AUTO CA04441013 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Odin Construction Solutions Inc. Endorsement Effective Date: 01/22/19 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any Principal wherein such waiver has been included before loss as part of a contractual undertaking by the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 4410 13 © Insurance Services Office, Inc.,2011 Page 1 of 1 Odin Construction Solutions Inc. dba Odin Engineering Policy# ECP2028152-10 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. ADDITIONAL INSURED — BLANKET This endorsement modifies insurance provided under the following: ENVIRONMENTAL COMBINED POLICY In consideration of the premium charged and notwithstanding anything contained in this policy to the contrary, it is hereby agreed and understood that this endorsement shall apply only to the Coverage Part(s) corresponding with the box or boxes marked below. X COVERAGES PARTS A AND B — GENERAL LIABILITY COVERAGE D — CONTRACTORS POLLUTION LIABILITY SECTION III — WHO IS AN INSURED is amended to include as an insured, with respect to Coverage A, B and D, any person(s) or organization(s) when you and such person(s) or organization(s) have agreed in a written contract or written agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such written contract or written agreement must be in effect prior to the performance of your work which is the subject of such written contract or written agreement. Such additional insured status applies only: 1. Under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY for claims or suits resulting from: a. Your work performed for such person(s) or organization(s) in the performance of your ongoing operations for the additional insured; or b. Your work performed for such person(s) or organizations(s) and included in the products -completed operations hazard. 2. Under COVERAGE D CONTRACTORS POLLUTION LIABILITY for claims or suits arising out of pollution conditions that are the result of: a. Your work performed for such person(s) or organization(s) in the performance of your ongoing operations for the additional insured; or b. Your work performed for such person(s) or organizations(s) and included in the products -completed operations hazard. With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those person(s) or organization(s) with which you have so agreed in a written contract or written agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ECP 1004 08 16 Page 1 of 1 Odin Construction Solutions Inc. dba Odin Engineering Policy# ECP2028152-10 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT SCHEDULE Designated Construction Projects: Each of your projects away from premises owned or rented to you, performed during the policy period when a Designated Per Project Aggregate Limit of Insurance is required in a written contractual agreement. A. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under SECTION I — COVERAGE A which can be attributed only to ongoing operations as shown in the schedule above: 1. A separate Designated Construction Project Limit applies to each designated construction project and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations page. Except for damages because of bodily injury or property damage included in the products -completed operations hazard, the Designated Construction Project Limit is the most we will pay for the sum of all damages under SECTION I —COVERAGE A regardless of the number of: a. Insureds; b. Claims made or suits brought; or C. Persons or organizations making claims or bringing suits. 3. Any payments made under SECTION I —COVERAGE A for damages shall reduce the Designated Construction Project Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations page nor shall they reduce any other Designated Construction Project Limit, except as affected by the Designated Construction Project Aggregate Limit described below. 4. The limits shown in the Declarations page for Each Occurrence and Damage to Premises Rented to you continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project Limit. 5. a. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under the Designated Construction Project Limit, described in 1. and 2. above. b. Regardless of the number of construction projects or designated construction projects covered under this policy, the most we will pay as the Designated Construction Project General Aggregate is $5,000,000. B. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under SECTION I —COVERAGE A which cannot be attributed only to ongoing operations as shown in the schedule above: Any payments made under SECTION I —COVERAGE A for damages shall reduce the amount available under the General Aggregate Limit or the Products Completed Operations Aggregate Limit, whichever is applicable; and ECP 1021 10 06 Page 1 of 2 Odin Construction Solutions Inc. dba Odin Engineering Policy# ECP2028152-10 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the products -completed operations hazard is provided, any payments for damages because of bodily injury or property damage included in the products -completed operations hazard will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION IV — LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. ECP 1021 10 06 Page 2 of 2 Odin Construction Solutions Inc. dba Odin Engineering Policy# ECP2028152-10 I, r her valid and collectible insurance is available to the insured for a loss we cover under this policy, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over: (1) Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for your work; (b) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for property damage to premises rented to you or temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, auto or watercraft to the extent not subject to Exclusion d., of Section I - Coverage A - Bodily Injury And Property Damage Liability. (2) Any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured by attachment of an endorsement. When this insurance is excess, we will have no duty under this policy to defend the insured against any suit if any other insurer has a duty to defend the insured against that suit. If no other insurer has the obligation to defend, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self insured retention amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this policy. C. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable Limits of Insurance of all insurers. 7. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. ECPO 1000 06 18 Page 23 of 30 Odin Construction Solutions Inc. dba Odin Engineering Policy# ECP2028152-10 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. WAIVER OF SUBROGATION It is agreed that the Company, in the event of any payment under this policy, waives its right of recovery against any Principal, but only at the specific written request of the Named Insured either before or after loss, wherein such waiver has been included before loss as part of a contractual undertaking by the Named Insured. This waiver shall apply only with respect to losses occurring due to operations undertaken as per the specific contract existing between the Named Insured and such Principal and shall not be construed to be a waiver with respect to other operations of such Principal in which the Named Insured has no contractual interest. No waiver of subrogation shall directly or indirectly apply to any employee, employees or agents of either the Named Insured or of the Principal, and the Company reserves its right or lien to be reimbursed from any recovery funds obtained by any injured employee. This waiver does not apply in any jurisdiction or situation where such waiver is held to be illegal or against public policy or in any situation wherein the Principal against whom subrogation is to be waived is found to be solely negligent. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ENV 2004 06 18 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 04 84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) 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 0.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Any Principal wherein such waiver has been included before loss as part of a contractual undertaking by the Named Insured. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy) Endorsement Effective 01 /22/2019 Insured Odin Construction Solutions Inc. Insurance Company: Great Divide Insurance Company Policy No. Endorsement No. WCA2028155 10 Premium Countersigned by WC 04 03 06 04 84 1998 by the Workers' Compensation Insurance Rating Bureau of California. Page 1 of 1 All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual 2001.