Loading...
HomeMy WebLinkAboutDewberry Architects - Insurance Certificate (2020)AC40R "® CERTIFICATE OF LIABILITY INSURANCE I DATE /YWY) 09125/201/2019 9 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 I CONTACTNAME: Molly Koch MARSH USA, INC. 1050 CONNECTICUT AVENUE, SUITE 700 I PHONE 202-263-6732 FAX (A p. Ext): (A/C. No): WASHINGTON, DC 20036-5386 E• )" ADDRESS: molly koch marsh.com INSURER(S) AFFORDING COVERAGE NAIC # CN102736896-7/1-1.1a-19-20 GAWU I INSURER A : Charter Oak Fire Insurance Company 25615 INSURED I DEWBERRY ENGINEERS INC. INSURER B : Travelers Indemnity Cc 25658 1760 CREEKSIDE OAKS, SUITE 280 I INSURER C : Travelers Property Casually Co. Of America 25674 SACRAMENTO, CA 95833 I INSURER D : Beazlev Insurance Company, Inc. 37540 INSURER E : Lloyd's Of London 1128623 INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006482907-03 REVISION NUMBER: 4 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ADDLSUBR POLICY EFF POLICY EXP LIMITS (MMIDDM(W) (MM/DD/YYW) A X COMMERCIAL GENERAL LIABILITY 630-7792B312-COF-19 07/01/2019 07/01/2020 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED CLAIMS -MADE OCCUR I PREMISES (Ea occurrencel $ 1,000,000 X CONTRACTUAL INS. COV. IVIED EXP (Any one person) $ 10,000 (INSURED CONTRACTS) I PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO ❑LOC 2,000,000POLICY JECT OTHER: $ B AUTOMOBILE LIABILITY 810-11\1788974-19-43-G 07/01/2019 07/01/2020 COMBINED SINGLE LIMIT $ (Ea accident) 2,000,000 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) COMP / COLL DED: $ 1,000 L X UMBRELLALIAB OCCUR CUP-4J580377-19-43 07/01/2019 07/01/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE I AGGREGATE $ 5,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION PKUB-1722B67-3-19 07/01/2019 07/01/2020 X I PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑N N /A I E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMB ER EXCLUDED'? (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,000 D PROFESSIONAL LIABILITY V11B5E191001 07/01/2019 07/01/2020 PER CLAIM/AGGREGATE 2,000,000 E EXCESS PROF. LIABILITY FINPA1900103 07/01/2019 07/01/2020 PER CLAIM/AGGREGATE $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: CITY OF GILROY RENOVATION. DEWBERRY PROJECT/JOB/PLN # 50118429, BU 8890. CITY OF GILROY PROJECT NO. 19-RFP-PW-429. CITY OF GILROY, ITS OFFICERS, AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECT TO THE GENERAL LIABILITY, AUTO LIABILITY, AND UMBRELLA POLICIES. THE GENERAL LIABILITY POLICY COMPLIES WITH THE PROVISIONS OF THE STANDARD ISO ENDORSEMENT FORMS FOR ONGOING AND COMPLETED OPERATIONS. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Altn:Julie Oates THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosnna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102736896 LOC #: Washington A�oRo® ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA, INC. DEWBERRY ENGINEERS INC. 1760 CREEKSIDE OAKS, SUITE 280 POLICY NUMBER SACRAMENTO. CA 95833 CARRIER NAIC CODE 1 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Other Limits PROF. LIABILITY SIR $1,000,000: RETRO. DATE: FULL PRIOR ACTS: AS RESPECTS THE GENERAL LIABILITY, AUTOMOBILE LIABILITY, UMBRELLA LIABILITY, AND WORKERS' COMPENSATION COVERAGES EVIDENCED ABOVE, NOTICE OF CANCELLATION WILL BE PROVIDED BY THE INSURER(S) TO THE CERTIFICATE HOLDER PER THE ATTACHED AS REQUIRED BY WRITTEN CONTRACT. Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: P-630-7792E312-COF-1 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 10-07-19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULED ADDITIONAL INSURED - WRITTEN CONTRACT (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA STREET GILROY, CA 95020 PROJECT/LOCATION OF COVERED OPERATIONS: DESIGN SERVICES, GILROY, CA 95020 9 1 a41TAMI M 1. The following is added to SECTION II — WHO IS AN INSURED: The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is limited as follows: c. In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the limits of insurance described in Section III — Limits Of Insurance. d. This insurance does not apply to the render- ing of or failure to render any "professional services" or construction management errors or omissions. e. This insurance does not apply to "bodily in- jury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifi- cally requires you to provide such coverage for that additional insured, and then the insur- ance provided to that additional insured ap- plies only to such "bodily injury" or "property damage" that occurs before the end of the pe- riod of time for which the "written contract re- quiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. CG D416 05 08 © 2008 The Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY 2. The following is added to Paragraph 4.a. of SEC- TION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured shown in the Schedule above is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this in- surance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this in- surance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But this insurance provided to the additional in- sured still is excess over any valid and collectible "other insurance", whether primary, excess, con- tingent or on any other basis, that is available to the additional insured when that person or or- ganization is an additional insured under any "other insurance". 3. The following is added to SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS: Duties Of An Additional Insured As a condition of coverage provided to the addi- tional insured: The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: L How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against the additional insured, the additional insured must: L Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and oth- erwise comply with all policy conditions. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of other insurance which would cover the additional insured for a loss we cover. However, this condition does not affect whether this insurance provided to the addi- tional insured is primary to that other insur- ance available to the additional insured which covers that person or organization as a named insured. 4. The following is added to the DEFINITIONS Sec- tion: "Written contract requiring insurance" means that part of any written contract or agreement with the person or organization shown in the Schedule above, under which you are required to include that person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agree- ment is in effect; and C. Before the end of the policy period. Page 2 of 2 © 2008 The Travelers Companies, Inc. CG D4 16 05 08 TRA1/ELERSk WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 06 R4100) POLICY NUMBER: (PYUB-1722B67-3-19) NOTICE OF CANCELLATION OR NONRENEWAL TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX — CONDITIONS: Notice Of Cancellation Or Nonrenewal To Designated Persons Or Organizations If we cancel or non -renew this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation or non -renewal to each person or organization designated in the Schedule below, We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation or nonrenewal to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation or nonrenewal. SCHEDULE Number of Name and Address of Designated Persons or Organizations: Days Notice ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN 30 CONTRACT THAT NOTICE OF CANCELLATION OR NON RENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NON RENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. DATE OE ISSUE: 06-17-19 STASSIGN: Page 1 of 3 9 2013 The Travelers Indemnity Company. All rights reserved. POLICY NUMBER: 810-1N788974-19-43-G COMMERCIAL AUTO ISSUE DATE; 06-03-19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VIRGINIA BLANKET CANCELLATION AND NONRENEWAL NOTICE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM In the event of cancellation or nonrenewal or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or nonrenewal or material change to: SCHEDULE Any person or organization to whom you have agreed to under any contract or agreement that notice of cancellation or material limitation of this policy will be given, but only if: 1. You send us a written request to provide such notice, including the name and address of such person or organization, after the first Named Insured receives notice from us of the cancellation or nonrenewal or material change of this policy; and 2, We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement. 3. Number of days advance notice: Cancellation for nonpayment of premium: Days Cancellation other than nonpayment of premium: 30 Days Nonrenewai: Days Material change: Days Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA F2 36 04 17 0 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. Effective date of this Endorsement: 01-Jul-2019 This Endorsement is attached to and forms a part of Policy Number: V11 B5E191001 Beazley Insurance Company, Inc. referred to in this endorsement as either the "Insurer" or the "Underwriters" DEWBERRY NOTICE OF CANCELLATION TO CERTIFICATE HOLDER This endorsement modifies insurance provided under the following: ARCHITECTS AND ENGINEERS PROFESSIONAL LIABILITY INSURANCE POLICY In consideration of the premium charged for the Policy, it is hereby understood and agreed that in addition to the provisions of the Cancellation section of the Conditions, if this policy is cancelled by us, other than for non-payment of premium, we will provide 30 days written notice to the following party(ies): As per list to be provided by the Named Insured or its Broker of Record. All other terms and conditions of this Policy remain unchanged. riz' Representative EDBO05NYFTZ 032011 ed. Class Code: 2-141 S0 Page 1 of 1 POLICY NUMBER: CUP-4J583077-19-43 ISSUE DATE: 06/19/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 Of 1