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HomeMy WebLinkAboutCOI - Ghirardelli Associates, Inc. - Expires 2022-11-15GHIRASS-01 BBOGART ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~' 6/1/2022 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 License# 0757776 CONTACT NAME: HUB International Insurance Services Inc. Fft8,NN~, Ext): (925) 609-6500 I r..e~. No):(925) 609-6550 P. 0. Box 4047 Concord, CA 94524-4047 E-MAIL ADDRESS: INSURERISl AFFORDING COVERAGE NAIC# INSURER A: The Continental Insurance Comoanv 35289 INSURED INSURER B ,American Casualtv Co of Readina PA 20427 Ghirardelli Associates, Inc. INsURER c: National Fire Insurance Comoanv of Hartford 20478 2055 Gateway Place, Suite 470 INSURER D: Continental Casualtv Comoanv 20443 San Jose, CA 95110 INSURER E: 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 ADDL t~,~i POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR "'~D IMM/DDNYYYl IMM/DD/YYYYl A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 f--------~ CLAIMS-MADE [R] OCCUR X C6075689503 11/15/2021 11/15/2022 DAMAGE TO RENTED 1,000,000 PREMISES /Ea occurrencel $ x Ded:O MED EXP /Anv one oersonl $ 15,000 ~ 1,000,000 PERSONAL & ADV INJURY $ ~ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY [R] ~r8r [R] LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY YE~~2~~Rn81NGLE LIMIT $ 1,000,000 X ANY AUTO X BUA6075689498 11/15/2021 11/15/2022 BODILY INJURY /Per oerson\ $ ~ OWNED ~ SCHEDULED ~ AUTOS ONLY ~ AUTOS BODILY INJURY /Per accidentl $ ~ll'r"tPs ONLY ~8ro~~t9 FP~?~tc~leht~AMAGE $ X Ded: 0 $ A UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS-MADE CUE6075689517 11/15/2021 11/15/2022 AGGREGATE $ 10,000,000 OED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION X I ~~f TUTE I I OTH-AND EMPLOYERS' LIABILITY ER Y/N 7033849267 6/1/2022 6/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE □ E,l, EACH ACCIDENT $ 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 D PROFESSIONAL LIAB MCH288376164 6/1/2022 6/1/2023 Per Claim &Aggregate 5,000,000 D PROFESSIONAL LIAB MCH288376164 6/1/2022 6/1/2023 Deductible 150,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Inspection and Labor Compliance Services for FY21 Citywide Pavement Project (GAi Project #19028). City of Gilroy, its officers, officials and employees as Additional Insured as respects General Liability and Auto Liability per attached forms CG2010 1219 and CA2048 1013. Professional Liability Retroactive Date: Full Prior Acts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ~~tU- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD iiiiii,; --- = - CNA CNA PARAMOUNT Additional Insured -Owners, Lessees Or Contractors - Scheduled Person Or Organization 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 CG 20 10 12 19 Page 1 of 2 The Continental Insurance Co. Insured Name: GHIRARDELLI ASSOCIATES, INC. Copyright Insurance Services Office, Inc., 2018 Policy No: 6075689503 Endorsement No: 5 Effective Date: 11/15/2021 CNA CNA PARAMOUNT Additional Insured -Owners, Lessees Or Contractors - Scheduled Person Or Organization Location(s) Of Covered Operations INSPECTION AND LABOR COMPLIANCE SERVICES FOR FY 21 CITYWIDE PAVEMENT PROJECT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to bodily injury or property damage occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 10 12 19 Page 2 of 2 The Continental Insurance Co. Insured Name: GHIRARDELLI ASSOCIATES/ INC. Copyright Insurance Services Office, Inc., 2018 Policy No: 6075689503 Endorsement No: 5 Effective Date: 11/15/2021 Business Auto Policy Policy I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: GHIRARDELLI ASSOCIATES, INC. Endorsement Effective Date: 11/15/2021 Name Of Person(s) Or Organization(s): CITY OF GILROY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. Form No: CA 20 48 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 9; Page: 1 of 1 Underwriting Company: American Casualty Company Of Reading, PA, 151 N Franklin St, Chicago, IL 60606 @ Copyright Insurance Services Office, Inc., 2011 Policy No: BUA 6075689498 Policy Effective Date: 11/15/2021 Policy Page: 70 of 342 POLICY NUMBER: WMC1963569 00 COMMERCIAL AUTO CA990312 0514 THE ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below Endorsement Effective: 4/27/2022 Countersigned By: Named Insured: JT Martin Trucking Inc SCHEDULE I Endorsement Premium $150 A. Section II -Who Is An Insured is amended to include as an "insured" any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed for that "insured". A person's or organization's status as an "insured" under this endorsement ends when your operations for that "insured" are complete. CA990312 0514 Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU TO INCLUDE WAIVER OF SUBROGATION PROVISION AND PRIMARY AND NONCONTRIBUTORY PROVISION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured Status -Ongoing Operations 1. "Section II-Who is an Insured" is amended to provide automatic coverage as an Additional Insured in conformity with the terms and conditions of the CG 20 10 04 13 endorsement, a copy of which is attached hereto and incorporated by reference. Automatic Additional insured coverage provided by this endorsement only applies to the extent permitted by law; and if coverage provided to the additional insured is required by and agreed in writing in a contract or agreement, the insurance afforded such additional insured will not be broader than that which you are required by the contract or agreement, only if such contract agreement is executed by each party prior to the start of your work to provide for such additional insured. B. Additional Insured Status -Completed Operations 1. "Section II-Who is an Insured" is amended to provide automatic coverage as an Additional Insured in conformity with the terms and conditions of the CG 20 37 04 13 endorsement, a copy of which is attached hereto and incorporated by reference. Automatic Additional insured coverage provided by this endorsement only applies to the extent permitted by law; and if coverage provided to the additional insured is required by and agreed in writing in a contract or agreement, the insurance afforded such additional insured will not be broader than that which you are required by the contract or agreement, only if such contract agreement is executed by each party prior to the start of your work to provide for such additional insured. 2. The coverage provided to the additional insured as outlined in paragraph B. Additional Insured Status -Completed Operations does not apply to Any "bodily injury", "property damage" or "personal and advertising injury" arising out of, related to, caused by, or associated with, in whole or in part, to operations and "your work", conducted by you or on your behalf, or work or operations conducted by an unrelated party, involving "residential property". C. Primary and Noncontributory Provision 1. Insurance afforded the Additional insured, when required by written contract or agreement, is primary and noncontributory in the event of an "occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured, or in connection with premises owned by or rented to you. Page 1 of 5 AG 19 60 05 15 D. Waiver of Subrogation Provision 1. "Section IV-Commercial General Liability Conditions Paragraph 8 The Transfer of Rights Of Recovery Against Others To Us" is amended to add the following: We waive any right of recovery we may have against those added as Additional Insured by this endorsement because of payments we make for injury or damage arising out of your ongoing operations or "your work" performed under written contract or agreement with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions and/or negligence of those added as Additional Insured by this endorsement. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. The following are added to SECTION V -DEFINITIONS: "Residential property" means structures intended for use or used for human dwelling, in whole or in part, including but not limited to single family dwellings, multi-family dwellings, townhomes, condominiums, and appurtenant structures. Page 2 of 5 AG 19 60 0515 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations See Terms and Conditions of Coverage on page 1 of All this endorsement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 3 of 5 AG 19 60 05 15 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 4 of 5 AG19600515 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations See Terms and Conditions of Coverage on page 1 This endorsement does not apply to your work on of this endorsement "residential property" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" 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 insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 5 of 5 II MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire, IL 60069 MDG2022 00009927 01 111111 llllll 11 1111l 111111 11111 •111••1111'111 1111•11 111 11 lll,l,III THE CITY OF GILROY ITS OFFICERS AND EMPLOYEES ATTN: CHIEF FOSTER 7351 ROSSANA STREET GILROY CA 95020 0. '" ~ (\J tl I 8 0 0 § 0 0 AGENCY CUSTOMER ID: 570000073826 LOC#: ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Aon Risk services central, Inc. American Medical Response, Inc. POLICY NUMBER see certificate Number: 570093183818 CARRIER I NAIC CODE see certificate Number: 570093183818 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance ... INSURER($) AFFORDING COVERAGE NAIC# INSURER INSURER .,. INSURER INSURER ..,... Page _ of _ I ADDITIONAL POLICIES If a policy below docs not include limit information, refer to the col'l'esponcling policy on the ACORD I certificate form for policy limits. ·- INSR POLICY POLICY ADDL SUBR POLICY NUMBER EFl•'ECTIVJ; EXPIRATION LIMITS L:l'R TYPE OF INSURANCE INSD WVD DAT[\ DATE (MM/DD/YYYY) (MM/DD/YYYY) WORKERS COMPENSATION C N/A SCFC6892O322 03/31/2022 03/31/2023 WI Paid Loss Retro ~ - ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo arf3 registered marks of ACORD