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HomeMy WebLinkAboutCity of Gilroy Insurance Certificate and EndorsementSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/17/2022 Beecher Carlson Insurance Services 21650 Oxnard Street, Suite 1600 Woodland Hills, CA 91367 404-460-1400 770-870-3043 www.beechercarlson.com ACE American Insurance Company 22667 Indian Harbor Insurance Company 36940 XL Specialty Insurance Company 37885 Lloyd's of London (Hiscox)N/A A 1,500,000XSL G27630911 10/1/2021 10/1/2022 1,500,000 3 0 3 1,500,000 3 SIR: $500,000 2,000,000 2,000,000 A ISA H08875509 10/1/2021 10/1/2022 2,000,000 3 Auto Physical Damage Self Insured3Ded: $500,000 B RES5000612-01 10/1/2021 10/1/2022 3,000,00033 3,000,0003 C RWE5000442-07 10/1/2021 10/1/2022 3 2,000,000N 2,000,000 SIR: $2,000,000 2,000,000 D Umbrella Liability PN2100870 10/1/2021 10/1/2022 Beecher Carlson Insurance Services, LLC Beecher Carlson Insurance Services 3 Each Occurrence Aggregate $5,000,000 $5,000,000 Recology South Valley 1351 Pacheco Pass Highway Gilroy CA 95020 69773125 3 3 DESIGNATED ENTITY where required by written contract, but only as respects liability arising out of work performed by or on behalf of the insured. cancellation (10 days for non-payment of premium) to first named insured. Copies of said notices will be provided to certificate holder. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 If additional insured (ADDL INSR) and/or subrogation waived (SUBR WVD) boxes are checked, applicable blanket policy endorsements apply in favor of the Additional Condition(s) as required by written contract: Primary/Non-Contributory status (GL); Policy provisions include 30 days notice of DESIGNATED ENTITY: City of Gilroy and its public officials, officers, employees and agents 69773125 | 21-22 Liability | Robert Schwartz | 8/17/2022 4:43:36 PM (PDT) | Page 1 of 1 DocuSign Envelope ID: 6A0B5976-18AD-4DE8-A497-C41A9127CEDF 1 XS-6W25b (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Named Insured Recology Inc. Endorsement Number 3 Policy Symbol XSL Policy Number G27630911 Policy Period 10/01/2021 to 10/01/2022 Effective Date of Endorsement Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization:Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1.In the performance of your ongoing operations; or 2.In connection with your premises owned by or rented to you. 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 III – Limits Of Insurance And Retained Limit: 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. Authorized Representative DocuSign Envelope ID: 6A0B5976-18AD-4DE8-A497-C41A9127CEDF 1 XS-20288a (05/14)©Chubb. 2016. All rights reserved.Page 1 of 1 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS Named Insured Recology Inc. Endorsement Number 56 Policy Symbol XSL Policy Number G27630911 Policy Period 10/01/2021 to 10/01/2022 Effective Date of Endorsement Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY Schedule Organization Additional Insured Endorsement Any additional insured with whom you have agreed to provide such non- contributory insurance, pursuant to and as required under a written contract executed prior to the date of loss (If no information is filled in, the schedule shall read: “All persons or entities added as additional insureds through an endorsement with the term “Additional Insured” in the title) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IV.4: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the “Additional Insured”) for a loss we cover under this policy, this insurance will apply to such loss and is primary (subject to satisfaction of the “retained limit”), meaning that we will not seek contribution from the other insurance available to the Additional Insured. Your “retained limit” still applies to such loss, and we will only pay the Additional Insured for the “ultimate net loss” in excess of the “retained limit” shown in the Declarations of this policy. Authorized Representative DocuSign Envelope ID: 6A0B5976-18AD-4DE8-A497-C41A9127CEDF 1 XS-6W34a (02/20)Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured Recology Inc. Endorsement Number 69 Policy Symbol XSL Policy Number G27630911 Policy Period 10/01/2021 to 10/01/2022 Effective Date of Endorsement Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization:Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this policy. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. All Other Terms And Conditions Remain Unchanged. Authorized Representative DocuSign Envelope ID: 6A0B5976-18AD-4DE8-A497-C41A9127CEDF UMR: B0180PN2100870 http://PortalGXB/Sites/RKH_44/LIVE/Documents/Quote/QuoteSlip/QPN2100870_QuoteSlip_PN.docx Page 53 of 61 ENDORSEMENT 27: WORDING AMENDATORY ENDORSEMENT: Damage to Property Exclusion It is understood and agreed that Section IV EXCLUSIONS, Paragraph E “Damage to Property”, Item 2 is deleted in its entirety. All other terms & conditions remain unchanged. ENDORSEMENT 28: WORDING AMENDATORY ENDORSEMENT: Additional Insured Required by Written Contract This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization: Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 in surance 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 III – Limits Of Insurance And Retained Limit: 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 ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. ENDORSEMENT 29: 33 H I S DocuSign Envelope ID: 6A0B5976-18AD-4DE8-A497-C41A9127CEDF UMR: B0180PN2100870 http://PortalGXB/Sites/RKH_44/LIVE/Documents/Quote/QuoteSlip/QPN2100870_QuoteSlip_PN.docx Page 42 of 61 ENDORSEMENT 13: LEAD EXCLUSION ENDORSEMENT This policy is amended as follows: Section IV. EXCLUSIONS is amended to include the following additional exclusion: Lead This insurance does not apply to any liability arising out of lead or the lead content of products. It is understood that to the extent any coverage may otherwise be provided under this policy or any of its endorsements, the provisions of this exclusion will supersede. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. ENDORSEMENT 14: WAIVER OF SUBROGATION (BLANKET) It is agreed that we, in the event of a payment under this policy, waive our right of subrogation against any person or organization where the insured has waived liability of such person or organizati on as part of a contractual agreement between the insured and such person or organization entered into prior to the Occurrence or offense. All other terms and conditions remain unchanged. ENDORSEMENT 15: PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABLITY POLICY Provided that the contract requiring that the additional insured be added to this insurance also requires that this insurance be primary and non -contributory with respect to any other insurance carried by the additional insured, then notwithstanding any other provisions of this policy to the contrary, including, Paragraph M., Other Insurance of SECTION V - CONDITIONS, with respect to any additional insured who is added through the provisions of subparagraph F.7 of SECTION VI - DEFINITIONS or as may be shown in the above Schedule, insurance provided under this policy shall be primary and non-contributory with respect to any other insurance providing coverage to the additional insured, other than Scheduled Underlying Insurance. All other terms and conditions of the policy remain the same. 33 H I S DocuSign Envelope ID: 6A0B5976-18AD-4DE8-A497-C41A9127CEDF