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HomeMy WebLinkAboutCertificate of Insurance 2018 (2)LEABR-1 l"�7�I�11i►P A4C "M® �.... - CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/MY) 66126/2016 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(les) 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 925-482-1000 CONTACT Certificates Department Legacy Risk & Insurance Svcs CA License #OH66758 1850 Mt. Diablo Blvd, Ste #400 Walnut Creek, CA 94596 PHONE 925-482-1000 FAX 925-482-1001 (A/C, No, Ext): (AIC, No): MAI E -L , Certificates le risk.net gaC y INSURERS AFFORDING COVERAGE NAIC # 6072482937 INSURER A: Continental Insurance Co 35289 0710112019 INSURED Lea & Braze Engineering, Inc. INSURER B; American Casualty Company 20427 2495 Industrial Parkway West Hayward, CA 94545-5037 INSURER C ; Insurance Co. of The West 27847 INSURER D ; Underwriters of Lloyd's 15792 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVlclnld Nu MBER• 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 LTR TYPE OF INSURANCE ADDL D SUBR WVD POLICY NUMBER POLICY EFF DDfYYYY) POLICY EXP (MMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 6072482937 07/0112018 0710112019 EACH OCCURRENCE $ 1,000,000 IAMA13ETORENTED 100,000 E SES TLoccu ence $ MED EXP (Anyoneperson) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY Ee aBcld D SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 6072482940 07/0112018 07/0112019 BODILY BODILY INJURY Per accident $ Oe�aCcident AMAGE $ X Ep AUT OS ONLY X AUTOS OR $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WPL504193000 07/0112018 07/01/2019 X PTATUTE EOR H E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liab ANE165796117 12/3112017 1213112018 Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Project #2180461 -SU. RE: Altamont Road- Los Altos Hills, California 94022. The Town of Los Altos Hills, Its elective and appointed officers, empployass, and volunteers as addltlonals insureds with respects to General liability. 30 day notice of cancellation applies to GL, Auto and WC. LOSALTO Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED Is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, 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: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. Il. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10-01 edition of CG2037; or B. additional insured coverage with "arising out of" language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph 1. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Page 1 of 2 Policy No: 6072482937 Endorsement No: 2 Effective Date: 7/1/2018 Insured Name: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. C1.'7c1 Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this Insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1, primary and non-contributing with other Insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the Investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph (4) does not apply to Insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. Vil. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GNA75079XX (10-16) Page 2 of 2 Policy No: 6072482937 Endorsement No: 3 Effective Date: 7/1/2018 Insured Name: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CERTIFICATE OF COVERAGE DATE(MM/DD YYYY) 12/7/2017 PRODUCER Alliant Insurance Services, Inc. 100 Pine Street, 11th Floor San Francisco CA 94111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PROGRAMS BELOW. PROGRAM AFFORDING COVERAGE COVEREDPARTY West Bay Sanitary District 500 Laurel St Menlo Park CA 94025 A: CSRMA - California Sanitation Risk Management Auth B: c: D: E: COVERAGES THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE COVERAGE PERIOD SHOWN BELOW, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED BY THE PROGRAM DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM(S) OF COVERAGE. THE FOLLOWING COVERAGE IS IN EFFECT. PRO LTR COVERAGE MEMORANDUM OF COVERAGE EFFECTIVE DATE (MM/DD/YYYY) EXPIRATION DATE (MMIDD/YYYY) LIMITS A GENERAL LIABILITY CSL WBSD 1718 1 12/31/2017 12/31/2018 EACHOCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMSMADE M OCCUR DAMAGE TORENTED PREMISES fEa occur. $2,000,000 MED. EXP (Anyone person) $2,000,000 X Ded$25,000 PERSONAL&ADV INJURY $2,000,000 GENERALAGGREGATE $ N/A GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $N/A -XI POLICY1-1 PROJECT LOC A AUTOMOBILE LIABILITY CSL WBSD 17181 12/31/2017 12/31/2018 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 2,000,000 X ALL OWNED VEHICLES BODILYINJURY SCHEDULEDAUTOS (Perperson) $ X HIREDAUTOS BODILYINJURY X NON-OWNEDAUTOS (Peracddent) $ X I Ded: $25,000 PROPERTYDAMAGE (Peracddent) $ GARAGELIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY WC STATU TORYDMITS OT ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/ EXECUTIVE/O F FI CERIMEM BER E.L. DISEASE -EA EMPLOYEE $ EXCLUDED? IF YES, DESCRIBE UNDER SPECIAL E.L. DISEASE -POLICY LIMIT $ PROVISIONS BELOW OTHER OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Town of Los Altos Hills is named as an Additional Covered Party per the Memorandum of Coverage with respect to Maintenance Services Agreement between the Town of Los Altos Hills and West Bay Sanitary District. Copies of the Memorandum of Coverage are available upon request. CERTIFICATE HOLDER CANCELLATION Town of Los Altos Hills Public Works Director 26379 Fremont Road Los Altos Hills CA 94022 SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING PROGRAM AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGRAM AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �,. ..v- CALIFORNIA SANITATION RISK MANAGEMENT AUTHORITY ADDITIONAL COVERED PARTY ENDORSEMENT This Endorsement forms a part of the Memorandum of Coverage issued by the CALIFORNIA SANITATION RISK MANAGEMENT AUTHORITY. ADDITIONAL COVERED PARTY: Town of Los Altos Hills CSRMA MEMBER ENTITY: West Bay Sanitary District DESCRIPTION OF ACTIVITY: Maintenance Services Agreement between the Town of Los Altos Hills and West Bay Sanitary District DATE(S) OF ACTIVITY: 12/31/2017 - 12/31/2018 LOCATION OF ACTIVITY: Town of Los Altos Hills MAXIMUM COVERAGE LIMIT: $2,000,000 DEDUCTIBLE: $25,000 The person or organization first named above is added as an ADDITIONAL COVERED PARTY pursuant to Section III(A), "Definitions" and Section VII, "Covered Parties." Coverage is provided through participation in a risk sharing joint powers authority, for general and automobile liability as defined in the Memorandum of Coverage. The coverage being provided by this Endorsement is limited to "occurrences" arising out of the activity or location described, and the time period indicated herein, and is subject to all the terms, conditions and exclusions of the Memorandum of Coverage. Pursuant to Section III (A), the person or entity named above is only an Additional Covered Party with respect to operations performed by or on behalf of the CSRMA MEMBER ENTITY, or facilities owned or used by the CSRMA MEMBER ENTITY. Coverage is in effect for the DATE(S) OF ACTIVITY indicated above and will not be cancelled or allowed to expire at a date other than the last date indicated except upon 30 days' written notice to the Additional Covered Party. Date issued: 12/07/2017 Authorized Representative