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HomeMy WebLinkAboutInsurance Certificate: Carollo Engineers (3) ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDlYYYY) 1/21/2009 PRODUCER Phone: 602-277-6672 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Brown & Brown Insurance of AZ, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE X800 North Central Avenue, Suite 1600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phoenix AZ 85004 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Property Casualty Co532 Carollo Engineers P.C. INSURERB:Great American Insurance Co. 55 3033 N. 44th Street, #101 INSURERc:Farmington Casualty Company Phoenix AZ 85018 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL POLICY EFFECTIVE POLICY EXPIRATION LIMITS POLICYNUMBER DATE M AT MM/ LTR N R P F INSURANCE A GENERAL LIABILITY 6300188B394TIL08 12/31/2008 12/31/2009 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREM ISES Ea occurence $500,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $20,000 X C'nn t ra ~fi u a l PERSONAL &ADV INJURY $1,000.000 GENERAL AGGREGATE $10,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2 000 000 X POLICY ERCOT Loc Professional Excluded AUTOMOBILE UABILITY 810995K5008TIL08 12/31/2008 12/31/2009 COMBINED SINGLE LIMIT A (Ea accident) $1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY fNJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESSIUMBRELLA LIABILITY TUU5 5 9 5 7 9 9 12/3 1/ 2 008 12 /3 1/ 2 00 9 EACH OCCURRENCE $1,000,000 :X :l F-1 CLAIMS MADE AGGREGATE $1,000,000 R DEDUCTIBLE $ X RETENTION $0 $ TORY LIIMITS OTHER A 009 C WORKERS COMPENSATION AND PFUB995K342108 12/31/2008 12/31/2009 EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1 000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE- EA EMPLOYEE $ 1 0 0 0 0 0 0 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 Q 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS dditional Insured applies to General Liability, subject to the conditions of the attached form CGD246 0805. Additional Insured applies to Automobile Liability, subject to the conditions of the attached form CAT301 0299. Re: 2008-08A: Engineering Services - Tap Water Pump Station Site Evaluation & Acquisition Assistance arollo Project 6891B.00 he City of Ashland, Oregon, and its elected officials, officers and employees are listed as additional insureds with espects to General Liability per form CGD2460805 and with respects to Auto Liability per form CAT301 0299. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Ashland WILL MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER 20 East Main Street NAMED TO THE LEFT. (*EXCEPT CANCELLATION FOR NON-PAYMENT OF Ashland OR 97520 PREMIUM: 30 DAYS FOR WORKERS COMPENSATION AND 10 DAYS FOR ALL OTHER POLICIES.) AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) COMMERCIAL GENERAL LIABILITY Policy P630-0188B394-TIL-08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: 4 COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended c) The insurance provided to the additional in- _ to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "property damage" or "personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage - organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is = this Coverage Part shown in the Declarations available to the additional insured for a foss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically „ surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III - Limits Of Insurance. for such loss, and we will not share with that b} The insurance provided to the additional in- "other insurance". But the insurance provided to sured does not apply #o "bodily injury", the additional insured by this endorsement still is y Jury' "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or = of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ante". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: dens or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- ii. rence" or an offense which may result in a Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities, should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 010959 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence" or ante" available to the additional insured offense- which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: S. The following definition is added to SECTION V. i. Immediately record the specifics of the - DEFINITIONS: claim or "suit" and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable- that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or "suit" as person or organization as an additional in- - sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of - the claim or defense against the "suit", and contract or agreement by you; otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and _ fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 C 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL AUTO POLICY NUMBER: P-810-995K5008-TIL-08 ISSUE DATE: 12-1 G-08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Paragraph c. of the WHO IS AN INSURED provision 1. No liability is assumed by that person or organi- includes the person or organization indicated below, zation for the payment of any premiums stated in but only for his, her or its liability because of acts or the policy or earned under the policy. omissions of an "insured" under paragraphs a. or b. of 2. In the event of cancellation of the policy, written that provision, subject to the following additional pro- notice of cancellation will be mailed by us to that - visions: person or organization. Person or Organization Address ANY PERSON OR ORGANIZATION WITH CONTRACT, EXECUTED PRIOR TO LOSS, WHOM YOU HAVE AGREED IN A WRITTEN TO NAME.AS ADDITIONAL INSURED. ' CA T3 01 02 99 Page I of 1