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HomeMy WebLinkAboutInsurance Certificate: Carollo Engineers, Inc TE AWRD CERTIFICATE OF LIABILITY INSURANCE 7/4/2024 DA06/29/2 23) 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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE FAX (A/C.No.Ext): (A/C.Nol: Kansas City MO 64112-1906 E-MAIL (816)960-9000 ADDRESS: kcasu@lockton.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: ZurichlAmerican Insurance Company 16535 INSURED CAROLLO ENGINEERS,INC. INSURER B:Travelers Property Casualty Company of America 25674 1472725 2795 MITCHELL DR. INSURER C: Allied World Surplus Lines Insurance Company 24319 WALNUT CREEK CA 94598-1601 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18109112 REVISION NUMBER: XXXXXXX 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 ADDL SUER POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 9730569 07/04/2023 07/04/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 25,000 Y N • 11 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE8-i LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP 9730571 07/04/2023 07/04/2024( t) SINGLE LIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED Y N BODILY INJURY(Per accident) $ XXXXXXX AUTOS ONLY —AUTOS HIRED X PROPERTY DAMAGE ONLY AUTOS ONLY ( accident) $ XXXXXXX DED: COMP/COI=L1,000 B X UMBRELLA LIABX OCCUR CUP-1S956429 07/04/2023 07/04/202 E4� ACHOCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE N N AGGREGATE $ 1,,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION I X I STATUTE OTH- ER A AND EMPLOYERS'LIABILITY Y/N WC 9730570 07/04/2023 07/04/2024 ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N N/A Al E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) I V E.L.DISEASE-EA EMPLOYEE $ 1,000,000 • If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C PROFESSIONAL 0313-9010 07/04/2023 07/04/2024 EACH CLAIM:$2,000,000; LIABILITY N N AGGREGATE:$2,000,000 UNLIMITED PRIOR ACTS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Phase II of the W WTP Disinfection System Upgrade Project-Construction Engineering Services.Carollo Project#:200947.City of Ashland,Oregon,and its elected officials,officers and employees are additional insureds as respects general liability and auto liability,and these coverages are primary and non-contributory,as required by written contract.Thirty(30)days'notice of cancellation by the insurer will be provided to the certificate holder,ten(10)days'notice in the event of nonpayment of premium. CERTIFICATE HOLDER CANCELLATION! See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 18109112 AUTHORIZED REPRESENTATIVE City of Ashland 20 East Main Street I Ashland OR 97520 ®1988-2015 CORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I , Attachment Code : D573119 Certificate ID : 18109112 POLICY NUMBER: 0313-9010 ENDORSEMENT NOTICE OF CANCELLATION TO DESIGNATED ENTITY(IES) Policy No. 0313-9010 Issued to Carollo Engineers, Inc. Issued by Allied World Surplus Lines Insurance Company In consideration of the premium charged, it is hereby agreed that Section VIII. CONDITIONS, Subsection H. is amended to include the following: In the event of cancellation or non-renewal of this Policy,,the Company will provide a thirty-day notice to the entity with whom the Named Insured has agreed, pursuant to a prior written contract, to provide to such entity with a notice of cancellation or non-renewal. Provided, however, that in the event of cancellation for non-payment of premium, the Company shall provide to such entity a ten-day notice of cancellation be ore the effective date of cancellation. In addition, in the event of a reduction in the Limits of Liability of this Policy not resulting from payment of Damages or Defense Expenses, the Company will provide a sixty-day notice to the entity with whom the Named Insured has agreed with;' pursuant to a prior written contract, to provide such entity with a notice of such reduction in limits. As a condition precedent to providing the notices specified above, the Named Insured will provide the Company, within ten (10) business days ofltheCompany's request, the names and addresses of the entities with whom the Named Insured agreed to provide the notices specified above. In the event the Named Insured omits or fails to provide the foregoing information, the Company shall not provide such notices. The Company's failure to provide such notices will riot extend the Policy cancellation date, negate cancellation, non-renewal or reduction in limits, lof this Policy. Nor shall such failure be cause for legal action against the Company. All other terms,conditions and limitations of this Policy shall remain unchanged. CEI Manu(06/23) Attachment Code : D573121 Certificate ID : 18109112 POLICY NUMBER: BAP 9730571 Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written:notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named;Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to;the effective date of such cancellation. C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims,we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and i 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Organization(s): Number of Days Notice: All certificate holders where notice of cancellation is 60 required by written contract with the Named Insured All other terms and conditions of this policy remain unchanged. U-CA-811-A CW(05/10) Attachment Code : D573122 Certificate ID : 18109112 POLICY NUMBER: GLO 9730569 Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A. If we cancel or non-renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written'notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part(s) by written notice to the first Nanied Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement�is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Organization(s): Number of Days Notice: All certificate holders where notice of cancellation is 60 required by written contract with the Named Insured All other terms and conditions of this policy remain unchanged. U-GL-1447-A CW(05/10) Attachment Code : D573124 Certificate ID : 18109112 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR REDUCTION OF INSURANCE ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS A. If we cancel or non-renew this policy by written notice to you for any reason other than nonpayment of premium,we will mail or deliver a copy of such written notice of cancellation or non-renewal to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. ' D. If notice as described in Paragraphs A., B. or C. of this endorsemient is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): All certificate holders where notice of cancellation is 60 required by written contract with the Named Insured All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy No.WC 9730570 Insured CAROLLO ENGINEERS, INC. Insurance Company Zurich American Insurance Company WC 99 06 34 (Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance,Inc.with its permission. Attachment Code : D573125 Certificate ID : 18109112 POLICY NUMBER: BAP 9730571 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 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. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization to whom or which you are required to provide additional insured status or additional insured status on a primary, non-contributory basis, in a written contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by law. f 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. CA 20 48 10 13 Attachment Code : D573129 Certificate ID : 18109112 POLICY NUMBER: GLO 9730569 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Any person or organization, other than an architect, Any Location or project, other than a wrap-up or other engineer or surveyor,whom you are required to add as consolidated insurance program location or project for an additional insured under this policy under a written which insurance is otherwise separately provided to contract mark or written agreement executed prior to you by a wrap-up or other consolidated insurance ' loss. program 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 B. With respect to the insurance afforded to to include as an additional insured the these additional insureds, the following person(s) or organization(s) shown in the is added to Section III — Limits Of Schedule, but only with respect to liability for Insurance: "bodily injury" or"property damage" caused, in whole or in part, by"your work" at the If coverage provided to the additional location designated and described in the insured is required by a contract or Schedule of this endorsement performed for agreement, the most we will pay on that additional insured and included in the behalf of the additional insured is the "products-completed operations hazard". amount ofl insurance: However: 1. Required by the contract or agreement; 1. The insurance afforded to such additional or insured only applies to the extent 2. Available under the applicable Limits of permitted by law; and Insuran,ce. 2. If coverage provided to the additional insured whicheveri is less. is required by a contract or agreement, the insurance afforded to such additional insured This endorsement shall not increase the will not be broader than that which you are applicable Limits of Insurance. required by the contract or agreement to provide for such additional insured. CG20371219 Attachment Code : D573181 Certificate ID : 18109112 POLICY NUMBER: GLO 9730569 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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 Any person or organization, other than an architect, Any Location or project, other than a wrap-up or other engineer or surveyor,whom you are required to add as consolidated insurance program location or project for an additional insured under this policy under a written which insurance is otherwise separately provided to contract or written agreement executed prior to loss. you by a wrap-up or other consolidated insurance program 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect toe liability oor and"bodily injury", This insurance does not apply to "bodily injury" or "property g p advertising property damage"occurring after: injury"caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations on ,behalf of the additional insured(s) at the for the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted other than another contractor or subcontractor by law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 12 19 Attachment Code : D573181 Certificate ID : 18109112 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we Limits of Insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or II CG 20 10 12 19 Attachment Code : D579070 Certificate ID : 18109112 POLICY NUMBER: GLO 9730569 Other Insurance Amendment Primary and Non-Contributory THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1. The following paragraph is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV— Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same"occurrence", offense, claim or"suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. U-GL-1327-B CW(04/13)