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HomeMy WebLinkAboutInsurance Certificate: Carollo Engineers Inc /"1 AC o° CERTIFICATE OF LIABILITY INSURANCE7/4/2021 DATE(MM2020 IDD/YYYY) 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 S CONTACT 444 W.47th Street,Suite 900 PHONE ON(V,Ext): FAX No): Kansas City MO 64112-1906 E-MAIL (816)960-9000 ADDRESS: INSURER(S1 AFFORDING COVERAGE NAIC# INSURER A: Zurich American Insurance Company 16535 INSURED CAROLLO ENGINEERS,INC. INSURER B: Travelers Property Casualty Co of America 25674 1472725 2795 MITCHELL DR. WALNUT CREEK CA 94598-1601 INSURER C: American Guarantee and Liab.Ins.Co. 26247 INSURER D: Continental Casualty Company 20443 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16714064 I 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LIMITS A x-COMMERCIAL GENERAL LIABILITY Y N GLO 97305697/4/2020 7/4/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISESO(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 25,000 I PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 2,000,000 poucyn ofn LOC OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y N BAP 9730571 7/4/2020 7/4/2021 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS 1 BODILY INJURY(Per accident $ XXXXXXX_ X AUTOS ONLY X AUUTOS ONLYY PROPERTY DAMAGE $ XXXXXXX (Per accident) I DED: COMP/COLL $ 1,000 B X UMBRELLA LIAB X OCCUR Y N ZUP-81N3080A-20-NF 7/4/2020 7/4/2021 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ XXXXXXX A WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N N WC 9730570 7/4/2020 7/4/2021 X STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE nN/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION uOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D PROFESSIONAL N N AEH 288354410 7/4/2020 7/4/2021 EACH CLAIM:$2,000,000; LIABILITY 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) WWTP Disinfection System Upgrade.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. 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. 16714064 AUTHORIZED REPRESENTATIVE City of Ashland 20 E.Main St. Ashland OR 97520 ACORD 25(2016/03) ©19 8-2015 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD CONTINUATION DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS(Use only if more space is required) The excess liability is considered follow form over the general liability,auto liability and employer's liability subject to the policy terms, conditions and exclusions.Professional Liability Deductible: $400,000. ACORD 25(2016/03) Certificate Holder ID:16714064 Attachment Code:D573119 Certificate ID : 16714064 PROFESSIONAL LIABILITY AND POLLUTION INSURED: Carollo Engineers,Inc. INCIDENT LIABILITY INSURANCE POLICY POLICY:AEH 288354410 EFFECTIVE: 7/4/2020 NOTICE ENDORSEMENT- CANCELLATION OR NON-RENEWAL We agree with you that your Policy is amended to include the following additional provisions. 1.Your Policy will not be: Canceled by us until we provide at least: 10 days prior written notice if we cancel your Policy for Non-payment of Premiums; 30 days prior written notice if we cancel your Policy for the following reasons: any reason other than non-payment of premiums Non-renewed by us until at least days prior written notice is given to the person or entity named in 2 below. 2. Person or Entity: 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 and expires concurrently with said Policy unless another effective date is shown above. Attachment Code :D573121 Certificate ID : 16714064 Notification to Others of Cancellation,~ Nonrenewal or Reduction of Insurance Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. j Producer No. Add'I.Prem Return Prem. BAP 9730571 7/4/2020 7/4/2021 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 writtennotice 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 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)/ Number of Days Notice: Organization(s): All certificate holders where notice of cancellation is I 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) Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Attachment Code:D573122 Certificate ID : 16714064 Notification to Others of Cancellation,'I Nonrenewal or Reduction of Insurance Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I.Prem Return Prem. GLO 9730569 7/4/2020 7/4/2021 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 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(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 endorsementis 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. U-GL-1447-A CW(05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Attachment Code:D573124 Certificate ID : 16714064 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 ororganization 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 endorsement 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.) Endorsement Effective Policy No.WC 9730570 Endorsement No. Insured CAROLLO ENGINEERS, INC. Premium$ 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. Page 1 of 1 Attachment Code:D573129 Certificate ID : 16714064 POLICY NUMBER: GLO 9730569 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 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 to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage" caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. 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 CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 Wolters Kluwer Financial Services I Uniform FormsTM Attachment Code:D573129 Certificate ID : 16714064 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III—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. Page 2 of 2 ©ISO Properties, Inc., 2004 CG 20 37 07 04 0 Attachment Code:D573125 Certificate ID : 16714064 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. Named Insured: American Guarantee and Liab. Ins. Co. Endorsement Effective Date: 7/4/2020 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. 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 ©Insurance Services Office, Inc., 2011 Page 1 of 1 Wolters Kluwer Financial Services I Uniform FormsTM