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HomeMy WebLinkAboutSKMBT_C35112070916020USI Northwest 700 NE Multnomah, Suite 1300 Portland, OR 97232 503 224-8390 City of Tiburon Attn: Diane Crane Iacopi 1505 TIBURON BLVD TIBURON CA 94920-2530 JUL -9 2012 Ire, ~ ~k--~ Client#: 835015 ALTAPLAN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/02/2012 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 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 CONTACT NAME: Karen Barry USI Northwest PHONE Ext : 503 299-4340 A/c, No): 610 362-8130 700 NE Multnomah, Suite 1300 E- RIESS: karen.barry@usi.biz Portland, OR 97232 INSURER(S) AFFORDING COVERAGE NAIC # 503 224-8390 INSURER A : Travelers Indemnity Company 25658 INSURED INSURER B : Travelers Property Casualty Ins 36161 Alta Planning and Design, Inc. INSURER C. Hanover Insurance Company 22292 711 SE Grand Avenue Portland, OR 97214 INSURER D : Continental Casualty Company 20443 INSURER E : INSURER F : COVERAGES cFRTIFlrATF NIIMRFR- ow101AKI Ku RRMCD. 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 CONTRACTOR 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. LTRR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY 68086259484 6/01/2012 06/01/201 EACH OCCURRENCE s2,000,000 B X COMMERCIAL GENERAL LIABILITY 680813259331 6/01/2012 06/01/201 PREMISES Ea occur ence $1,000,000 _ CLAIMS-MADE Fx] OCCUR 7 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $2,000 000 GENERAL AGGREGATE , $4 000 000 FEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG , , $4,000,000 PRO - POLICY X JECT LOC $ B AUT OMOBILE LIABILITY BA7A574417 7/01/2012 07/01/201 CO accident SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per accident) ( ) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR CUP8B259933 6/01/2012 06/01/201 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1.000 000 DED X RETENTION $0 . $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WHF918358700 9/01/2011 09/01/201 X WC STATU OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) If E.L. DISEASE - EA EMPLOYEE $1,000,000 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D Professional Liability MCH114135257 7/01/2012 07/01/201 $2,000,000 Per Claim $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Projects as on file with the insured including but not limited to Share the Path Program. City of Tiburon is named as additional insured on general liability policy-see attached endorsement. vL_ri , „ MOM , L_ , wwcn GANGtLLA 1 IUN City of Tiburon Attn: Diane Crane lacopi 1505 Tiburon Blvd. Tiburon, CA 94920 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 (2010/05) 1 of 1 #S7440691 /M7439564 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KAKZP This page has been left blank intentionally: E7 Pt5LICY NUMBER: 6801-81 59331-TIL-12 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680-8B259484-IND-12 ISSUE DATE: 05-07-12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Et~ NAME OF PERSON(S) OR ORGANIZATION(S): PER SCHEDULE ON FILE. PROJECT/LOCATION OF COVERED OPERATIONS: PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for "bod- ily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products-completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services". e. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the addi- tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non-contributory basis,, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such addi- tional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional in- sured when the additional insured is also an addi- tional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the pro- ject, or at the location, shown in the Schedule above, performed by you, or on your behalf, un- der a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal in- jury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include the person or organization shown in the Schedule as an ad- ditional insured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs, and the "personal injury" is caused by an of- fense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. C 777/ Y Page 2 of 2 © 2007 The Travelers Companies, Inc. CG D3 82 09 07 Includes the copyrighted material of Insurance Services Office, Inc., with its permission