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HomeMy WebLinkAboutSKMBT_C35113022514240STETS-1 OP ID: RB CERTIFICATE OF LIABILITY INSURANCE 02/18/2 YYYY) DATE 02/18/2013 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 endorsements . PRODUCER Phone: 408-241-0014 CONTACT NAME: InsPro- Jim Lohmann x105-(A&E) Fax: 408-241-0037 Insurance Services PHONE FAX A/C No Ext : A/C No : 4020 Moorpark Avenue, #104 E-MAIL ADDRESS: San Jose, CA 95117 Rhonda Buck INSURERS AFFORDING COVERAGE NAIC # INSURER A : U.S. Specialty Insurance Co. INSURED Stetson Engineers, Inc. INSURER B : Valle Forge Insurance Company 2171 E. Francisco Blvd, Ste. K S R f l CA INSURER C : Transportation Insurance Co. an a ae , 94901 INSURER D : Continental Casual Company INSURER E : Twin CI Fire Ins Co. INSURER F COVERAGES CERTIFICATE NUMBER.: REVISION NUMBER: 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 SUB POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 C X COMMERCIAL GENERAL LIABILITY 2099943204 03/07/2013 07/01/2013 DAMAGE TO RENTED PREMISES Ea occurrence 300,000 $ CLAIMS-MADE a OCCUR MED EXP (Any one person) $ 10,0001 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ B X ANY AUTO 2099943218 03/07/2013 07/01/2013 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident t $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 D X EXCESS LIAB CLAIMS-MADE 2099445066 03/07/2013 07/01/2013 AGGREGATE $ 3,000,00 DED X RETENTION $ 0 $ WO RKERS COMPENSATION X WC STA IT- OTH- AND EMPLOYERS' LIABILITY E ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N / OFF E F-1 N/A 57WECZX9384 07/01/2012 07/0112013 E.L. EACH ACCIDENT $ 1,000,00 IC R MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE - - $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below F E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Professional Liab US 05 10141 07 01/01/2013 07/01/2014 ea. Claim 2,000,00 Retro Date 1/1/97 DEDUCTIBLE $75,000 aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder is additional insured as required by written contract with respect to operations of the named insured per form SB300176B and CA20480299. Waiver of subrogation per attached WC990303B. CERTIFICATE HOLDER rANCF1 I eTInN TOWNO-5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Tiburon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Curran 1505 Tiburon Boulevard Tiburon, CA 94920 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2099943218 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS 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" 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: Stetson Engineers Inc. Policy Term: March 7, 2013 to July 1, 2013 SCHEDULE OF PERSON(S) or ORGANIZATION(S): Any Person or Organization as required by written contract. (if no entry appears above, information required to complete this endorsement will be shown in the declarations as applicable to the endorsement.) Each person or organization shown in the schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc. 1998 Page 1 of 1 SB-300176-B IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C., OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS COMPLETED OPERATIONS COVERAGE & BLANKET WAIVER OF SUBROGATION The following is added to Section C. WHO IS AN INSURED: A. The Businessowners Liability Coverage Form is amended to include as an insured any person or organization whom you are required to add as additional insured on this policy under a written contract or written agreement; but the written contract or written agreement must be: 1) Currently in effect or becoming effective during the term of this policy; and 2) Executed prior to the "bodily injury" , "property damage" or "personal and advertising injury". B. The insurance provided to the additional insured is limited as follows: 1. That person or organization is an additional insured solely for liability due to your negligence specifically resulting from "your work" for the additional insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole negligence of the additional insured. 2. The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of, and not in addition to the limits of insurance shown in the declarations. 3. The coverage provided to the additional insured within this endorsement and section titled LIABILITY AND MEDICAL EXPENSE DEFINITIONS - Insured Contract (Section F 9) within the Businessowners Liability Coverage Form, does not apply to "bodily injury" or "property damage" arising out of the "products-completed operations hazard" unless required by written contract or written agreement. 4. The insurance provided to the additional insured does not apply to "bodily injury," "Property damage" "personal and advertising injury" arising out of an architects, engineers, or surveyors rendering of or failure to render any professional services including: a) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications by any architect, engineer or surveyor performing services on a project of which you serve as construction manager or; b) Inspection, supervision, quality control, engineering or architectural services done by you on a project of which you serve as construction manager. 5. This insurance does not apply to "bodily injury" "property damage" or "personal and advertising injury" arising out of. a) The construction or demolition work while you are acting as a construction or demolition contractor. This exclusion does not apply to work done for or by you at your premises. C. BUSINESSOWNERS GENERAL LIABILITY CONDITIONS - Duties In The Event of Occurrence, Offense, Claim or Suit (Section E2.) of the Businessowners Liability Coverage Form is amended to add the following: An Additional Insured under this endorsement will as soon as practicable: 1. Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance. 2. Tender the defense and indemnity of any claim or "suit" to us for a loss we cover under this coverage part. 3. Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this coverage part and 4. Agree to make available any other insurance which the additional insured has for a loss we cover under this coverage part. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. D. OTHER INSURANCE (Section H. 2 &J") of the Business~iowners Common Policy Conditions are deleted and replaced with the following: 2. This insurance is excess over any other insurance naming the additional insured as an insured whether primary excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance is excess over any other insurance to which the additional insured has been added as an additional insured by endorsement. 3. When this insurance is excess, we will have no duty under Coverage A or B to defend the additional insured against any "Suit" if any other insurer has a duty to defend the additional insured against that "Suit" if not other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of. (A) The total amount that all such other insurance would pay for the loss in the absence of this insurance and (B) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance Provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. E. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (Section K.2) of the Businessowners Common Policy Conditions is deleted and replaced with the following: 2. We waive any right or recovery we may have against any person or organization against whom you have agreed to waive such right of recovery in a written contract or written agreement because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included within the "products completed operations hazard." Named Insured: STETSON ENGINEERS INC. Policy Number: 2099943204 Policy Term: March 7, 2013 to July 1, 2013 SB-300176-B (Ed. 01/08)