HomeMy WebLinkAboutCertficate of InsuranceAC"RDV CERTIFICATE OF LIABILITY INSURANCE
�•..---�' 7/1/2022'
DATE(MMIDD/YYYY)
11/24/2021
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(les) 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
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816)960-9000
kctsu@lockton.com
E c
PHONE J'FAX
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: Sentinel Insurance Company, LTD 11000
INSURED BELLECCI &ASSOCIATES, INC.
1 501 276 2290 DIAMOND BLVD, SUITE 100
CONCORD CA 94520
INSURER B: Trumbull Insurance Company 27120
INSURER C: Arch Insurance Company 11150
INSURER D :
INSURER E:
INSURER F
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
INSD
SUB
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENEPALLIA8ILITY
CLAIMS-MADE� OCCUR
Y
Y
84SBWBH4370
I
07/01/2021
0 . 7/01/2022
EACH OCCURRENCE $ 1 OOOOOO
DAMAGE TO RE TEPREMISE (Ea r
_L1,000.000
MED EXP An one person)$ 10,000
GEN'L
PERSONAL & ADV INJURY $ 1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
$
B
AUTOMOBILE
Ix
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOSY
X NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
84UEGAE4160
07/01/2021
07/01/202
EOccld.,tSINGLELIMIT $ 1,000,000
BODILY INJURY (Per person) $ XXXXXXX
BODILY INJURY Per accident $ XXiaXXX
( )HIRED
PReOaccldent AMAGE $ XXXXXXX
P
$ XXX)(xXX
A
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
Y
Y
84SBWBH4370
07/01/2021
07/01/2022
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
DED I X I RETENTION $ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY
OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVEF 7N
(Mandatory In NH)E.L.
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
Y
57WEBAD4C78
07/01/2021
07/01/2022
X I PER
STATUTE 'Rf_
E.L. EACH ACCIDENT $ 1,000,000
-
DISEASE EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1 000 000
C
PROFESSIONAL
LIABILITY
N
N
PAAEP0105803
12/04/2021
12/04/2022
$2,000,000 PER CLAIM/AGGREGATE
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
*SEE ATTACHED*
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
18044490
AUTHORIZED REPRESENTATIVE
TOWN OF LOS ALTOS HILLS
26379 FREMONT ROAD
LOS ALTOS CA 94022
ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rinhtc rPCPrvPrt
The ACORD name and logo are registered marks of ACORD
-.1--u. UCJVRII' IIVIY VI' VrGRHI IVIVJILVVMI IVIYJ/VGRIVLGJ/CAV LUJIVNJ HUUCU 6T CNllVKJCMCN I/JYCLIAL YKVVIJIVNJ IUSe omv IT more
RE: UNDERGROUNDING PROJECT AROUND EL MONTE FIRE STATION. TOWN, ITS OFFICERS, OFFICIALS,
EMPLOYEES, AND VOLUNTEERS ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND
AUTO LIABILITY, AND THESE COVERAGES ARE PRIMARY AND NON-CONTRIBUTORY, IF REQUIRED BY
WRITTEN CONTRACT. WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY, AUTO LIABILITY AND
WORKERS COMPENSATION/EMPLOYER'S LIABILITY WHERE ALLOWED BY STATE LAW AND IF REQUIRED
BY WRITTEN CONTRACT. THE UMBRELLA/EXCESS LIABILITY IS CONSIDERED FOLLOW FORM OVER THE
GENERAL LIABILITY, AUTO LIABILITY AND EMPLOYERS LIABILITY SUBJECT TO THE POLICY TERMS,
CONDITIONS AND EXCLUSIONS. PROFESSIONAL LIABILITY DEDUCTIBLE: $35,000. PROFESSIONAL
LIABILITY RETROACTIVE DATE: 02/01/1983.
ACORD 25 (2016/03) Certificate Holder ID: 18044490
Attachment Code: D600214 Certificate ID : 18044490
POLICY NUMBER: 84SBWBH4370
6. Additional Insureds When Required By Written
Contract, Written Agreement Or Permit
The person(s) or organization(s) identified in Paragraphs
a. through f. below are additional insureds when you
have agreed, in a written contract, written agreement or
because of a permit issued by a state or political
subdivision, that such person or organization be added
as an additional insured on your policy, provided the
injury or damage occurs subsequent to the execution of
the contract or agreement, or the issuance of the
permit.
A person or organization is an additional insured under
this provision only for that period of time required by the
contract, agreement or permit.
However, no such person or organization is an
additional insured under this provision if such person or
organization is included as an additional insured by an
endorsement issued by us and made a part of this
Coverage Part, including all persons or organizations
added as additional insureds under the specific
additional insured coverage grants in Section F. -
Optional Additional Insured Coverages.
a. Vendors
Any person(s) or organization(s) (referred to below as
vendor), but only with respect to "bodily injury" or
"property damage" arising out of "your products" which
are distributed or sold in the regular course of the
vendor's business and only if this Coverage Part
provides coverage for "bodily injury" or "property
damage" included within the "products -completed
operations hazard".
(1) The insurance afforded to the vendor is subject to
the following additional exclusions:
This insurance does not apply to:
(a) "Bodily injury" or "property damage" for which the
vendor is obligated to pay damages by reason of the
assumption of liability in a contract or agreement.
SS 00 08 04 05
This exclusion does not apply to liability for damages
that the vendor would have in the absence of the
contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product
made intentionally by the vendor;
(d) Repackaging, except when unpacked solely for
the purpose of inspection, demonstration, testing, or
the substitution of parts under instructions from the
manufacturer, and then repackaged in the original
container;
(e) Any failure to make such inspections,
adjustments, tests or servicing as the vendor has
agreed to make or normally undertakes to make in
the usual course of business, in connection with the
distribution or sale of the products;
(f) Demonstration, installation, servicing or repair
operations, except such operations performed at the
vendor's premises in connection with the sale of the
product;
(g) Products which, after distribution or sale by you,
have been labeled or relabeled or used as a
container, part or ingredient of any other thing or
substance by or for the vendor; or
(h) "Bodily injury" or "property damage" arising out of
the sole negligence of the vendor for its own acts or
omissions or those of its employees or anyone else
acting on its behalf. However, this exclusion does not
apply to:
(i) The exceptions contained in Subparagraphs (d) or
(f); or
(ii) Such inspections, adjustments, tests or servicing
as the vendor has agreed to make or normally
undertakes to make in the usual course of business,
in connection with the distribution or sale of the
products.
(2) This insurance does not apply to any insured
person or organization from whom you have acquired
such products, or any ingredient, part
Attachment Code : D600214 Certificate ID : 18044490
Attachment Code : D600214 Certificate ID : 18044490
or container, entering into, accompanying or containing
such products.
b. Lessors Of Equipment
(1) Any person or organization from whom you lease
equipment; but only with respect to their liability for
"bodily injury", "property damage" or "personal and
advertising injury" caused, in whole or in part, by your
maintenance, operation or use of equipment leased to
you by such person or organization.
(2) With respect to the insurance afforded to these
additional insureds, this insurance does not apply to any
"occurrence" which takes place after you cease to lease
that equipment.
c. Lessors Of Land Or Premises
(1) Any person or organization from whom you lease land
or premises, but only with respect to liability arising out of
the ownership, maintenance or use of that part of the land
or premises leased to you.
(2) With respect to the insurance afforded to these
additional insureds, this insurance does not apply to:
(a) Any 'occurrence" which takes place after you cease
to lease that land or be a tenant in that premises; or
(b) Structural alterations, new construction or demolition
operations performed by or on behalf of such person or
organization.
d. Architects, Engineers Or Surveyors
(1) Any architect, engineer, or surveyor, but only with
respect to liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in whole or in
part, by your acts or omissions or the acts or omissions
of those acting on your behalf:
(a) In connection with your premises; or
(b) In the performance of your ongoing operations
performed by you or on your behalf.
(2) With respect to the insurance afforded to these
additional insureds, the following additional exclusion
applies:
This insurance does not apply to "bodily injury", "property
damage" or "personal and advertising
injury" arising out of the rendering of or the failure to
render any professional services by or for you,
including:
(a) The preparing, approving, or failure to prepare or
approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection, architectural or
engineering activities.
e. Permits Issued By State Or Political
Subdivisions
(1) Any state or political subdivision, but only with
respect to operations performed by you or on your
behalf for which the state or political subdivision has
issued a permit.
(2) With respect to the insurance afforded to these
additional insureds, this insurance does not apply to:
(a) "Bodily injury", "property damage" or "personal
and advertising injury" arising out of operations
performed for the state or municipality; or
(b) "Bodily injury" or "property damage" included
within the "products -completed operations hazard"
f. Any Other Party
(1) Any other person or organization who is not an
insured under Paragraphs a. through e. above, but
only with respect to liability for "bodily injury",
"property damage" or "personal and advertising
injury" caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
(a) In the performance of your ongoing operations;
(b) In connection with your premises owned by or
rented to you; or
(c) In connection with "your work" and included within
the "products- completed operations hazard", but
only if
(i) The written contract or written agreement requires
you to provide such coverage to such additional
insured; and
Attachment Code : D600214 Certificate ID : 18044490
(ii) This Coverage Part provides coverage for "bodily
injury" or "property damage" included within the
"products -completed operations hazard".
(2) With respect to the insurance afforded to these
additional insureds, this insurance does not apply to:
"Bodily injury", "property damage" or "personal and
advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural,
engineering or surveying services, including:
(a) The preparing, approving, or failure to prepare or
approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders, designs or drawings
and specifications; or
(b) Supervisory, inspection, architectural or engineering
activities.
The limits of insurance that apply to additional insureds
are described in Section D.. Limits Of Insurance.
How this insurance applies when other insurance is
available to an additional insured is described in the Other
Insurance Condition in Section E.. Liability And Medical
Expenses General Conditions.
No person or organization is an insured with respect to
the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a
Named Insured in the Declarations.
F. OPTIONAL ADDITIONAL INSURED
COVERAGES
If listed or shown as applicable in the Declarations, one or
more of the following Optional Additional Insured
Coverages also apply. When any of these Optional
Additional Insured Coverages apply, Paragraph 6.
(Additional Insureds When Required by Written Contract,
Written Agreement or Permit) of Section C., Who Is An
Insured, does not apply to the person or organization
shown in the Declarations. These coverages are subject
to the terms and conditions applicable to Business
Liability Coverage in this policy, except as provided
below:
1. Additional Insured - Designated Person Or
Organization
WHO IS AN INSURED under Section C. is amended to
include as an additional insured the
person(s) or organization(s) shown in the
Declarations, but only with respect to liability for
"bodily injury", "property damage" or "personal and
advertising injury" caused, in whole or in part, by your
acts or omissions or the acts or omissions of those
acting on your behalf:
a. In the performance of your ongoing operations; or
b. In connection with your premises owned by or
rented to you.
2. Additional Insured - Managers Or Lessors Of
Premises
a. WHO IS AN INSURED under Section C. is
amended to include as an additional insured the
person(s) or organization(s) shown in the
Declarations as an Additional Insured - Designated
Person Or Organization; but only with respect to
liability arising out of the ownership, maintenance or
use of that part of the premises leased to you and
shown in the Declarations.
b. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
(1) Any 'occurrence" which takes place after you
cease to be a tenant in that premises; or
(2) Structural alterations, new construction or
demolition operations performed by or on behalf of
such person or organization.
3. Additional Insured - Grantor Of Franchise
WHO IS AN INSURED under Section C. is amended
to include as an additional insured the person(s) or
organization(s) shown in the Declarations as an
Additional Insured - Grantor Of Franchise, but only
with respect to their liability as grantor of franchise to
you.
4. Additional Insured - Lessor Of Leased
Equipment
a. WHO IS AN INSURED under Section C. is
amended to include as an additional insured the
person(s) or organization(s) shown in the
Declarations as an Additional Insured . Lessor of
Leased Equipment, but only with respect to liability
Attachment Code : D600214 Certificate ID : 18044490
for "bodily injury", "property damage" or "personal
and ad\tertising injury" caused, in whole or in part, by
your maintenance, operation
Attachment Code : D600214 Certificate ID : 18044490
or use of equipment leased to you by such person(s) or (2) "Bodily injury" or "property damage" included in
organization(s). the "product -completed operations" hazard.
b. With respect to the insurance afforded to these
additional insureds, this insurance does not apply to any
"occurrence" which takes place after you cease to lease
that equipment.
5. Additional Insured - Owners Or Other Interests
From Whom Land Has Been Leased
a. WHO IS AN INSURED under Section C. is amended
to include as an additional insured the person(s) or
organization(s) shown in the Declarations as an
Additional Insured - Owners Or Other Interests From
Whom Land Has Been Leased, but only with respect to
liability arising out of the ownership, maintenance or use
of that part of the land leased to you and shown in the
Declarations.
b. With respect to the insurance afforded to these
additional insureds, the following additional exclusions
apply:
This insurance does not apply to:
(1) Any "occurrence" that takes place after you cease to
lease that land; or
(2) Structural alterations, new construction or demolition
operations performed by or on behalf of such person or
organization.
6. Additional Insured - State Or Political
Subdivision - Permits
a. WHO IS AN INSURED under Section C. is amended
to include as an additional insured the state or political
subdivision shown in the Declarations as an Additional
Insured - State Or Political Subdivision - Permits, but
only with respect to operations performed by you or on
your behalf for which the state or political subdivision
has issued a permit.
b. With respect to the insurance afforded to these
additional insureds, the following additional exclusions
apply:
This insurance does not apply to:
(1) "Bodily injury", "property damage" or "personal and
advertising injury" arising out of operations performed for
the state or municipality; or
7. Additional Insured -Vendors
a. WHO IS AN INSURED under Section C. is
amended to include as an additional insured the
person(s) or organization(s) (referred to below as
vendor) shown in the Declarations as an Additional
Insured - Vendor, but only with respect to "bodily
injury" or "property damage" arising out of "your
products" which are distributed or sold in the regular
course of the vendor's business and only if this
Coverage Part provides coverage for "bodily injury" or
"property damage" included within the
"products -completed operations hazard".
b. The insurance afforded to the vendor is subject to
the following additional exclusions:
(1) This insurance does not apply to:
(a) "Bodily injury" or "property damage" for which
the vendor is obligated to pay damages by reason of
the assumption of liability in a contract or
agreement.
This exclusion does not apply to liability for
damages that the vendor would have in the absence
of the contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product
made intentionally by the vendor;
(d) Repackaging, unless unpacked solely for the
purpose of inspection, demonstration, testing, or the
substitution of parts under instructions from the
manufacturer, and then repackaged in the original
container;
(e) Any failure to make such inspections,
adjustments, tests or servicing as the vendor has
agreed to make or normally undertakes to make in
the usual course of business, in connection with the
distribution or sale of the products;
(f) Demonstration, installation, servicing or repair
operations, except such operations performed at the
vendor's premises in connection with the sale of the
product;
Attachment Code : D600214 Certificate ID : 18044490
Attachment Code : D600214 Certificate ID : 18044490
(g) Products which, after distribution or sale by you, have
been labeled or relabeled or used as a container, part or
ingredient of any other thing or substance by or for the
vendor; or
(h) "Bodily injury" or "property damage" arising out of the
sole negligence of the vendor for its own acts or
omissions or those of its employees or anyone else
acting on its behalf. However, this exclusion does not
apply to:
(i) The exceptions contained in Subparagraphs (d) or (f);
or
(ii) Such inspections, adjustments, tests or servicing as
the vendor has agreed to make or normally undertakes to
make in the usual course of business, in connection with
the distribution or sale of the products.
(2) This insurance does not apply to any insured person
or organization from whom you have acquired such
products, or any ingredient, part or container, entering
into, accompanying or containing such products.
8. Additional Insured - Controlling Interest
WHO IS AN INSURED under Section C. is amended to
include as an additional insured the person(s) or
organization(s) shown in the
Declarations as an Additional Insured - Controlling
Interest, but only with respect to their liability arising out
of:
a. Their financial control of you; or
b. Premises they own, maintain or control while you
lease or occupy these premises.
This insurance does not apply to structural alterations,
new construction and demolition operations performed by
or for that person or organization.
9. Additional Insured - Owners, Lessees Or
Contractors - Scheduled Person Or Organization
a. WHO IS AN INSURED under Section C. is amended
to include as an additional insured the person(s) or
organization(s) shown in the Declarations as an
Additional Insured - Owner, Lessees Or Contractors, but
only with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury" caused, in
whole or in part, by your acts or omissions or the acts or
omissions of those acting on your behalf:
1) In the performance of your ongoing operations for
the additional insured(s); or
(2) In connection with "your work" performed for that
additional insured and included within the
"products -completed operations hazard", but only if
this Coverage Part provides coverage for "bodily
injury" or "property damage" included within the
"products -completed operations hazard".
b. With respect to the insurance afforded to these
additional insureds, this insurance does not apply to
"bodily injury", "property damage" or "personal an
advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural,
engineering or surveying services, including:
(1) The preparing, approving, or failure to prepare or
approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders, designs or
drawings and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
10. Additional Insured - Co -Owner Of Insured
Premises
WHO IS AN INSURED under Section C. is amended
to include as an additional insured the person(s) or
Organization(s) shown in the
Declarations as an Additional Insured - Co- Owner
Of Insured Premises, but only with respect to their
liability as co-owner of the premises shown in the
Declarations.
The limits of insurance that apply to additional
insureds are described in Section D. - Limits Of
Insurance.
How this insurance applies when other insurance is
available to an additional insured is described in the
Other Insurance Condition in Section E. - Liability
And Medical Expenses General Conditions.
Attachment Code : D600214 Certificate ID : 18044490
Attachment Code : D600224 Certificate ID : 18044490
POLICY NUMBER: 84SBWBH4370
(7) When You Add Others As An Additional
Insured To This Insurance
That is other insurance available to an additional
insured.
However, the following provisions apply to other
insurance available to any person or organization
who is an additional insured under this Coverage
Part:
(a) Primary Insurance When Required
By Contract
This insurance is primary if you have
agreed in a written contract, written
agreement or permit that this insurance be
primary. If other insurance is also primary,
we will share with all that other insurance
by the method described in c. below.
(b) Primary And Non -Contributory To
Other Insurance When Required By
Contract
If you have agreed in a written contract,
written agreement or permit that this
insurance is primary and non-contributory
with the additional insured's own
insurance, this insurance is primary and
we will not seek contribution from that
other insurance.
Paragraphs (a) and (b) do not apply to
other insurance to which the additional
insured has been added as an additional
insured.
When this insurance is excess, we will have no
duty under this Coverage Part to defend the insured
against any "suit" if any other insurer has a duty to
defend the insured against that "suit". If no other
insurer defends, we will undertake to do so, but we
will be entitled to the insured's rights against all
those other insurers.
SS 00 08 04 05
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:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) 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.
c. Method Of Sharing
If all the other insurance permits contribution by
equal shares, we will follow this method also.
Under this approach, each insurer contributes
equal amounts until it has paid its applicable limit
of insurance or none of the loss remains, whichever
comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute by
limits. Under this method, each insurer's share is
based on the ratio of its applicable limit of
insurance to the total applicable limits of insurance
of all insurers.
Attachment Code : D600224 Certificate ID : 18044490
Attachment Code : D600225 Certificate ID : 18044490
POLICY NUMBER: 84SBWBH4370
SS 00 08 04 0S
b. Waiver Of Rights Of Recovery (Waiver Of
Subrogation)
If the insured has waived any rights of recovery
against any person or organization for all or part
of any payment, including Supplementary
Payments, we have made under this Coverage
Part, we also waive that right, provided the
insured waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed prior to
the injury or damage.
Attachment Code : D600204 Certificate ID : 18044490
POLICY NUMBER: 84UEGAE4160
BUSINESS AUTO COVERAGE FORM
D. Additional Insured if Required by Contract
(1) Paragraph A.1. - WHO IS AN INSURED - of
Section II - Liability Coverage is amended to add:
f. When you have agreed, in a written contract or
written agreement, that a person or organization be
added as an additional insured on your
The insurance afforded to any such additional
insured applies only if the "bodily injury" or
"property damage" occurs:
(1) During the policy period, and
(2) Subsequent to the execution of such written
contract, and
(3) Prior to the expiration of the period of time that
the written contract requires such insurance be
provided to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract or written
agreement that another person or organization be
added as an additional insured on your policy, the
most we will pay on behalf of such additional
insured is the lesser of:
(a) The limits of insurance specified in the written
contract or written agreement; or
(b) The Limits of Insurance shown in the
Declarations.
Such amount shall be a part of and not in addition
to Limits of Insurance shown in the Declarations
and described in this Section.
(3) Additional Insureds Other Insurance
If we cover a claim or "suit" under this Coverage
Part that may also be covered by other insurance
available to an additional insured, such additional
insured must submit such claim or "suit" to the
other insurer for defense and indemnity.
However, this provision does not apply to the extent
that you have agreed in a written contract or written
agreement that this insurance is primary and
non-contributory with the additional insured's own
insurance.
HA 99 16 03 12
business auto policy, such person or organization is
an "insured", but only to the extent such person or
organization is liable for "bodily injury" or "property
damage" caused by the conduct of an "insured"
under paragraphs a. or b. of Who Is An Insured with
regard to the ownership, maintenance or use of a
covered "auto."
(4) Duties in The Event Of Accident, Claim, Suit or
Loss
If you have agreed in a written contract or written
agreement that another person or organization be
added as an additional insured on your policy, the
additional insured shall be required to comply with
the provisions in LOSS CONDITIONS 2. - DUTIES IN
THE EVENT OF ACCIDENT, CLAIM, SUITOR
LOSS - OF SECTION IV - BUSINESS AUTO
CONDITIONS, in the same manner as the Named
Insured.
E. Primary and Non -Contributory if Required by
Contract
Only with respect to insurance provided to an
additional insured in 1.D. —Additional Insured If
Required by Contract, the following provisions apply:
(3) Primary Insurance When Required By Contract
This insurance is primary if you have agreed in a
written contract or written agreement that this
insurance be primary. If other insurance is also
primary, we will share with all that other insurance by
the method described in Other Insurance 5.d.
(4) Primary And Non -Contributory To Other Insurance
When Required By Contract
If you have agreed in a written contract or written
agreement that this insurance is primary and
non-contributory with the additional insured's own
insurance, this insurance is primary and we will not
seek contribution from that other insurance.
Paragraphs (3) and (4) do not apply to other
insurance to which the additional insured has been
added as an additional insured.
Attachment Code : D600204 Certificate ID : 18044490
When this insurance is excess, we will ham no
duty to defend the insured against any "suit" if any
other insurer has a duty to defend the insured
against that "suit". If no other insurer defends, we
will undertake to do so, but we will be entitled to
the 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:
(1) The total amount that all such other insurance
would pay for the loss in the absence of this
insurance; and
(2) The total of all deductible and self-insured
amounts under all that other insurance.
We will share the remaining loss, if any, by the
method described in Other Insurance 5.d.
Attachment Code : D600205 Certificate ID : 18044490
POLICY NUMBER: 84UEGAE4160
HA 99 16 03 12
BUSINESS AUTO COVERAGE FORM
15. WAIVER OF SUBROGATION
TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US - of SECTION IV - BUSINESS AUTO
CONDITIONS is amended by adding the following:
We waive any right of recovery we may have against
any person or organization with whom you have a
written contract that requires such waiver because of
payments we make for damages under this Coverage
Form.
Attachment Code : D600229 Certificate ID : 18044490
POLICY NUMBER: 57WEBAD4C78
WC 99 03 03 B
3. Waiver of Our Right To Recover From Others
A. We have the right to recover our payments from
anyone liable for an injury covered by this policy. We
will not enforce our right against any person or
organization for whom you perform work under a
written contract that requires you to obtain this
agreement from us.
This agreement shall not operate directly or
indirectly to benefit anyone not named in the
agreement.
B. This provision 3. does not apply in the states of
Pennsylvania and Utah.