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HomeMy WebLinkAboutEngineered Soil Repairs IncAe R& CERTIFICATE OF LIABILITY INSURANCE DATE/3/2020 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 (WC) Heffernan Insurance Brokers 1350 Carlback Avenue Walnut Creek, CA 94596 CONTACT Che I vanWestro PHONE FAX C No): 925-934-8278 A/c No Ext): 925-934-8500 NC. ADDRESS: ChE)rylv@heffins.com INSURERS AFFORDING COVERAGE NAIC # Y INSURERA: United Specialty Insurance Company 12537 ATN2096111 INSURED ENGISOI-02 Engineered Solo Repairs Inc 1267 Springbrook Road INSURER B: Starr Indemnit & Liability Company 38318 INSURER C: Redwood Fire & Casualty Insurance Company 11673 INSURER D: Lloyd's of London Walnut Creek, CA 94597 INSURER E: Westchester Surplus Lines Insurance Company10172 X Ded. $25,000 INSURER F: American Fire and Casualty Comeany 1 24066 COVERAGES CERTIFICATE NUMBER: 1723847874 REVISION NIUMI 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. ILTR TYPE OF INSURANCE ADDL S SUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR Y ATN2096111 4/1/2020 4/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $50,000 MED EXP (Anyone person) $ 5,000 X Ded. $25,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- ❑ POLICY XJECT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 X OTHER: Prof Agg Cap 5M $ F AUTOMOBILE LIABILITY BAA2057014467 10/1/2019 10/1/2020 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS ld Peraccent BODILY INJURY ( ) $ X HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ B UMBRELLA LAB X OCCUR 100058503121 4/1/2020 4/1/2021 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I X IRETENTION$n $ G WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? N/A ENWC012744 10/1/2019 10/1/2020 N STATUTE )TH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below E D Pollution, Ded$2,500/Claim Professional Liability Claims Made Coverage G27512793006 CY0005220 10/1/2019 4/1/2020 10/1/2020 4/1/2021 EechCondition/Agg $1M/$1M Each Claim/Agg $1M/$1M Deductible $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: As Per Contract or Agreement on File with Insured. The City of Los Altos Hills is included as an additional insured on General Liability policy per the attached endorsement, if required. CERTIFICATE HOLDER rANIrl 1 ATInN ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Los Altos Hills ACCORDANCE WITH THE POLICY PROVISIONS. Building Inspection Dept. AUTHORIZED REPRESENTATIVE 26379 Fremont Road Los Altos, CA 94022 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ATN2096111 COMMERCIAL GENERAL LIABILITY CG 24 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF INSURED CONTRACT DEFINITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Paragraph 9. of the Definitions Section is replaced by the following: 9. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of prem- ises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with per- mission of the owner is not an "insured con- tract"; b. A sidetrack agreement; e. Any easement or license agreement, except in connection with construction or demolition op- erations on or within 50 feet of a railroad; d. Ari obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; L That pant of any other contract or agreement pertaining to your business (including an in- demnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, pro- vided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph L does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, with- in 50 feet of any railroad property and af- fecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or (b) Giving directions or instructions, or failing to give them, if that is the prima- ry cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the in- sured's rendering or failure to render profes- sional services, including those listed in (2) above and supervisory, inspection, architec- tural or engineering activities. CG 24 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 11 POLICY NUMBER: ATN2096111 UNITED SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 015 01 (05/18) - AMENDED TO COVER REPAIR CONDOMINIUM, TOWNHOME AND TRACT EXCLUSION This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to SECTION 1 - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions and SECTION 1 — COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM; This insurance does not apply to and the Company shall have no obligation to provide indemnity or defense for any "bodily injury", "property damage", or "personal and advertising injury" arising from work or product performed or supplied by you or contractors or subcontractors: 1. "Condominiums or townhomes", or "tract houses"; 2. Any location which has been or becomes converted into condominiums or townhomes, regardless of whether: a. Any insured had involvement in the conversion; b. Any insured had knowledge of the conversion; c. The conversion is prior to or subsequent to any insured's work at the location This exclusion does not apply to: 1. Remodeling or repair of existing individual condominium or townhome units if the work is performed for the individual unit owner. 2. Remodeling, repair, or additions to an existing single house in a "tract house" development if the work is performed for the individual unit owner. 3. Maintenance, service, remodeling, or repair of a completed and occupied "residential condominium or townhome" or "tract house" development. 4. Work done for existing Homeowner's Associations. The following are added to Section V — DEFINITIONS: "Condominiums or townhomes" means real estate, portions of which are designated, designed or intended for occupancy in whole or in part by any person, persons, or organization with separate ownership and the remainder of which is designated for common ownership by the owners of those portions and where the undivided interests in the common elements are vested in the unit owners. A "tract house" is a house that was originally built as part of a tract house development project. A tract house development project is comprised of a piece or parcel of land subdivided into five or more lots for the development, construction and sale of freestanding one or two family dwellings. All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. VEN 015 01 (05/18) Page 1 of 1 POLICY NUMBER: ATN2096111 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 069 02 (04/18) WRAP- UP EXCLUSION (Limited off-site exception) This Exclusion modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to SECTION 1 - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions and SECTION 1 — COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM; This insurance does not apply to "bodily Injury", "property damage", or "personal and advertising injury" arising out of any project which is insured, in whole or in part, under a Consolidated Insurance Program commonly known as an Owner Controlled Insurance Program, a Contractor Controlled Insurance Program, a Wrap -Up Insurance Program or any other type of insurance program designed to provide liability coverage for parties involved in the development, design, construction, erection, supervision or management of a specific project or projects. This exclusion applies whether or not the Consolidated Insurance Program: 1. Provides coverage identical to that provided by this policy: 2. Has limits adequate to cover all claims; 3. Remains in effect. However, this exclusion does not apply to work performed by you or on your behalf for a project that is insured under a Consolidated Insurance Program if the work is performed away from the premises insured under the Consolidated Insurance Program and that no coverage for this work is found in the Consolidated Insurance Program. This exception to the exclusion does not apply to "bodily injury" or "property damage" which is included in the "products -completed operations hazard". Nothing in this endorsement shall be construed as to grant any products -completed operations coverage. All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. VEN 069 02 (04/18) Page 1 of 1 POLICY NUMBER: ATN2096111 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 As Required By Written Contract, Fully Executed Prior As Required By Written Contract, Fully To The Named Insured's Work Executed Prior To The Named Insured's Work 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your be- half; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions ap- ply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment fiunished in connection with such work, on the pro- ject (other than service, maintenance or repairs) to be performed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing op- erations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ HEFFERNAN INSURANCE BROKERS 1350 CARLBACK AVE STE 200 WALNUT CREEK CA 94596-7299 CITY OF LOS ALTOS HILLS BUILDING INSPECTION DEPT 26379 W FREMONT RD LOS ALTOS CA 94022-2624