The URL can be used to link to this page

Home My WebLink AboutContracts & Agreements_151-13_CCv0001.pdf a�o> CERTIFICATE OF LIABILITY INSURANCEF7! (MMIDDIYYYY) 71312013 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 Ed eWood Partners Insurance Center(EPIC) _-_ CONTACT NAME.__ _--. 19 0(}MacArthur Blvd. PH Floor PHONE tare Na �Jt1__94 }2 3 X64 i----- 1AX_ArG 001-_J94%263-090 Irvine, CA 926'12 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE MAIC# ..__ . .. —_ ---- - _ www.edgeWoodins_Gom ..-- _-- ___-- _._. ----- -- --- -- . _ -----LIBER A_:_Westchester rllt Lin��nsurancQ Co---- — — -- INSURED INSURER B _ACE_Ei_re l�_n_d� rit Iflstx'anCe Co Naz Mat Trans, Inc. ---- ---- _-- 230 Dumas Street INSURER C:-Staie..C�_mDensatiorl to uranc a Funs! San Bernardino CA 92408 INSURER D_ INSURER E: - INSURER F: — — — COVERAGES CERTIFICATE NUMBER: 16929321 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. -- -- tNSR IASL UBI?rEXP T ---- LTR TYPE OF INSURANCE POLICY NUMBER MMt MMtDD1YYYY LIMITS A GENERAL LIABILITY j 624219987002 8/1!2012 181112013 EACH OCCURRENCE $ 1,000,000 ✓ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMIS —( -_ 100 000 j ! ES(Ea occaxrence) $ _ _ _ -- CLAIMS-MADE OCCUR MED EXP(Any one person) $ _ 000 Contractors Pollution ' j PERSONAL&ADV INJURY $ ._ 1,000,000 ✓ Professional Liab f i Prof Liab Claims GENERALAGGREGATE IMade Retro 4-19-99 -- GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS-COMP/OP AGG $ 2,000,000 (� PRO- i t s i POLICY; :LOC i I I$ B AUTOMOBILE LIABILITY i 'H08453317002 8/1/2012 811/2013 COMBf Ean)SINGLE LIMIT $ 1000 t}00 i . -------- V ANY AUTO BODILY INJURY(Per person) $ III' ALL OWNED r--�SCHEDULED --- {�AUTOS _ AUTOS I BODILY INJURY(Per accident) $ _-- -- r NON-ONMED ( - ( PROPERTY DAMAGE .. HIRED AUTOS ✓�AUTOS I i(Par aceident) fi$ r - MCS90 Endorsement i V t Polution per CA9948 I 'UMBRELLA LIAR OCCUR CE 4000000 ( EACH OCCURRENCE '$ A L I !!G24219999002 8/1/2012 811/2013 - —_-- _- .. -'._-- EXCESS LIAO ., __ CLAIMS-MADE Excess over GL I AGGREGATE $ 4,000,000 - -—} .. . - — _?DED -(--RETENTIONS 10t�4 j and Auto --- �$ ' } $ $ C WORKERS COMPENSATION 191578413 14/1/2013 14/1/2(}14 N STATttO f AND EMPLOYERS'LIABILITY Y 1 N( r I TORY LIMITS -t-� - ----!— ANY PROPRIETOR/PARTNERtEXECLM t E L-EACH ACCIDENT $ .1,000 OOO .-__ ---- _-_—� _...- _- (Mandatory _._ (MandaOFFICER/MEMBER ryiEXCLUDEOZ i N/A E.L.DISEASE-EA EMPLOYEE$ (yes,dory in NH) l i _ed__ __- .._ If yes,describe under [E.L DISEASE-POLICY LIMIT . $ DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(Attach ACORD 141,Additional Remarks Schedule,if more space is required) Certificate holder is additional insured with respect to general liability,pollution liability and automobile liability but only if required by Written contract with the named insured executed and effective prior to commencement of the work and as provided by forms ENV-3101 (08/04);ENV-3226(10108)and DA6Z04 0500 attached and all terms and conditions of the policy. Primary wording(ENV-3101 08104} and waiver of sub- ation EW--3143 03105 and DA-13115 1202 also aoDlyWhen muired ty written contract and as per policy terns. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Environmental Systems Research Institute THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Prolaerw One LLC ACCORDANCE WITH THE POLICY PROVISIONS. City of edlands 3130 New York Street AUTHORIZED REPRESENTATIVE Redlands CA 92373 Barbara A.Bums C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CERT NO.: 15929321 Barbara A. Hurls '7/3/2013 2:50:58 PM Daae 1 of 8 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP D3 • 915-13 000784 RENEWAL SJ 2-40-23-60 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 5, 2013 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 1, 2014 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HAZ MAT TRANS, INC. 230 E DUMAS ST SAN BERNARDINO, CA 92408 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHM ANDING. IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, PROPERTY ONE WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK. PERFORMED BY, HA2 MAT TRANS. INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNING OF SUCH EMPLOYEES SHALL BE INCREASED BY a3%. NOT14ING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTS R, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIOWF OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY ;MALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREE[TENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: APRIL 9, 2013 2570 4 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.1-2012) OLD DP 217 CERT NO- 16929321 Barbara A. R—n., 7.x56:58 PM Page 2 of 8 ENDORSEMENT AGREEMENT WAIVER. OF SUBROGATION REP D3 915-13 000784 STATS RENEWAL SJ FUND 2-40-23-60 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 5, 2013 AT 12. 01 A.M. ALL EFFECTIVE DATE$ARE AND EXPIRING APRIL 1, 2014 AT 12. )l A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HAZ MAT TRANS, INC. 230 E DUMAS ST SAN BERNARDINO, CA 92408 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHST,WDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANC:- FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST,. ENVIRONMENTAL SYSTEMS RESEARCH WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER 'CHIS POLICY IN CONNECTION WITH WORK PERFORMED BY. HAZ MAT TRANS INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNE2ATION OF EMPLOYEES MILE ENGAGED IN WORD FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEM=ALTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: APRIL 9, 2013 2570 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO OLD DP 217 SCIF FORM 10217 (REV.1-2012) CERT NO.. 16929321 Barb—a A. 3--' 2.50:58 PM Page 3 of 8 7/3/2013 Named Insured Endorsement Number Haz Mat Trans, Inc. Policy Symbol Poky Ntu Policy Period Effectim Date of Endorsement GLW IG24219987002 TO 8/1/2013 8/1/2012 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company - trised the policy number. The remainder of the information Is to be completed only when this endorsement is issued subsequent to the preparation of the policy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT-OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON-CONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or QManlzaft: 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 this endorsement.) SECTION It-WHO 13 AN INSURED is amended to include: A. SECTION 11 -WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds,the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the site 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 contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV-3401 (178-04) Includes copyrighted material of Insurance Services Office,Inc,with its permission Page I of I CERT NO.: 1692932, 8arhara A. 8urns 7/3!20133 2:50:58 PP. Page 4 oL 8 713/2013 ADDITIONAL INSURED ENDORSEMENT-PRODUCTS-COMPLETED OPERATIONS HAZARD PRIMARY&NON-CONTRIBUTORY Named Insured Endorsement r � Haz Mat Trans,Inc. Policy symw Efkx;dft Date of Endorsement 131-1 1 ZVI'99 i 7 0 0 2 18'/1/20P'12 to 81112013 8/1/2012 Issued By(Name of kistamme CompmV) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE 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 this endorsement.) Section 11-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 or property damage caused,in whole or in part, by your work performed for that additional insured and included in the products-completed operations hazard. Furthermore, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. All other terms and conditions remain the same. ENV-3226(10-08) Copyright 02008 Page I of 1 CIERT NO- 1692-321 Barbar.A- Burn. 7/312013 2:50:58 P,,. Page 5 of 3 7/3/2013 Named Insured Endorsement Number Haz Mat Trans, Inc. Policy Symbo Pow Nvnber Policy Period Effective Date of Erdorsern7;,at � GBA 624219987002 8/112012 To 8/1/2013 8/1/2012 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or 0mairlizatim: 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 this endorsement) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above 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 in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above, All other terms and conditions remain the same. ENV-3143(03-05) IrK*Aes copyrighted material of Insurance Services Office,Inc.v✓ith its permission Page 1 of I -ERT NO- 16929321 Barbara A. Bu=s 7/3/2013 2:50:58 26t I'Dage 6 of 8 713/2013 Flamed Insured Endorsement umber Haz Met Trans, Inc. Policy Sym ixsl FoNcy Number Policy Period Effective Date of Endorsement CAL 084533170021112012 81112013 8/1/2012 Issued By(Blame of Insurance c�rnpany) — —_ AGE Fire Underwriters Insurance Company The above is required to be completed only when this endorsement is issued subsequent to the preparation of the policy. AUTOMATIC ADDITIONAL. INSURED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO}PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM SECTION It - LIABILITY COVERAGE,WHO IS AN INSURED is amended to include as an "insured" any person or organization you are required in a written contract or agreement to name as an Additional Insured on your policy but only for"bodily injury"or"property damage"to which this insurance applies if the"accident"is caused by; 1. You, while using a covered "auto"or 2. Any other person, while using a covered "auto"with your permission. The insurance prodded by this endorsement shall be subject to the following additional conditions; 1. The Limit of Insurance provided for the Additional Insured shall not be greater than those required by contract and, in no event,shall the policy Limits of Insurance be increased by the contract. 2. All insuring agreements,exclusions, terms and conditions of the policy shall apply to the coverage(s) provided to the Additional Insured, and such coverage shall not be enlarged or expanded by reason of the contract. 3. Coverage provided by this endorsement shall be excess over any other valid and collecti- ble insurance available to the Additional Insured (s) whether primary, excess, contin- gent or on any other basis unless the contract specifically requires that this insurance be primary or you request that it apply on a primary basis prior to loss. F F Authorized Agent tt DA-6ZO4 (05/2000)Ptd. in U.S.A. s� ..^ T 2.u.: 155253?1 Barbara A. nus:is X312{}13 2:50:55 Pi`. rage. 7 of 7/3/2013 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured Endorsement Number Naz Mat Trans, Inc. 02 Policy Symbol Policy Period Effective Date of Endorsement CAL Inc_. J8/1/2012 to 8/1/2013 8/1/2012 Issued By(Name of Insurance Company) ACE Fire Underwriters Insurance Company The above Is required to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement Modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM MOTOR CARRIERS COVERAGE FORM GARAGE COVERAGE FORM We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a"covered auto'. The waiver applies only to the person or organization shown in the Schedule. SCHEDULE Any person or organization for whom you are required in a written contract or agreement to waive any right of recovery we may have against the person or organization, but only for"bodily injury"or"property damage"to which this insurance applies if the"accident is caused by a)you,while using a covered"auto", or b)a er person,while using a covered"auto"with your permission. Authorized Agent DA-13115 12/02 Page I Of 1 64 CERF NO,: 16929321 8.rb— A. H-9 7/2/2013 2:50:58 P'll Paq. 8 of 6