HomeMy WebLinkAboutInsuranceClient#: 13851
CIVILSOUR
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Dealey, Renton & Associates
P. O. Box 10550
'ta Ana, CA 92711-0550
427-6810
DATE (MM/DD/YYYY)
09/22/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
Civil Source, Inc-
500 Wald Street
Irvine, CA 92618
INSURER A Travelers Indemnity Co. of Connectic
INSURER B Travelers Property Casualty Co of Am
INSURERC: Travelers Casualty&Surety Co of Amer
INSURER D:
NAIC #
25682
25674
31194
INSURER E:
COVERAGES
I r 1i I-Vt_,,.nw yr- IIVOUfCtUVyC uO I Cu tscwvV HAVE tittN ISSUtU I O I HE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'L
INSRC
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MMIDD/yY)
LIMITS
A
GENERAL
LIABILITY
6802810L758
07/20/10
07/20/11
EACH OCCURRENCE
$1,000,000
X
COMMERCIAL GENERAL LIABILITY
General Liab.
DAMAGE RENE
PR£M SESO(Fa occur° noel
$1,000,000
CLAIMS MADE X OCCUR
excludes claims
MED EXP (Any one person)
$10,000
X
Contractual Liab.
arising out of
PERSONAL &ADV INJURY
$1,000,000
the performance
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
of professional
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY X PRO-
JECT LOC _
services.
B
AUTOMOBILE
LIABILITY
BA4592L377
07/20/10
07/20/11
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident)
$1,000,000
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
X
HIRED AUTOS
BODILY INJURY
X
NON -OWNED AUTOS
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN FA ACC
$
AUTO ONLY: AGG
$
B
EXCESS/UMBRELLA LIABILITY
CUP6772Y251
07/20/10
07/20/11
EACH OCCURRENCE
$1,000,000
X
OCCUR CLAIMS MADE
Does not
include
AGGREGATE
$1,000,000
$
DEDUCTIBLE
Professional
RETENTION $
Liability.
$
$
B
WORKERS COMPENSATION AND
UB6771Y518
07/20/10
07/20/11
X WC STATU- OTH-
EMPLOYERS' LIABILITY
TORY I IMITS FR
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - EA EMPLOYEE
$1,000,000
S
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
C
OTHER Professional
105316987
07/20/10
07/20/11
$2,000,000 per claim
Liability
$2,000,000 arm! aggr.
C
Claims made
$5,000 Ded. per claim
DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
The City of National City, its elected officials, officers, agents, and
employees are additional insured on General & Auto Liability coverage as
per written contract.
Waiver of subrogation included in work comp.
(See Attached Descriptions)
IFICATE HOLDER
City of National City
Attn: Maryam Babaki, P.E.
1243 National City
National City, CA 91950
CANCELLATION
Ten Day Notice for Non Payment of Premium
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL stRim MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,XyQXFA K
) OCNRXMCXXXRDtJQX7 IOIK-XXVXXWXXiN IXtegNICOt6C IXOCI eC3 AXSOSCDCD6M WXX
Kbrb£SWIXRX
AUTHOREPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S2742461M274245
2
THC
o ACORD CORPORATION 1988
General Liability Deductible: $0
AMS 25.3 (2001/08) 2 of 2 #S274246/M274245
3
POLICY NUMBER: BA4592L377 COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
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.
Endorsement effective
09/22/10
Named Insured
Civil Source,
Inc.
Name of Person(s) or Organization(s):
City of National City
Attn: Maryam Babaki, P.E.
1243 National City
National City, CA 91950
SCHEDULE
The City of National City, its
elected officials, officers,
agents, and employees.
(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
CA20480299
Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
4
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76 (00) --
POLICY NUMBER: UB6771Y518
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
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 the person or organization named in the Schedule.
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be % of the California workers' Compensation pre-
mium otherwise due on such remuneration.
Person or Organization:
City of National City
Attn: Maryam Babaki, P.E.
1243 National City
National City, CA 91950
DATE OF ISSUE: 09/22 /10,
Schedule
Job Description:
The City of National City, its
elected officials, officers,
agents, and employees.
5
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
(ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. The following is added to WHO IS AN INSURED
(Section II):
Any person or organization that you agree in a
"contract or agreement requiring insurance" to in-
clude as an additional insured on this Coverage
Part, but only with respect to liability for "bodily in-
jury", "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 on any basis to
any person or organization for which cover-
age as an additional insured specifically is
added by another endorsement to this Cover-
age Part.
e. This insurance does not apply to the render-
ing of or failure to render any "professional
services".
f. The limits of insurance afforded to the addi-
tional insured shall be the limits which you
agreedin 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
CG D3 81 09 07
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 the insurance
provided to an additional insured under this Cov-
erage Part must apply on a primary basis, or a
primary and non-contributory basis, this insurance
is primary to other insurance that is available to
such additional insured which covers such addi-
tional 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". But this insur-
ance still is excess over valid and collectible other
insurance, whether primary, excess, contingent or
on any other basis, that is available to the insured
when the insured is an additional 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 any person or organization because of
payments we make for "bodily injury", "property
damage" or "personal injury" arising out of "your
work" performed by you, or on your behalf, under
a "contract or agreement requiring insurance" with
that person or organization. We waive these
rights only where you have agreed to do so as
part of the "contract or agreement requiring -insur-
ance" with such person or organization entered
into by you before, and in effect when, the "bodily
2007 The Travelers Companies, Inc.
Includes the copyrighted material of Insurance Services Office, Inc with its permission
6
Page 1 of 2
COMMERCIAL GENERAL LIABILITY
injury" or "property damage" occurs, or the "per-
sonal injury" offense is committed.
D. The following definition is added to DEFINmONS
(Section V):
"Contract or agreement requiring insurance"
means that part of any contract or agreement un-
der which you are required to indude a person or
organization as an additional insured on this Cov-
erage Part, provided that the "bodily injury" and
"property damage" occurs, and the "personal in-
jury" is caused by an offense 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.
Page 2 of 2
m 2007 The Travelers Companies, inc.
includes the copyrighted material of insurance Services Office, inc., with Its permission
7
CG D3 81 09 07