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HomeMy WebLinkAboutInsurance� �`' UERTIFICATE OF LIABILITY INSURANCE OATE(MM/201YYYY) O6lOS/20„ EMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: HOLDER THIS BY THE POLICIES AUTHORIZED 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 , , ficate holder in lieu of such endorsement(s)- PRODUCER AOn Risk Services Northeast, Inc. Parsippany NJ OfficeP 10 Lanidex Center West P.O. BOX 608 Parsippany Ni 07054-0608 USA CONTACT NAME: (NcN .Ext): NE (866) 283-7122 FAx (847) 953-5390 (NC. No.): EMAIL ADDRESS: INSURERISI AFFORDING COVERAGE NAIC k INSURED Bureau veritas North America, Inc. 11590 w. Bernardo Court, #100 San Diego CA 92127 USA COVERAGES r`FRT71=Ir`ATC All.Aorn. r-Innan-r-rrr.-rn INSURER A: Lexington Insurance Company 19437 INSURERS: New Hampshire Ins Co 23841 INSURER C: National Union Fire Ins Co of Pittsburgh 19445 INSURERD: Commerce & Industry Ins Co 19410 INSURER E: Granite State Insurance Company 23809 INSURER F: Holder Identifier ; - - --_-_ _, — -- .-.. �� -- r cvLJluN NUMtjtI: THIS INDICATED- CERTIFICATE EXCLUSIONS INSR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR D TypE of INSURANCE AD 5 INSR tJRR WVD POLICY NUMBER POLICY E1-F MM/DD POLICY EXP iiMM/DDIYYW1 LIMITS GENERALUABIUTY X GL6439313 4/01/201 04/01/201 EACH OCCURRENCE S1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS DAMAGE TO RENeEU PREMISES (Ea occurrence) S1,000,000 -MADE I X I OCCUR MED EXP (Any one person) S25,000 PERSONAL & ADV INJURY S1,000,000 GENERALAGGREGATE 82,000,000 u: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n X 1 PRODUCTS . COMP/OP AGG S2,000,000 0, C LDC JiC7 11 a 0 AUTOMOBILE LIABILrrY CA 3377177 AOS 04/01/2011.64/01/2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 E X ANYAUTO AU OWNED SCHEDULED CA 3377178 MA 04/01/2011 04/01/2012 - BODILYINJURY(Perperson) C A AUTOS A AUTOS BODILY INJURY (Per accident) Z 6 HIRED AUTOS NON -OWNED PROPERTY DAMAGE (Per accident) ra O t: UMBRELLA LIAB OCCUR EACH OCCURRENCE a) 0 EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION B WORKERS COMPENSATIONAND EMPLOYERS- UABWTY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE WCO25842303 AOS 04/01/2011 01/2011 04/01/2012 01/2012 X WC STATU- TORY LIMITS OT ERH B f OFFICER/MEMBEREXCLUDED? I N I (Mandatory in NH) 111 N/A WCO25842304 04/01/2011 04/01/2012 EL. EACH ACCIDENT S1,000,000 Il yes, describe under DESCRIPTION OF OPERATIONS CA E.L. DISEASE- EMPLOYEE11,000,000 below E.L. DISEASE -POLICY LIMIT S1,000,000 A Archit&Eng Prof 026030221 SIR applies per policy terns 11/30/2010 & condi :ions 12/15/2011 Each Claim Aggregate $1,000,000 $1,000,000 — NM-___���fff JJJ... DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required! The Architects & Engineers policy includes coverage for Professional Liability and Contractors Pollution Liabi RE: On Call Professional Engineer-ng & Construction Services. City of National City is included as Additiona required by written contract, but limited to the operations of the Insured under said contract, per the applicable with respect to the General Liability and Automobile Liability policies. A waiver of Subrogation is granted in Certificate Holder as required by written contract but limited to the operations of the Insured under said contract, respect to the Workers' Compensation. ity. Insured as endorsement favor of with it, 7-'9 iii CANCELLATION City of National City Attn: Barby Tipton 1243 National City National City CA 91950 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE Will BE DELIVERED IN ACCORDANCE IMTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MIN ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and IDgo are registered marks of ACORD 2 ENDORSEMENT this ett.!orement, effective 12:01 A.M. 04/01/2011 forms a part of po!:cy No_CA 337-71-77 issued to BUREAU VERITAS NORTH AMERICA, INC. by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADD'L INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED AUTO SECTION II - LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement_ 87950 (10/05)Archive Copy Authdrfized Representative or Countersignature (in States Where Applicable) Page 1 of 1 3 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Thi ^nrtorsement changes the policy to which it is attached effective on inception date of the policy unless a different a?a ; indicated below. `ping clause" need be completed only when this endorsement is issued subsequent to preparation o: the policy). This endorsement, effective 12:0f AM 04/0112011 Issued to BUREAU VERITAS NORTH AMERICA, INC. By NEW HAMPSHIRE INSURANCE COMPANY Premium forms a part of Policy No. WC 025-84-2303 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. This agreement applies only to the extent that 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 any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Tennessee, Texas, Utah, or Washington. WC 00 03 13 (Ed. 04/84) Countersigned by Authorized Representative 5