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HomeMy WebLinkAboutCOI 04-19-2024ACOR" DATE (MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 04/19/2024 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 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. Astatement on this certificate does not confer rights to the certificate holder in lieu ofsuch endorsement(s). PRODUCER CONTACT NAME: Desmond Sandlin PHONE FAX 1297 Flynn Rd Ste 220 (A/C. NO, EXT): 805-389-6822 (A/C, NO): 805-389-6994 E-MAIL Camarillo CA 93012-8029 ADDRESS: desmond@sandlinagency.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: GEMINI INSURANCE COMPANY INSURERS: TRUCK INSURANCE EXCHANGE RCH Construction, Inc. INSURERc: REDWOOD FIRE & CASUALTY INSURANCE CO 935 Riverside Ave #8 INSURER D: Paso Robles, Ca 93446 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDTL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE /� OCCUR DAMAGE TO RENTEDPREMISES(EaOccurrence) $ 100,000 MED EXP (Anyone person) $ 5,000 PERSONALS, ADV INJURY $ 1,000,00 A X X VCGP031494 03/26/2024 03/26/2025 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,00 COMBINED SINGLE LIMIT (Ea accident) $ $ 1,000,00 OTHER: AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ C OWNEDAUTOS X SCHEDULED 1APM036961-01 07/12/2023 07/12/2024 PROPERTY DAMAGE (Per accident) $ HIREDAUTOS X NON -OWNED ONLY AUTOS ON LY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE E.L. DISEASE- POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below All Risk Contractors Equipment Floater Physical Damage Coverage B X X 07035994 07/12/2023 07/12/2024 RENTED/BORROWED EQUIPMENT LIMIT $250,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is named as additional insured for both ongoing and completed operations on a primary and non-contributory basis on the Commercial General Liability insurance policies. Waiver of subrogation is in favor of the certificate holder in regards to the General and Auto Liability coverage. CERTIFICATE HOLDER CANCELLATION City of San Luis Obispo, A Municipal Corporation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Public Works Department DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 919 Palm Street AUTHORIZED REPRESENTATIVE San I iris Obispo CA 93401 ACORD 25 (2016/03) 31-1769 11-15 u 1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD Policy Number: VCGP031494 CG 20 12 12 19 Insured Name: RCH Construction Inc. Number: 33 Effective Date:03/26/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL Rill-.1Qky/61[M00»SLyy I116"Ke7:7_11�9:[6]:lIF,&IIEel ►61 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule State Or Governmental Agency Or Subdivision Or Political Subdivision: Any qualifying entity when you have agreed in a written and executed contract, prior to an "occurrence", that such qualifying entity be added as an additional insured on your policy. 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 All other terms and conditions of this Policy remain unchanged. CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 Policy Number: VCGP031494 CG 20 18 12 19 Insured Name: RCH Construction Inc. Number: 34 Effective Date: 03/26/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MORTGAGEE, ASSIGNEE OR RECEIVER This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Names Of Persons Or Organization(s) Designation Of Premises Any person or organization you have agreed in a All premises for which you have agreed in a written and executed contract, prior to an written and executed contract prior to an "occurrence", that such person or organization be "occurrence." added as an additional insured on your policy. 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 their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of the premises by you and shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. All other terms and conditions of this Policy remain unchanged. CG 20 18 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VCGP031494 CG 24 04 12 19 Insured Name: RCH Construction Inc. Number: 35 Effective Date: 03/26/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Person(s) Or Organization(s): Any person or organization you have agreed in a written and executed contract, prior to an 'occurrence", that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. All other terms and conditions of this Policy remain unchanged. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VCGP031494 VE 09 73 04 20 Insured Name: RCH Construction Inc. Number: 40 Effective Date: 03/26/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other Commercial General Liability insurance available to an additional insured under your policy, but only if: (1) The additional insured is a Named Insured under such other Commercial General Liability insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other Commercial General Liability insurance available to the additional insured. Coverage granted to an additional insured remains subject to all terms, conditions, limitations, and exclusions set forth in the endorsement form that conferred the additional insured status. In the event of conflict between this endorsement and an endorsement conferring additional insured status, then the endorsement conferring additional insured status shall govern the scope of coverage available to the additional insured. All other terms and conditions of this Policy remain unchanged. VE 09 73 04 20 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission Policy Number: VCGP031494 CG 20 10 04 13 Insured Name: RCH Construction Inc. Number: 41 Effective Date: 03/26/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR 101hole _ L1IIF, /_,IIIs] 0 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 Any person or organization when you have agreed All locations for which you have agreed in a written in a written and executed contract prior to an and executed contract prior to an "occurrence." "occurrence", that such person or organization be added as an additional insured on your policy. 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 behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 location of the covered operations has been completed; or CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 Policy Number: VCGP031494 CG 20 37 04 13 Insured Name: RCH Construction Inc. Number: 42 Effective Date: 03/26/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person or organization when you have agreed All locations and completed operations for which in a written and executed contract, prior to an you have agreed in a written and executed "occurrence", that such person or organization be contract prior to an 'occurrence." added as an additional insured on your policy. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1