2018 SEWER POINT REPAIRS AND IMPROVEMENTS PROJECT - 17-0060-UT - CERTIFICATE OF LIABILITY INSURANCE (6) P5260028002
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DATE(MM/DDIYYYY)
AC"RV CERTIFICATE OF LIABILITY INSURANCE
09/13/2019
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($).
CONTACT
PRODUCER LIC #OC36861 1-415-403-1491 NAME:_ Kimberly Leikan
Alliant Insurance Services, Inc. PHONE 415-403-1491 �FAX
415-874-4818
>
E-MAIL
ADDRESS, kleikam@alliant.com
100 Pine Street, 11th Floor LU
INSURES)AFFORDING COVERAGE
NAIC If
San Francisco, CA 94111 INSURERA:VALLEY FORGE INS CO 20508
INSURED -INSURERS: CONTINENTAL CASCO 120443
Granite Inliner, LLC INSURERC: TRANSPORTATION INS CO 20494
585 West Beach Street INSURIERD:AGCS MARINE INS CO 22837
-
INSURERE:
lWatsonville, CA 95076 INSURER F;
COVERAGES CERTIFICATE NUMBER: 57222080 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.
...........
NBRT I L SUBRI P LICY EFF
LICY EXP
LTR TYPE OF INSURANCE IN 0 WVD POLICY NUMBER (MWDDIYYYY)I(M0M,PDrMYI 1 LIMITS
A X COMMERCIAL GENERAL LIABILITY X X GL2074978689 10/01/1810/01/21 EACHOCCURRENCE $ 2,000,000
CLAIMS-MADE lil OCCUR A PR�Mlsl (Ea occurrence) ,—I
- , 2,000,000
� —.--
X XCU MED EXP An one person) $ Nil
X Contractual Liability PERSONAL&ADV INJURY $ 2,000,000
9EN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
1�10,000,000
X PRO-
POLICY JECT LX j LOC PRODUCTS-COMPIOPAGG $ 2,000,000
OTHER; $
A AUTOMOBILE LIABILITY 10/01/18 10/0117/25_1 7COMBYINED SINGLE LIMIT
X X BTJA2074978692
_.JEa accident- 1$ 2,000,000
ANY AUTO BODILY INJURY(Per person) $
X .,L IN
OWNED SCHEDULED
I I BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED VROPEVIY�bkk E �s
X AUTOS ONLY AUTOS ONLY
I — I$
0 EACHOCCURRENCE B j UMBRELLA LIAB X 'OCCUR CUE2068209453 I � 8,000,000
rX 10,01/,9 10/01/2 NCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 8,000,000
RETENTION $
DED
WORKERS COMPENSATION STATUTE!AND EMPLOYERS'LIABILITY X WC274978644 (AOS/StopG&p)10/01/19 10/01/20 _ X UTE ER
C I YIN 10/01/19 10/01/20 E.L.EACH ACCIDENT $ 2,000,000
IANYPROPRIETOR/PARTNEPJEXECUTIVE X WC274978661 (MT,WI,HI)
OFFICER/MEMBER EXCLUDED N NIA
C (Mandatory In NH X WC274978658 (NY) 10/01/19 10/01/20 E,L.DISEASE.EA EMPLOYEEI$ 2,000,000
If as,describe under
A D SCRIPTION OF OPERATIONS below X WC274978630 (CA) 10/01/19 10/01/20 E,L.DISEASE-POLICY LIMIT $ 2,000,000
D owned, Leased/Rented Eqpt MX193059745 07/01/18 07/01/20 !Limit 2,000,000
gPer Occurrence
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Re: 2018 Sewer Point Repair & Improvements Project # 17-0060-UT
City of Clearwater, its respective officers and employees are included as an additional insured as respects General
Liability on a primary and non-contributory basis, and Automobile Liability, per the attached endorsements. General
Liability, Automobile Liability and Workers' Compensation waiver of subrogation applies in favor of the above reference
additional insureds, per the attached endorsements.
30 Days Written Notice of Cancellation for Non-Renewal and 10 Days Notice of Cancellation for Non-Payment of Premiums
OL Per ISO Form C00001 10/01; AL Per ISO Form CA0001 10/13
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Construction Office Specialist AUTHORIZED REPRESENTATIVE
P.O. Box 4748
Clearwater FL 33758-4748 USA
01988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 01
dltamayo SEP 2 0
57222080
'322W028002 e
SUPPLEMENT TO CERTIFICATE OF INSURANCE 09/DATE
13/2019
NAME OFINSURED: Granite xnliner, LLC W
ri
r
SUPP(10/00)
P5260028002
G-140831-D
CNA (Ed.01/13)
BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE
PART as follows: N
Z
SCHEDULE(OPTIONAL)
Name of Additional Insured Persons Or Organizations
(As required by"written contract"per Paragraph A. below.)
Locations of Covered Operations
(As per the"written contract,"provided the location is within the"coverage territory"of this Coverage Part.)
A. Section 11-Who Is An Insured is amended to include as an additional insured:
1. Any person or organization whom you are required by "written contract" to add as an additional insured on
this Coverage Part;and
2. The particular person or organization, if any, scheduled above.
B. The insurance provided to the additional insured is limited as follows:
1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property
damage,"or"personal and advertising injury"caused in whole or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of
your ongoing operations specified in the"written contract";or
b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage"
included in the"products-completed operations hazard,"and only if:
(1) The"written contract"requires you to provide the additional insured such coverage; and
(2) This Coverage Part provides such coverage.
2. If the"written contract"specifically requires you to provide additional insurance coverage via the 10/01 edition
of CG2010(aka CG 20 10 10 01), or via the 10/01 edition of CG2037(aka CG 20 37 10 01), or via the 11/85
edition of CG2010(aka CG 20 10 11 85),then in paragraph B.1.above,the words'caused in whole or in part
by'are replaced by the words'arising out of'.
3. We will not provide the additional insured any broader coverage or any higher limit of insurance than:
a. The maximum permitted by law;
b. That required by the"written contract"; SEP 2 0 206
c. That described in B.1.above;or
d. That afforded to you under this policy,
whichever is less,
4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is
excess of all other insurance available to the additional insured whether on a primary, excess, contingent or
G-140331-D (Ed.01/13) POLICY#:GL2074978689
Page 1 of 2 EFFECTIVE: 10/01/2018
Copyright,CNA All Rights Reserved.
�m --
� 8F140831-O
� (Edi 01/13)
CNA |
any other basisBut if — -' the "written contract" tobe primary—' and non-contributory, this insurance
will boprimary and . relative toinsurance un additional insured isNamed Insured. �~
�
5. The insurance additional insured does not apply to "bodily injury," "property damage," or
'.personal and advertising injury"arising out of:
a. The rendering of, or the failure to ender, any professional amhitectuna|, ongineahng, or surveying �
services, including: >
(1) The preparing, approving, or failing to prepare or approve maps, shop dmwings, opinions, reports, � |
surveys,field orders,change orders or drawingand specifications;and /
(2) Gupemisory, inspection, architectural or engineering activities;o/
b. Any premises orwork for which the additional insured is specifically listed as an additional insured on
another endorsement attached hothis Coverage Part.
C. SECTION |V- COMMERCIAL GENERAL LIABILITY CONDITIONS ioamended aofollows:
1. The Duties in The Event of Occurrence,Offense, Claim or Suit condition in amended to odd the following
additional conditions applicable 10the additional insured:
Anadditional insured under this endorsement will oosoon aapracticable: '
(1) Give us written ncdiuo of an "occurrence" or an offense which may result inaclaim or "suit" under this
insurance, and Vfany claim or"suit"that does result;
(2) Except as provided in Paragraph B.4. of this ondomnmend, agree to make available any other insurance
the additional insured has for eloss wecover under this Coverage Part;
(3) Gond us copies of all legal papers reoeived, and otherwise cooperate with us in the investigation,
defense,orsettlement oithe claim or"muir';and
(4) Tender the defense and indemnity of any claim or "suit" 8uany other insurer nrself insurer whose policy
or program applies to o|omo we cover under this Coverage Part. But if the"written contract" requires this
insurance to be primary and non-nonhibutory, this provision(4)does not apply to insurance on which the
additional insured ieeNamed Insured.
We have no duty to defend o,indemnify an additional insured under this endorsement until we receive from
the additional insured written notice ofaclaim or"muit"
D. Only for the purpose of the insurance provided by this endorsement, SECTION V~ DEFINITIONS is amended to
add the following definition:
"Written contract" means a written contract or written agreement that requires you to make u person or
organization onadditional insured onthis Coverage Pmrt, provided the contract or agreement:
1. Is currently in effect or becomes effective during the term of this policy;and
2. Was executed prior to: �
o. The"bodily injury"or"property damego ;or
b. The offense that caused the"personal and advertising hnjurK"
for which the additional insured seeks coverage under this Coverage Part. |
|
All other terms and conditions of the Policy remain unchanged.
Material used with permission ofISO PmporUnn. Inc.
G-140331-D (Ed.01/13) POLICY#: GL2074978689
Page 2 of 2 EFFECTIVE: 10/01/2018
Copyright,CNA All Rights Reserved.
|
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ O[CAREFULLY.
�
Waiver w{Transfer of Rights of Recovery Against Others to Us
�
C�
This endorsement modifies insurance provided under the following: —
Commercial General Liability Coverage Form
Under SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS,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 any person or organization because of payments we
make for injury ordamage arising out of: �
1. Your ongoing operations;or
2. "Your work"included in the"products completed operations hazard."
However,this waiver applies only when you have agreed in writing to waive such rights of recovery in a
contract o/agreement,and only ifthe contract oragreement:
1. |mineffect orbecomes effective during the term ofthis policy;and
2. Was executed prior\oloss.
This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective
date ioshown below.
Must Be Completed Complete Only When This Endorsement Is Not Prepared
with the Policy Or Is Not to be Effective with the Policy
ENDT.NO. POLICY NO. ISSUED TO: EFFECTIVE DATE OF THIS �
26 ENDORSEMENT:
GIL 2074978689 Granite Construction Incorporated 10/01/18
�
|
�
-
� CNA71627XX
(Ed. 10/12)
ADDITIONAL UNSURED ~ PRIMARY AND NON-CONTRIBUTORY
kisunderstood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:
SCHEDULE
Name of Additional Insured Persons Or Organizations
�
Any person or organization whom the named insured is required by written contract to add as an additional insured
on this policy.
|
1. In conformance with paragraphA.1.c. ofWho |sAmInsured ofSection U - LIABILITY COVERAGE, the person
ororganization scheduled above|nuninsured under this policy.
2. The insurance afforded to the additional insured under this policy will apply on u primary and non-contributory
basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the
^aooident"[orwhiohtheeddi\iona|inuumdaeehmcnvarogaund*rthinpo|icy.
All other terms and conditions ofthe Policy remain unchanged.
CNA71527XX(10/12) Policy No: BUA2074978692
Page 1 of 1 Endorsement No:
Effective Date: 10/01/2018
Insured Name: Granite Construction Incorporated
Copyright CNA All Rights Reserved.
POLICY NUMBER: BUA2074978692 COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY 3
C>
AGAINST OTHERS TO US (WAIVER OF SUBROGATION) >
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: Granite Construction Incorporated
Endorsement Effective Date: 10/01/2018
SCHEDULE
Name(s)Of Person(s)Or Organization(s):
Any person or organization for whom or which you are required by written contract or agreement to obtain this
waiver from us.
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against
Others To Us condition does not apply to the
person(s) or organization(s) shown in the Schedule,
but only to the extent that subrogation is waived prior
to the "accident" or the "loss" under a contract with
that person or organization.
CA 04 44 1013 Copyright, Insurance Services Office, Inc.,2011 Page 1 of 1
P260028002
G-1 9160-B
(Ed, 11/97)
WORMERS'COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE POLICY
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS-CALIFORNIA
This endorsement changes the policy to which it is attached, >
It is agreed that Part One—Workers'Compensation Insurance G.Recovery From Others and Part Two—Employers'Liability
Insurance H.Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations.(This agreement applies only to the extent that you perform
work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE 1q
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure.
The amount is nla
UTAH WAIVER OF SUBROGATION ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Utah Is shown in Item &A. of the Information
Page,
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 anyone not named in the Schedule. Our waiver of rights does not
release your employees' rights against third parties and does not release our authority as trustee of claims against third
parties.Schedule : Any person or organization for whom the named Insured has agreed by written contract to furnish
this waiver,
WC43 03 05(Ed 7-00)
............... ......................................................... ....................
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
All Other States where allowed(except CA,TX,UT)
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 Vie 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 anyone not named in the Schedule.
Schedule
Any person or organization for whom the named Insured has agreed by written contract to furnish this waiver
WCOO 03 13(Ed 4-84)
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement Is issued subsequent to preparation of the policy.)
Endorsement Effective 10/01/2019
WC274978644 Valley Forge Insurance Company
WC274978658 Transportation Insurance Company
WC274978661 Transportation Insurance Company
WC274978630 Valley Forge Insurance Company
G-19160-B Page I of 1
(Ed. 11/97)
Alliant Insurance Services, Inc.
100 Pine Street, I I th Floor
San Francisco, CA 94111
Electronic Service Requested EBIX BPO
ALL FOR AADC 342
10291 1.1458 AB 0.409
111111111 111111
City of Clearwater 39
Engineering Department >
PO BOX 4748 z
ATTN: CONSTRUCTION OFFICE SPECIALIST
CLEARWATER, FL 33758-4748
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SEP 2 0 2019,
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