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HomeMy WebLinkAboutCertificateANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 10/3/2023 License # 0E67768 (925) 660-3507 (925) 416-7869 20443 Environment Planning Development Solutions Inc dba EPD Solutions Inc 3333 Michelson Dr., Suite 500 Irvine, CA 92612 29424 A 2,000,000 X X B6025654530 6/23/2023 6/23/2024 1,000,000 10,000 2,000,000 4,000,000 4,000,000 1,000,000A X X B6025654530 6/23/2023 6/23/2024 4,000,000A X X B6025663132 6/23/2023 6/23/2024 4,000,000 10,000 B X 57WEGAC20BW 9/30/2023 9/30/2024 1,000,000 N 1,000,000 1,000,000 A Professional Liab.X EEH591923312 9/30/2023 Per Claim 2,000,000 A Professional Liab.X EEH591923312 9/30/2023 9/30/2024 Aggregate 4,000,000 Lakeside Project (PA 2021-11) As required by Certificate Holder written contract or agreement, in-addition to (if applicable) the governing written contract or agreement: (1) Commercial General Liability policy shall include (a) additional insured coverage and contain (b) primary & non-contributory and (c) waiver of subrogation provisions for any additional insured; (2) to the extent applicable, Automobile Liability policy shall include (a) additional insured coverage and contain (b) primary & non- contributory and (c) waiver of subrogation provisions for any additional insured; (3) to the extent applicable, Commercial Excess Liability policy shall apply on a follow-form basis, excess of commercial general liability, automobile liability and employers’ liability policy(ies) with such coverage being concurrent with underlying insurance; (4) to the extent applicable, Workers Compensation and Employers’ Liability policy shall include a waiver of subrogation provision; SEE ATTACHED ACORD 101 City of Lake Elsinore 130 South Main Street Lake Elsinore, CA 92530 ENVIPLA-02 PATILL IOA Insurance Services 3875 Hopyard Road Suite 200 Pleasanton, CA 94588 David Sifuentes David.Sifuentes@ioausa.com Continental Casualty Company Hartford Casualty Insurance Company X 9/30/2024 X X X X X X X X FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. IOA Insurance Services ENVIPLA-02 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance License # 0E67768 1 SEE P 1 Environment Planning Development Solutions Inc dba EPD Solutions Inc 3333 Michelson Dr., Suite 500 Irvine, CA 92612 SEE PAGE 1 PATILL 1 Description of Operations/Locations/Vehicles: (5) Professional Liability policy shall apply on a claims-made basis and include a waiver of subrogation provision. (a) City and its officers, employees, servants, volunteers and authorized agents and independent contractors, including without limitation, the City Manager SB146902G (6-16) Policy No: Page 1 Endorsement No: Effective Date: Insured Name: © CNA All Rights Reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AUTO AND NON-OWNED AUTO LIABILITY This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS SCHEDULE Insurance is provided only with respect to those coverages for which a specific limit is shown: COVERAGE LIMIT Hired Auto Liability: $ _______________ Non-owned Auto Liability: $ _______________ (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) PROVISIONS A. COVERAGE With respect only to the Coverage(s) for which a limit is shown in the SCHEDULE above, the insurance provided under Coverage A.1. Business Liability for "bodily injury" and "property damage" also applies to “bodily injury” or “property damage” arising out of the maintenance or use of a: • "Hired auto" used by you or your “employee” in the course of your business; and/or • "Non-owned auto" used in the course of your business. Maintenance or use of a "non-owned auto" includes test driving in connection with an "auto business." With respect only to the coverage provided by this endorsement, under Coverages, coverage A.1. Business Liability is amended to: 1. Delete paragraph A.1.b.(1)(b) and replace it with the following: b. This insurance applies: (1) To “bodily injury” and “property damage” only if: (b) The “occurrence” occurs during the policy period; and 2. Delete paragraph A.1.b.(2),. B. LIMITS OF INSURANCE With respect only to the coverage provided by this endorsement, SECTION D. Liability And Medical Expenses Limits of Insurance is deleted in its entirety and replaced with the following: D. Limits Of Insurance 1. Regardless of the number of: a. Insureds; b. Claims made or "suits" brought; c. Persons or organizations making claims or bringing "suits"; or   SB146902G (6-16) Policy No: Page 2 Endorsement No: Effective Date: Insured Name: © CNA All Rights Reserved. d. "Autos," the applicable Hired Auto Liability limit or Non-Owned Auto Liability limit shown in the Declarations is the most we will pay for damages under SECTION A. Coverages because of all "bodily injury" and "property damage" resulting from any one “occurrence” arising out of the maintenance or use of a “hired auto” or “non-owned auto”. C. EXCLUSIONS With respect only to the insurance provided by this endorsement: 1. Under Exclusions, the paragraph entitled Applicable to Business Liability Coverage is amended to delete all exclusions except exclusions a., b., d., e., f. and i. and to add the following exclusions: This insurance does not apply to: • Fellow Employee "Bodily injury" to: (1) Any fellow "employee" of the insured arising out of and in the course of employment by the insured or while performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that fellow “employee” while as a consequence of Paragraph (1) above. • Care, Custody or Control "Property Damage" to: (1) Property owned or being transported by, or rented or loaned to the insured; or (2) Property in the care, custody or control of the insured. D. WHO IS AN INSURED With respect only to the insurance provided by this endorsement, Who Is An Insured is replaced by the following: Each of the following is an insured under this insurance to the extent set forth below: 1. You; 2. Subject to paragraph 3.c. below, your "employee" while operating an "auto" hired or rented under a contract or agreement, with your permission, in that "employee's" name, while performing duties related to the conduct of your business. 3. Anyone else including any partner or "executive officer" of yours while using with your permission a "hired auto" or a "non-owned auto" except: a. The owner or lessee (of whom you are a sublessee) of a "hired auto" or the owner or lessee of a "non-owned auto" or any agent or "employee" of any such owner or lessee; b. Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household;   SB146902G (6-16) Policy No: Page 3 Endorsement No: Effective Date: Insured Name: © CNA All Rights Reserved. c. Your "employee" if the covered "auto" is leased, hired or rented by him or her or a member of his or her household under a lease or rental agreement for a period of 180 days or more; d. Any partner or "executive officer" with respect to any "auto" owned by such partner or officer or a member of his or her household; e. Any partner or "executive officer" with respect to any "auto" leased or rented to such partner or officer or a member of his or her household under a lease or rental agreement for a period of 180 days or more; f. Any person while employed in or otherwise engaged in duties in connection with an "auto business," other than an "auto business" you operate; g. Anyone other than your "employees," partners, a lessee or borrower or any of their "employees," while moving property to or from a "hired auto" or a "non-owned auto"; or 4. Any other person or organization, but only with respect to their liability because of acts or omissions of an insured under 1., 2. or 3. above. E. AMENDED DEFINITION The Definition of "insured contract" in Section F – Definitions is amended by the addition of the following exceptions to paragraph f.: Paragraph f. does not include that part of any contract or agreement: • That pertains to the loan, lease or rental of an "auto" to you or any of your "employees," if the "auto" is loaned, leased or rented with a driver; or • That holds a person or organization engaged in the business of transporting property by "auto" for hire harmless for your use of a covered "auto" over a route or territory that person or organization is authorized to serve by public authority. F. ADDITIONAL DEFINITIONS Section F. Definitions is amended by the addition of the following definitions: a. "Auto Business" means the business or occupation of selling, repairing, servicing, storing or parking "autos." b. "Hired auto" means any "auto" you or your "employee" lease, hire, rent or borrow in the course of your business. This does not include: i. Any "auto" you lease, hire or rent under a lease or rental agreement for a period of 180 days or more, or ii. Any "auto" you lease, hire, rent or borrow from any of your "employees," partners, stockholders, or members of their households. c. "Non-owned auto" means any "autos" you do not own, lease, hire, rent or borrow that are being used in the course and scope of your business at the time of the "occurrence." This includes "autos" owned by your "employees" or partners or members of their households but only while being used in the course and scope of your business at the time of the "occurrence." If you are a sole proprietor, "non-owned auto" means any "autos" you do not own, lease, hire, rent or borrow that are being used in the course and scope of your business or personal affairs at the time of the "occurrence."   SB146902G (6-16) Policy No: Page 4 Endorsement No: Effective Date: Insured Name: © CNA All Rights Reserved. G. With respect only to the operation of a "hired auto" or "non-owned auto," Paragraph H, of the Businessowners Common Policy Conditions is deleted and replaced with the following: H. Other Insurance 1. Except for any liability assumed under an "insured contract" the insurance provided by this Coverage Form is excess over any other collectible insurance. However, if your business is the selling, servicing, repairing, parking or storage of "autos," the insurance provided by this endorsement is primary when covered "bodily injury" or "property damage" arises out of the operation of a customer's "auto" by you or your "employee." 2. When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy.   THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Form WC 04 03 06 Policy Expiration Date: WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Endorsement Number:Policy Number: Effective Date: Named Insured and Address: SCHEDULE Person or Organization Job Description