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HomeMy WebLinkAboutA5845 (2)A55� - v ACO114.�ROe CERTIFICATE OF LIABILITY INSURANCE GATE (11/29/2022MMIDD/YYYY) 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 endorsements . PRODUCER AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230 CONTACT NAME: Marie Swaney PNONE 626-698-189D FAIL No. MAIL Awns : CertsDesi nPr AssuredPartners.com Lafayette CA 94549 INSURERS AFFORDING COVERAGE NAIL• INSURER A: Sentinel Insurance Company 11000 INSURED CNSENGLO1 CNS Engineers, Inc. 949-588-6191 INSURERS: Travelers Casualty and Surely Cc Of America 31194 INSURER : Propeq & Casualty Insurance Company of Hartford 34690 INSURERD: 1 Orchard Rd, #225 Lake Forest CA 92630 INSURER:: INSURER F: COVERAGES CERTIFICATE NUMBER: 100691101 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. INSR LTR TYPE OF INSURANCE ADDL POLICYNUMBER POLICY EFF MMIDD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 57SBABN8700 12/11/2022 12/11/2023 EACHOCCURRENCE s1,000,0GO CI -AIMS -MADE FxIOCCUR PREMISES IEe 000J"n0e $1,000,000 X MED EXP (Any one ) $10,000 Curt atial Uab X I XCU Included PERSONAL&ADVINJURY $1,000,000 GEM AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY [K] JEcTT F�] LOC PRODUCTS-COMP/OPAGG $2,000.000 $ OTHER: A AUTOMOBILE LIABILITY Y Y 57SBABN8700 12/11/2022 12/11/2023 COMBINED SINGLE LIMIT Ea accident g1,000,000 BODILY INJURY (Par person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X S NoCamed Au[o A X UMBRELLAUAS X OCCUR Y Y 67SRABN8700 12/11/2022 12/11/2023 EACHOCCURRENCE $5,000,000 AGGREGATE $6,000,000 EXCESS UAB CWMSMADE DELI IXI RETENTIONS 10 OW $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICEMMEMBEREXCLUDEDZ El NIA Y 57WECAE4RW7 12H 1/2022 12/11/2023 X STATUTE ERA E.L. EACH ACCIDENT $1,000,000 EL. DISEASE - EA, EMPLD S1,000,000 (Mandatory In NH) K yes, descnbe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POUCY LIMIT I $1,000,000 B Pioresaimal Gablllly& 106214202 12/11/2022 12/11/2023 Par CIMrN3,000,000 $5,000,000/Aggr Polkhon Gab. Induded DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES (ADDING 101, Additional Remark. Schedule. in" be attached N more apace is required) Insured owns no company vehicles; therefore, hired/non-owned auto is the maximum coverage that applies. Umbrella Liability policy is follow -form to its undedyingg Policies: General Liability/Auto Liability/Employers Liability Re: #9002 Agreement #A5845, City Proj #08-25, Ramon Road Widening, San Luis Rey Drive to Landan Blvd. - City of Palm Springs, its officials, employees and agents are named as additional insured's as respects general and auto liability as required per written Contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached endorsement(s). CERTIFICATE HOLDER CANCELLATION 30 day Notice will be sent to holder CEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs, Eng Svcs Dept D EC 052022 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Vonda Teed, Eng Admin SEC AUTHORIZED REPRESENTATIVE 3200 E Tahquitz Canyon Way CIIy Hall Palm Springs CA 92262 Raceptjon Desk 00 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD