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HomeMy WebLinkAboutA8559 - SOUTH STAR ENGINEERING & CONSULTING. #1A g55� /1 SOUTENG-05 MICHELLIELYON CERTIFICATE OF LIABILITY INSURANCE DATE D 8/15/202rc3) 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 CONTAw,ACT Suzanne Okafor NFP Prop" & Casualty Services, Inc. 1551 North Tustin Avenue Suite500 PHONE FAX AM, No, Ext : ACC No): epp`glks,suzanne.okafo nfp.com INSURE S AFFORDING COVERAGE NAICa Santa Ana, CA 92705 INSURER A: Sentinel Insurance Company Ltd 11000 INSURED INSURER B:California Automobile Insurance Company 38342 INSURER c:Insurance Company of the West 27847 SouthStar Engineering & Consulting, Inc. 1945 Chicago Avenue Suite C-2 INSURERD:Llo dsSyndicate 2987 BritSyndicates Limited) XXXXX INSURER E: Riverside, CA 92507 INSURER F COVERAGES CERTIFICATE NUMBER- 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 CONDMON 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 SUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Im TYPE OF INSURANCE ADDL SU POLICY NUMBER IMP& EFF POUCYEXP ITS A X COMMERCIALGENERAL LIABILRY CI -AIMS -MADE �X OCCUR X 72SBABE7952 1/14/2023 111412024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 1,000,000 MED EXP M one erson S 10,000 PERSONAL &ADV INJURY 11000,000 GENL AGGREGATE LIMIT . APPLIES PER. X POLICY ElPEC7 EI LOC OTHER' GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGO 2,000,000 f B AUTOMOBILE t.ABIury ANY AUTO OWNED O�pE�S ONLY AAUUpTNNO.p(SyAA,T}����Dpp MUTOS ONLY X AUT0.R ONLY X BA040000063415 11/17/2022 11117/2023 COMBINED SINGLE LIMIT $11000,006 X BODILY INJURY Par n S BODILY INJURY Per actident X PP OPER MADE S f A X uMMELLA ME EXCESS LAB X OCCUR CLAIMS -MADE 72SBABE7952 1114/2023 111412024 EACH OCCURRENCE S 5,000,000 AGGREGATE 5,000,000 DELI I I RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETCR/PARTNERIEXECUTNE Y❑ OFF R�ryJ BER EXCLUOEOT INI NN) If yes describe under DESCRIPTION OF OPERATIONS tel. NIA X BD-5064219-01 2l9/2023 21912024 X I PER OTH- TA LITE E.L. EACH ACCIDENT f 1,000,000 E.L. DISEASE - EA EMPLOYE f 1,000,000 E..DISEASE - POLICY LIMIT 1,000,000 D E&O/Professional Lia PF00048A22 1211/2022 12/112023 Ded $76,000 3,000,000 DESCRIPTION OF OPERATIONS I LOCAnMS I VEHICLES (ACORD 101, Additional RemaMa Schedule, may ba aftchW X mon apace b raqulrW ) Project: On Call Construction Management and Inspection Services for a variety of future projects Excess Liability is follow form to underlying General Liability, Business Auto Liability and Worker's Compensation. CERTIFICATE HOLDER L7 Fr FTI/Fn CANCELLATION City of Palm Springs Attn: City Manager AUG 16 2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E. Tahquitz Way City Hall AUTHORIZED REPRESENTATIVE Palm Springs, CA 92262 Reception Desk ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT In consideration of the premium charged for this Policy, it is hereby understood and agreed that the following entity: - any client of yours is added as an additional Insured for claims made against it, but only to the extent you would have been liable and coverage would have been afforded under the terms and conditions of this Policy had such claim been made against you. The above -mentioned extension of coverage shall not apply to any claim which includes allegations or facts indicating actual or alleged independent or direct liability on the part of any such entity detailed above. It is a condition precedent to liability under the above -mentioned extension of coverage that such entity detailed above shall prove, to our satisfaction, the extent of any claim arising out of your conduct as described above. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED Page 43 of 54 PRIMARY NON-CONTRIBUTORY ENDORSEMENT In consideration of the premium charged for this Policy, it is hereby understood and agreed that Section VII. OUR OBLIGATIONS IN THE EVENT OF A CLAIM/CIRCUMSTANCE, subsection F. is amended by the addition of the following: Notwithstanding the foregoing, where required by a written contract or agreement coverage under this Policy shall qualify as primary and non-contributory insurance to any client of yours if; 1. a claim is made against them and you would have been liable and coverage would have been afforded under the terms and conditions of this Policy had such claim been made against you; and 2, the claim does not include allegations or facts indicating actual or alleged independent or direct liability on the part of your client. However, this insurance provided to the additional Insured shall still apply in excess of and shall not contribute with valid and collectible other insurance whether primary, excess, contingent or on any other basis, that is available to the additional Insured when that person or entity is an additional Insured under any other Policy. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED Page 44 of 54 conditions, mold conditions or media activities with respect to which insurance is afforded under this Polity; and 4. attending hearings and trials and assisting in securing and giving evidence and obtaining the attendance of witnesses. C. If you shall make any claim under this Policy knowing such claim to be false or fraudulent, with regards to the amount or otherwise, this Policy shall become null and void, and all coverage hereunder shall be forfeited. D. By acceptance of this Policy, you agree that the statements contained in any application submitted therewith are your agreements and representations, that they shall be deemed material to the risk assumed by us, and that this Policy is issued in reliance upon the truth thereof. The misrepresentation or non -disclosure of any matter by you or your agent in any application submitted to us will render the Policy null and void and relieve us from all liability under the Policy. The application is deemed incorporated into and made a part of this Policy. VII. OUR OBLIGATIONS IN THE EVENT OF A CLAIM/CIRCUMSTANCE A. We shall have the right and duty to defend, subject to the Limit of Liability, exclusions and other terms and conditions of this Policy: 1. any claim against you seeking damages which are payable under the terms of this Polity, even if any of the allegations of the claim are groundless, false or fraudulent; or 2. any claim in the form of a civil suit against you that seeks injunctive relief (meaning a temporary restraining order or a preliminary or permanent injunction) for one or more of the acts listed in Insuring Clause 7.a. B. We shall have the right to make any investigation we deem necessary, including, without limitation, any investigation with respect to the application and statements made in the application and with respect to coverage. However, notwithstanding the above, your rights under this Policy shall not be prejudiced by any refusal to disclose the identity of any confidential source of information, or to produce any documentation or information obtained in the course of media activities in respect of which you have asserted a claim of reporter's privilege or any other privilege regarding the protection of news - gathering activities. C. We have the right, at our discretion, to negotiate and settle any claim but will not enter into a settlement without your written consent. If you shall refuse to consent to any settlement or compromise we recommend which is acceptable to the claimant and you elect to contest the claim, our liability for any damages and claims expenses shall not exceed: 1. the amount for which the claim could have been settled, less the remaining Each Claim Deductible, plus the claims expenses incurred up to the time of such refusal; and Page 17 of 54 2. 30% of any damages and claims expenses incurred after the date such settlement or compromise was recommended to you, with the remaining 70% of such damages and claims expenses to be borne by you at your own risk and uninsured; or 3. the applicable Limit of Liability, whichever is less. At that point we shall have the right to withdraw from the further defense thereof by tendering control of said defense to you. The portion of any proposed settlement or compromise that requires you to cease, limit or refrain from actual or alleged infringing or otherwise injurious activity, or is attributable to future royalties or other amounts that are not damages, shall not be considered in determining the amount for which a claim could have been settled. D. It is further provided that we shall not be obligated to pay any damages or claims expenses, or to undertake or continue defense of any suit or proceeding after the applicable Limit of Liability has been exhausted, or after deposit of the applicable Limit of Liability in a court of competent jurisdiction. E. In the event we make any payment under this Policy, we shall be subrogated to all of your rights of recovery therefore against any person, organization or other third party, and you shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. You will do nothing to prejudice such subrogation rights. Any amount recovered upon the exercise of such rights of subrogation shall be applied as follows: first, to the repayment of expenses incurred toward subrogation; second, to damages and/or claims expenses paid by us; and third, to the Deductible. Any additional amounts recovered shall be paid to you. We agree to waive our rights of recovery against any client of yours for a claim which Is covered pursuant to this Policy if you had, prior to such claim, a written agreement in place to waive such rights. F. This Insurance shall apply in excess of and shall not contribute with: 1. any other insurance or indemnification available to you, whether such insurance or indemnification is collectible or uncollectible, whether such insurance is stated to be primary, pro rata, contributory, excess, contingent or otherwise, including, but not limited to, any project specific professional liability, contractors pollution liability and/or products and completed operations liability insurance; and 2. any self -insured retention or deductible portion thereof; unless such other insurance is written only as specific excess Insurance over the Limit of Liability of this Policy. A. You may cancel this Policy with thirty days' (30) notice by: Page 18 of 54 1. surrendering a copy of the Policy to us; or 2. delivering to us written notice stating your desire to cancel the Policy and providing a date for cancellation. B. We may cancel this Policy by delivering to you at the address shown in the Declarations, written notice stating our intention to cancel the Policy with the reasons for cancellation. This written notice must be delivered to you not less than thirty days (30) prior to the proposed cancellation date. The effective date of cancellation stated in the notice shall become the end of the policy period. If you fail to pay a premium when due, then upon ten days' notice to you, the Policy is cancelled at inception and no coverage will be provided by us. C. If this Policy is cancelled by you, we shall retain the pro rata portion of the premium as determined by the cancellation date, subject to a minimum amount of 30%of the annual premium. If this Polity is cancelled by us, we shall retain the pro rata portion of the premium as determined by the cancellation date. Payment or tender of any unearned premium by us shall not be a condition precedent to the effectiveness of cancellation. D. In the event of any claim or circumstance under this Policy, all premium shall be deemed as earned at the time of notice of such claim or circumstance, and we are not obligated to return any premium to you In the event of pursuant cancellation by you or us. This section applies in respect of Insuring Clauses 1-7 and 12: A. If this Policy is cancelled or non -renewed by us (except for non-payment of premium) or cancelled by you, then you shall have the right, upon payment of an additional premium calculated at that percentage shown in Item 7.(a) of the Declarations of the total premium for this Policy, to an extension of the coverage granted by this Policy with respectto any claim first made against you and reported in writing to us during the period of time set forth in Item 7.(b) of the Declarations after the end of the polity period, but only with respect to any act, error, omission, pollution condition or mold condition committed, performed or arising wholly on or after the Retroactive Date and wholly before the effective date of cancellation or non -renewal. B. As a condition precedent to your right to purchase an extended reported period, the total premium for this Policy, and any Deductible payments due, must have been paid. The right to purchase an extended reported period shall terminate unless written notice together with full payment of the premium for the extended reported period is given to us within thirty days (30) after the effective date of cancellation or non -renewal. C. At the commencement of the extended reported period, the entire premium shall be deemed fully earned, and in the event of you terminating the extended reported period for any reason, we shall not be liable to return to you any portion of the premium received. Page 19 of 54 Policy No. BA040000063415 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Business Auto Broadening Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED) II. EMPLOYEES AS INSUREDS III. AUTOMATIC ADDITIONAL INSURED IV. EMPLOYEE HIRED AUTO LIABILITY V. SUPPLEMENTARY PAYMENTS VI. FELLOW EMPLOYEE COVERAGE VII. ADDITIONAL TRANSPORTATION EXPENSE VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE X. LOAN/LEASE GAP COVERAGE XI. GLASS REPAIR —DEDUCTIBLE WAIVER XII. TWO OR MORE DEDUCTIBLES XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS XIV. WAIVER OF SUBROGATION XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT XVIII. HIRED AUTO — COVERAGE TERRITORY XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH Copyright 2017 Mercury Insurance services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 1 of 6 BUSINESS AUTO COVERAGE FORM NEWLY ACQUIRED OR FORMED ENTITY (Broad Form Named Insured) SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: d. Any business entity newly acquired or formed by you during the policy period provided you own 50% or more of the business entity and the business entity is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisition or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Coverage does not apply to an "accident" which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: e. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. Ill. AUTOMATIC ADDITIONAL INSURED SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: f. Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. IV. EMPLOYEE HIRED AUTO LIABILITY SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: g. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. V. SUPPLEMENTARY PAYMENTS SECTION II — LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments, Subparagraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We are not obligated to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. Copyright 2017 Mercury Insurance services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance services Office, Inc., with its Permission Page 2 of 6 XIV. WAIVER OF SUBROGATION SECTION IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, section is replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation, or Fraud, the following is added: Any unintentional omission of or error in information given by you, or unintentional failure to disclose all exposures or hazards existing as of the effective date or at any time during the policy period shall not invalidate or adversely affect the coverage for such exposure or hazard or prejudice your rights under this insurance. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, b. For Hired Auto Physical Damage Coverage, is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: 1. Any covered "auto" you lease, hire, rent or borrow; and 2. Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5.Other Insurance, the following is added and supersedes any provision to the contrary: e. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other 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 insurance available to the additional insured. Copyright 2017 Mercury Insurance services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 5 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -BLANKET (Ed. 8-00) 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). The additional premium for this endorsement shall be 2% of the total California Workers' Compensation premium otherwise due. Schedule Person or Organization Job Description Any person or organization when All California operations required by written contract. Policy Number: WSD 5064219 01 Insured: SouthStar Engineering & Consulting Inc. Endorsement Effective: 2/09/2023 Issue Date: 1/13/2023 WC 99 06 34 (Ed. 8-00) Coverage Provided by: Insurance Company of the West Countersigned by: