Loading...
Project 2022-10 Insurance Certificates 2023/26 Moon River Dr Pavement RehabP526(*28'X)2 `� DATE (MMIDDIYYYY) ARa CERTIFICATE OF LIABILITY INSURANCE 09/12/2023 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 policyjies) 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 LIC #OC36861 1-415-403-1491 C°11-1C ]Kimberly Leikam Alliant Insurance Services, Inc. HAKE C �xt). 415-403-1491 r fAlC.Nok 415-874-4818 _ 560 Mission Street, 6th Floor pppR as: kleikam@alliant.com INSURERS AFFORDING COVERAGE NAIC9 San Francisco, CA 94105 INSURERA: TRANSPORTATION INS CO 20494 INSURED INSURER B: VALLEY FORGE INS CO 20508 Granite Construction Company INSURER C 585 West Beach Street INSURERD: - INSURER E. Watsonville, CA 95076 INSURERF: COVERAGES CERTIFICATE NUMRFR- 69608058 RFVISInKI NIIMFtFR- 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. INBR TYPE OF INSURANCE A S BR - POLICY EFF POLICY E7lP LTR POLICYNUMBER MM1DD/YYYY) IA1MfDDffYYY5 LIMITS A X COMMERCIAL GENERAL LIABILITY X X GL2074978689 10/01/23 10/01/26 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE E OCCUR PREMISES_(Ee occcurren�) S 2,000,000 X S Nil Contractual Liability MEDEXP Any one person X _ XCU Hazards PERSONAL $ADVINJURY $ 2,000,000 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 10,000,000 GeNt POLICY JECI— T ..1 LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY X X BUA2074978692 10/01/23 10/01/26 COMOINEDSINGLE LIMIT Ea aeckkn $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AT $ _ BODILY INJURY (Per accident) X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY OPERTYVAMAGE Par ac_cld�r nl}_ $ X CO>�traeltlra g UMBRELLALUIB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CLAIMS•MADE DED RETENTION $ $ B A TION AND EMPLOYERS' LIABILITY AND EMPSYERS'LIAILIT OFFICEPJMEMBEREXCLUDANYPROPRIETOR/PARTNER/EXECUTNE ED7 NIA X X WC274978630 (CA) WC274978644 (A09/Stop G 10/01/23 �D/Gl/23 10/01/24 10/01/24 X STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory In NH) If yyes, describe under DESCRIPTION OF OPERATONS_tapW E.L. DISEASE - POLICY LIMIT 000 $ 2500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job #TBD / Project No. 2022-10 / Moon River Drive Pavement Rehabilitation City of La Quints, its officials, employees, and agents are included as Additional Insured where required by written & executed contract and per the attached endorsements. Coverage is primary & non-contributory and waivers of subrogation apply. Thirty (30) day notice of cancellation or material change in coverage provided per attached endorsements. GL PER ISO FORM CG0001 10/01; AL PER ISO FORM CA0001 03/10 CERTIFICATE HOLDER CANCELLATION 2250 City of La Quints Attn: Jon McMillen, City Manager 70-495 Calle Tampico La Quints, CA 92253 ACORD 25 (2016103) ttaganap 69608058 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE USA ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD W P526(X)28002 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 09/12/2023 NAME OF INSURED: Granite construction company N W 0 N The named insured reserves its rights to provide any additional coverages under the policies above to only those expressly negotiated for by contract. a r a SUPP R10:00y P5260028002 i 0G-14031-D (Ed. 1/13) rq BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - w WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE ° It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: z SCHEDULE (OPTIONAL) w 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 II - 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"; 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) Page 1 of 2 POLICY #: GL2074978689 EFFECTIVE: 10/01 /2023 Copyright, CNA All Rights Reserved. P5200029I"12 CNA G-140331-D (Ed. 01 /13) any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the 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 render, any professional architectural, engineering, or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; (2) Except as provided in Paragraph BA. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit'; and (4) Tender the defense and indemnity of any claim or "suit' to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a,claim or "suit." 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 a person or organization an additional insured on this Coverage Part, 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: a. The "bodily injury" or "property damage"; or b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. G-140331-D (Ed.01/13) Page 2 of 2 Material used with permission of ISO Properties, Inc. POLICY #: GL2074978689 EFFECTIVE: 10/01 /2023 oa N w 0 M Copyright, CNA All Rights Reserved. P5260028ia2 g S POLICY NUMBER: GL2074978689 EFFECTIVE: 10/01 /2023 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Any construction project as required by a written contract or agreement that was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I - Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I - Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard," and for General Aggregate Limit. medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." N C W CG 25 03 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 2 r526002K002 B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. w Page 2 of 2 Copyright, Insurance Services Office, Inc., 2008 CG 25 03 05 09 P52(A)028IN12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. N w O n Waiver of Transfer of Rights of Recovery Against Others to Us This endorsement modifies insurance provided under the following: z Commercial General Liability Coverage Form w 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 or damage 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 or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed ENDT. NO. POLICY NO. 26 GL 2074978689 Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ISSUED TO: EFFECTIVE DATE OF THIS ENDORSEMENT: Granite Construction Incorporated 10/01/23 r52(A)028 02 r (Ed. 10/89) m N w POLICY NUMBER: GL2074978689 EFFECTIVE: 10/01 /2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES - NOTICE OF CANCELLATION OR MATERIAL COVERAGE CHANGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of can- cellation or material change to: SCHEDULE 1. Name: Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change. 2. Address: Per Certificates of Insurance on file with the broker. 3. Number of days advance notice: For non-payment of premium, the greater of: • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of: Y 60 days or • the number of days required in a written contract G-15115-A Page 1 of 1 (Ed. 10/89) C�Jc1 CNA71527XX (Ed. 10/12) ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY It is understood 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 paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a 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 "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the Policy remain unchanged. CNA71527XX (10/12) Page 1 of 1 Insured Name: Granite Construction Incorporated Copyright CNA All Rights Reserved. Policy No: Endorsement No: Effective Date: BUA2074978692 10/01 /2023 N W 0 z w 4SNSN)2W,, POLICY NUMBER: BUA2074978692 COMMERCIAL AUTO CA 04 44 10 13 N w THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) z W 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: 10/01/2023 SCHEDULE Name(s) Of Person(s) Or Organlzatlon(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 10 13 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1 r526(K)28 wx 'THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Notice of Cancellation or Material Change — Designated Person or Organization This endorsement modifies insurance provided under the following: Business Auto Coverage Form ;In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or material change to: SCHEDULE 11. Name: Any person or organization you are required by written contract or agreement to mail prior i written notice of cancellation or material change. 2. Address: Per Certificates of Insurance on file with the broker, 3. Number of days advance notice: For non-payment of premium, the greater of: • the number of days required by state statute or • the number of days required by written contract For any other reason, the lesser of,, 60 days or • the number of days required in a written contract This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. Must Be Completed ENDT. NO, 19 POLICY NO. BUA 2074978692 Complete Only When This Endorsement Is Not Prepared With the Policy Or Is Not to be Effective with the Polic ISSUED TO: EFFECTIVE DATE OF THIS Granite Construction Incorporated ENDORSEMENT 10101/2023 OVA r IEAIM19BB18 G-39543A mw- rs201028Mz CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 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 - Refer to the Schedule of Operations 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 2%. 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, Makes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below, Form No: G-19160-B (11-1997) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 6; Page: 1 of 1 Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 Policy No: WC 2 74978630 Policy Effective Date: 10/01/2023 Policy Page: 53 of 83 Copyright CNA All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 00 r` N r 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. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operation's. 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 Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy Ut11ess another expiration date is shown below. Form No: WC 00 03 13 (04-1984) Policy No: WC 2 74978644 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 10/01/2023 Endorsement No: 32; Page: 1 of 1 Policy Page: 296 of 442 Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 Copyright 1983 National Council on Compensation Insurance. P52(M28W2 0A(Ed. 10l93) � N WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY o NOTICE OF CANCELLATION OR MATERIAL CHANGE ENDORSEMENT In the event of cancellation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number of days advance notice is shown in the Schedule. z w This endorsement shalt not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 1, Number of days advance notice: For non-payment of premium, the greater of: 0 the number of days required by state statute or a the number of days required by written contract For any other reason, the lesser of: ■ 60 days or ■ the number of days required in a written contract 2. Notice will be mailed to: Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change. Address: Per Certificates of Insurance on file with the broker This endorsement changes the polity to which It Is allached 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 10.1-23 Policy No. WC274978630 Vauey forge Insurance Company 14C274978844 Transportation Insurance Company WC 99 06 06 G-20472-A Page 1 of 1 (Ed. 10193)