HomeMy WebLinkAboutCarollo Engineers, Inc - Certificate of Liability InsuranceacoRc�� CERTIFICATE OF LIABILITY INSURANCE
`....�� 7/4/2024
IDATE (MMIDD/YYYY)
06/29/2023
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 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).
PRODUCER Lockton Companies
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9000
AN TACT
PHONE AX
AIC,No,'A..
0 No),
E-MAIL
ADDRESS:
kcasu@lockton.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Zurich American Insurance Company
16535
INSURED CAROLLO ENGINEERS, INC.
INSURERB: Travelers Prop" Casualty Company of America
25674
INSURERC: Allied World SurplusLines insurance m
24319
14727252795 MITCHELL DR.
WALNUT CREEK CA 94598-1601
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 16845826 REVISION NUMBER: XXXXXXX
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
DDL
INSD
UB
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MMIDDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
GLO 9730569
07/04/202
07/04/2024
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
N
$ 1,000,000
MED EXP (Any oneperson)
$ 25,000
Y
N
PERSONAL & ADV INJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY PECOT- ❑ LOC
GENERAL AGGREGATE
$ 2,000,000
GEN'L
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
BAP 9730571
07/04/202
07/0412024
Ee accident nt)SINGLE LIMIT
$ 2,000,000
X
ANY AUTO
BODILY INJURY (Per person)
$ XXXXXXX
X
IAUTOS
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED X NON -OWNED
ONLY AUTOS ONLY
Y
N
BODILY INJURY (Per accident)
$ XXXXXXX
ROPERTY AMAGE
Per accident
$XXXXXXX
DED: COMP/C
EL1 000
B
JXJ
UMBRELLA LIAB
X
OCCUR
CUP-1S956429
07/04/202
07/04/2024
EACH OCCURRENCE
$ 1,000,000
EXCESS LIAB
CLAIMS -MADE
Y
N
AGGREGATE
$ 1,000,000
DED I I RETENTION $
$ XXXXXXX
WORKERS COMPENSATION
X IPER -
A
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
AI
f V
WC 9730570
07/04/202
07/04/202
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1 000.000
C
PROFESSIONAL
LIABILITY
UNLIMITED PRIOR ACTS
N
N
0313-9010
07/04/202
07/04/2024
EACH CLAIM: $2,000,000;
AGGREGATE: $2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
20250 - Butterfield Water Treatment Plant Facility Plan, Agreement No. 20-020. Carollo Project #: 12011A00. City of Pasco is additional insured as respects general liability
and auto liability, and these coverages are primary and non-contributory, as required by written contract.
CEK I IFICA I E HULUEK CANCELLATION Jee NLLacrlments
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
16845826 AUTHORIZED REPRESENTATIVE
City of Pasco
P.O. Box 293
Pasco WA 99301
t -or /17
@ 198ORPORATION. All rights reserved
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
wn I nv um i—u"—r1i-v yr yr-11-1-- Ivrvory--oI ... viva,...u-v'i--
The excess liability is considered follow form over the general liability, auto liability and employer's liability subject
to the policy terms, conditions and exclusions. Professional Liability Deductible: $500,000.
ACORD 25 (2016103) Certificate Holder ID: 16845826
Attachment Code : D573119 Certificate ID : 16845826
POLICY NUMBER: 0313-9010
ENDORSEMENT
NOTICE OF CANCELLATION TO DESIGNATED ENTITY(IES)
Policy No. 0313-9010
Issued to Carollo Engineers, Inc.
Issued by Allied World Surplus Lines Insurance Company
In consideration of the premium charged, it is hereby agreed that Section VIII. CONDITIONS,
Subsection H. is amended to include the following:
In the event of cancellation or non -renewal of this Policy, the Company will provide a thirty -day
notice to the entity with whom the Named Insured has agreed, pursuant to a prior written
contract, to provide to such entity with a notice of cancellation or non -renewal. Provided,
however, that in the event of cancellation for non-payment of premium, the Company shall
provide to such entity a ten-day notice of cancellation before the effective date of cancellation.
In addition, in the event of a reduction in the Limits of Liability of this Policy not resulting from
payment of Damages or Defense Expenses, the Company will provide a sixty-day notice to the
entity with whom the Named Insured has agreed with, pursuant to a prior written contract, to
provide such entity with a notice of such reduction in limits.
As a condition precedent to providing the notices specified above, the Named Insured will
provide the Company, within ten (10) business days of the Company's request, the names and
addresses of the entities with whom the Named Insured agreed to provide the notices specified
above. In the event the Named Insured omits or fails to provide the foregoing information, the
Company shall not provide such notices.
The Company's failure to provide such notices will not extend the Policy cancellation date,
negate cancellation, non -renewal or reduction in limits, of this Policy. Nor shall such failure be
cause for legal action against the Company.
All other terms, conditions and limitations of this Policy shall remain unchanged.
CEI Manu (06/23)
Attachment Code: D573121 Certificate ID : 16845826
POLICY NUMBER: BAP 9730571
Notification to Others of Cancellation, Nonrenewal or Reduction of
Insurance
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial Automobile Coverage Part
A. If we cancel or non -renew this Coverage Part by written notice to the first Named Insured for any reason other than
nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non -renewal:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation or non -renewal, as advised in our notice to the
first Named Insured, or the longer number of days notice if indicated in the Schedule below.
B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will
mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person
or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance
due to payment of claims, we will mail or deliver notice of such reduction or restriction:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if
indicated in the Schedule below.
D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient
proof of such notice.
SCHEDULE
Name and Address of Other Person(s) /
Number of Days Notice:
Or anization s :
All certificate holders where notice of cancellation is
60
required by written contract with the Named Insured
All other terms and conditions of this policy remain unchanged.
U-CA-811-A CW (05/10)
Attachment Code : D573122 Certificate ID : 16845826
POLICY NUMBER: GLO 9730569
Notification to Others of Cancellation,
Reduction of Insurance
Nonrenewal or
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
Liquor Liability Coverage Part
Products/Completed Operations Liability Coverage Part
A. If we cancel or non -renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than
nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non -renewal:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation or non -renewal, as advised in our notice to the first
Named Insured, or the longer number of days notice if indicated in the Schedule below.
B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will
mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or
organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance
due to payment of claims, we will mail or deliver notice of such reduction or restriction:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if
indicated in the Schedule below.
D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof
of such notice.
SCHEDULE
Name and Address of Other Person(s) /
Organ izations :
Number of Days Notice:
All certificate holders where notice of cancellation is
required by written contract with the Named Insured
60
All other terms and conditions of this policy remain unchanged.
U-GL-1447-A CW (05/10)
Attachment Code : D573124 Certificate ID : 16845826
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34
NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR
REDUCTION OF INSURANCE ENDORSEMENT
This endorsement is used to add the following to Part Six of the policy.
PART SIX
CONDITIONS
A. If we cancel or non -renew this policy by written notice to you for any reason other than nonpayment of
premium, we will mail or deliver a copy of such written notice of cancellation or non -renewal to the name and
address corresponding to each person or organization shown in the Schedule below. Notification to such
person or organization will be provided at least 10 days prior to the effective date of the cancellation or
non -renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule
below.
B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of
such written notice of cancellation to the name and address corresponding to each person or organization
shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to
payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address
corresponding to each person or organization shown in the Schedule below. Notification to such person or
organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the
longer number of days notice if indicated in the Schedule below.
D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be
sufficient proof of such notice.
SCHEDULE
Name and Address of Other Person(s) /
Organization s :
Number of Days Notice:
All certificate holders where notice of cancellation is
required by written contract with the Named Insured
60
All other terms and conditions of this policy remain unchanged.
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.)
Policy No. WC 9730570
Insured CAROLLO ENGINEERS, INC.
Insurance Company Zurich American Insurance Company
WC 99 06 34
(Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission.
Attachment Code : D573129 Certificate ID : 16845826
POLICY NUMBER: GLO 9730569
COMMERCIAL GENERAL LIABILITY
CG20371219
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization(s)
Location And Description Of Completed Operations
Any person or organization, other than an architect,
Any Location or project, other than a wrap-up or other
engineer or surveyor, whom you are required to add as
consolidated insurance program location or project for
an additional insured under this policy under a written
which insurance is otherwise separately provided to
contract mark or written agreement executed prior to
you by a wrap-up or other consolidated insurance
loss.
program
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended B.
to include as an additional insured the
person(s) or organization(s) shown in the
Schedule, but only with respect to liability for
"bodily injury" or "property damage" caused,
in whole or in part, by "your work" at the
location designated and described in the
Schedule of this endorsement performed for
that additional insured and included in the
"products -completed operations hazard".
However:
1. The insurance afforded to such additional
insured only applies to the extent
permitted by law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG20371219
With respect to the insurance afforded to
these additional insureds, the following
is added to Section III — Limits Of
Insurance:
If coverage provided to the additional
insured is required by a contract or
agreement, the most we will pay on
behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement;
or
2. Available under the applicable Limits of
Insurance;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance.
Attachment Code : D579070 Certificate ID : 16845826
POLICY NUMBER: GLO 9730569
Other Insurance Amendment - Primary and Non -Contributory
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
1. The following paragraph is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
This insurance is primary insurance to and will not seek contribution from any other insurance available to an
additional insured under this policy provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by a written contract or written agreement that this insurance would be primary and would not
seek contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same 'occurrence", offense, claim or "suit". This provision does not apply to any policy in
which the additional insured is a Named Insured on such other policy and where our policy is required by written
contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis.
All other terms and conditions of this policy remain unchanged.
U-GL-1327-B CW (04/13)
Attachment Code : D573125 Certificate ID : 16845826
POLICY NUMBER: BAP 9730571
COMMERCIAL AUTO
CA20481013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
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 this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage
under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage
provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
SCHEDULE
Name Of Person(s) Or Organization(s):
Any person or organization to whom or which you are required to provide additional insured status or additional
insured status on a primary, non-contributory basis, in a written contract or written agreement executed prior to
loss, except where such contract or agreement is prohibited by law.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies
as an "insured" under the Who Is An Insured
provision contained in Paragraph A.1. of Section II —
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
Paragraph D.2. of Section I — Covered Autos
Coverages of the Auto Dealers Coverage Form.
CA20481013