The URL can be used to link to this page

2018/03/01 Delta Pipeline, Inc. Certficiate of Liability Insurance _ 7 c-0 DATE(MMIDD/YYYY) ��oRo CERTIFICATE OF LIABILITY INSURANCE 2/27/2019 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 CONTACT NAME: (PT)Heffernan Insurance Brokers PHONE FAX 101 Second Street, Suite 120 City of Menifee ._Nz ;(r)7 707-781-3400 {A[ ,-NO):707-781-0800 Petaluma CA 94952 City Clerk ADD 1NSU S AFFORDING COVERAGE NAIC# INSURED IILTPIWINSURER A:National Fire Insurance Company of Hartford 20478 INSURED DELTPI -Delta Pipeline Inc. INSURERB:Continental Casualty Company 20443 1407 Foothill Blvd., Suite 232 INsuRERc:Travelers Property Casualty Company of America 25674 La Verne CA 91750 Received INSURERD:Zurich American Insurance Company 16535 INSURERE: Illinois Union Insurance Company 27960 INSURER F: COVERAGES CERTIFICATE NUMBER:1796579450 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. ILTR TYPE OFINSURANCE �4DDLI US POLJCY NUMBER MN/D/YYYY I MiOYtlLIC EXP LIMITS LTR 1 A X COMMERCIAL GENERAL LIABILITY Y 4030457243 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR P SSOE.e"ufF— $500,000 X Ded$2K but$10k MED EXP(Any one person) $15,000 Res[Subsidence PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I -- l PRO ❑JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 6046395399 3/1/2019 3/1/2020 COM13rNeDtSINGLELIMIT $1,000,000 X 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 C X UMBRELLALIAB X OCCUR ZUP16N1735019NF 3/1/2019 3/1/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10.000,000 DFD I X I RETENTJON$jn.QW $ D WORKERS COMPENSATION WC110084502 3/1/2019 3/1/2020 X PER AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1.000.000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000.000 If yes,describe under - DESCRIPTION OF OPERATIONSbelow E.L D1SFASE-PDLICY LIMIT $1,000.000 E Pollution w/Mold CPYG2706436AO04 3/1/2018 3/1/2020 Per Poll Condition/Ag 3,000,000 SIR 15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re: MCI Job#3-1175,Menifee Lakes Plaza, NW Corner of Newport Road/Antelope Road,Menifee,CA 92584.City of Menifee is included as an additional insured on General Liability policy per the attached endorsement,if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Menifee 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee, CA 92586 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CNA CNA PARAMOUNT Construction Wrap-Up Program Exclusion Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed that under COVERAGES, Coverage A— Bodily Injury And Property Damage Liability and Coverage B—Personal And Advertising Injury Liability, the paragraphs entitled Exclusions, are amended to add the following exclusion: This insurance does not apply to bodily injury, property damage or personal and advertising injury arising out of any current or completed operation performed by the Named Insured or on the Named Insured's behalf which is or was insured under a consolidated (wrap-up) insurance program. This exclusion applies whether or not the consolidated(wrap-up) insurance program: A. provides coverage identical to that provided by this Coverage Part; B. has limits adequate to cover all claims;or C. remains in effect. Consolidated (wrap-up) insurance program means a construction, erection or demolition project for which the prime contractor/project manager or owner of the project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project. Consolidated (wrap-up) insurance program includes an Owner Controlled Insurance Program (O.C.I.P.)or a Contractor Controlled Insurance Program (C.C.I.P.). 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. CNA74863XX(1-15) Policy No: 4030457243 Page 1 of 1 Endorsement No: 23 Nat'l Fire Ins Co of Hartford Effective Date: 03/01/2019 Insured Name:DELTA PIPELINE INC. Copyright CNA All Rights Reserved. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract;or B. in the performance of your work subject to such written contract, but only with respect to 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. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037;or B. additional insured coverage with"arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I.above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. m III. Subject always to the terms and conditions of this policy, including the limits of insurance,the Insurer will not provide Y such additional insured with: N A. coverage broader than required by the written contract;or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement 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. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance is amended to add the following,which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX(10-16) Policy No: 4030457243 Page 1 of 2 Endorsement No: 12 Nat'1 Fire Ins Co of Hartford Effective Date: 03/01/2019 Insured Name:DELTA PIPELINE INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured,this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured;or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above,this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense,or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self-insurer,whose policy or program applies to a loss that the Insurer covers under this coverage part. However, I if the written contract requires this insurance to be primary and non-contributory,this paragraph 3.does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement,the section entitled 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: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage;or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. 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. CNA75079XX(10-16) Policy No: 4030457243 Page 2 of 2 Endorsement No: 12 Nat'l Fire Ins Co of Hartford Effective Date: 03/01/2019 Insured Name:DELTA PIPELINE INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. HEFFERNAN INSURANCE BROKERS 101 SECOND ST. SUITE 120 PETALUMA CA 94952-7411 wj CITY OF MENIFEE 29714 HAUN RD MENIFEE CA 92586-6540