HomeMy WebLinkAboutR.J. NOBLE COMPANY 1 - 2003INSURANCE ON FILE
WORK PROCEED
UNTIL !~N~UR~ANC£ EXPIRES
'?-i o3
OF,COUNCiL
RIGHT OF ENTRY AGREEMENT
N-2003-034
THIS RIGHT OF ENTRY AGREEMENT ("Agreement") is made and entered into as
of~3/~r-day of [L[aKJv) 2003 by and between the CITY OF SANTA ANn, a charter city and
municipal corporation duly organized under the Constitution and laws of the State of California
(the "City"), and R.J. NOBLE COMPANY, a California corporation (the "Contractor"), with
respect to the following:
RECITALS
A. The Contractor (or its principal) has entered into an agreement with the City to
undertake certain public work improvements on Main Street in the City.
B. The Contractor desires to use the portion of the Property owned by the City,
commonly known as 1112 and 1114 South Cypress Street, and further identified on the Site Map
attached hereto as Exhibit A as a storage and staging area for the work to be performed by
Contractor pursuant to said agreement (hereafter referred to as "Construction Staging").
C. The City wishes to accommodate the Contractor's desire to utilize the Property
for Construction Staging by granting a right of entry to Contractor upon certain terms and
conditions.
NOW, THEREFORE, for good and valuable consideration, Contractor and City do
hereby agree as follows:
1. Right of Entry. Provided that all of the terms and conditions of this Agreement
are fully satisfied, the City hereby grants to Contractor and its employees, agents and contractors
the nonexclusive, nonassignable, personal right to enter upon the Property for the Construction
Staging, and for no other purposes without the prior written approval of the Executive Director
of the Community Development Agency. This Agreement shall automatically terminate and
expire one year from the date of this Agreement, or thirty (30) days after written notice of
expiration is provided by City, whichever occurs first. It is expressly understood that this
Agreement does not in any way whatsoever grant or convey any rights of possession, easement
or other interest in the Property.
2. Agreement. By execution of this Agreement, Contractor agrees for itself and on
the behalf of its employees, agents, consultants and contractors as follows:
(a)
the Property.
That Contractor will not permit any dangerous condition to be created on
(b) All acts and things done by Contractor on the Property will be done in a
careful and reasonable manner, in accordance with all federal, state and local laws.
(c)
Contractor shall enter the Property entirely at its own cost, risk and
expense.
(d) Prior to undertaking performance of work under this Agreement,
1
DOCSOC\872119v2k22782.0022
Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain
insurance as described below:
i. Commercial General Liability Insurance. Contractor shall
maintain commercial general liability insurance naming the City, its respective officers,
employees, agents, volunteers and representatives as additional insured(s) and shall include, but
not be limited to protection against claims arising from bodily and personal injury, including
death resulting therefrom and damage to property, resulting from any act or occurrence arising
out of Contractor's operations in the performance of this Agreement, including, without
limitation, acts involving vehicles. The amounts of insurance shall be not less than the
following: single limit coverage applying to bodily and personal injury, including death resulting
therefrom, and property damage, in the total amount of $1,000,000.00 per occurrence.
Contractor shall supply the City with a fully executed additional insured endorsement in
substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall
be approved in form by the City Attorney.
ii. The following requirements apply to the insurance to be provided
by Contractor pursuant to this section:
· Contractor shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
· Certificates of insurance shall be furnished to the City upon execution
of this Agreement and shall be approved in form by the City Attorney.
· Certificates and policies shall state that the policies shall not be
canceled or reduced in coverage or changed in any other material
aspect without thirty (30) days prior written notice to the City.
iii. If Contractor fails or refuses to produce or maintain the insurance
required by this section or fails or refuses to furnish the City with required proof that insurance
has been procured and is in force and paid for, the City shall have the right, at its election, to
forthwith terminate this Agreement.
(e) Contractor shall not permit any mechanics', materialmen's or other liens
of any kind or nature ("Liens") to be filed or enforced against the Property in connection with the
Construction Staging. Contractor shall indemnify, defend and hold harmless City from all
liability for any and all liens, claims and demands, together with costs of defense and reasonable
attorneys' fees, arising from any Liens. City reserves the right, at its sole cost and expense, at
any time and from time to time, to post and maintain on the Property, or any portion thereof, or
on the improvements on the Property, any notices of non-responsibility or other notice as may be
desirable to protect the City against liability. In addition to, and not as a limitation of the City's
other rights and remedies under this Agreement, should the Contractor fail, within ten (10) days
of written request from the City, either to discharge any Lien or to bond for any Lien, or to
defend, indemnify, and hold harmless City from and against any loss, damage, injury, liability or
claim arising out of a Lien, then City, at its option, may elect to pay such Lien, or settle or
discharge such Lien and any action or judgment related thereto and all costs, expenses and
attorneys' fees incurred in doing so shall be paid to City, as applicable, by the Contractor upon
2
DOCSOC\872119¥2L22782.0022
written demand.
(f) Contractor shall not have any interest in the Property or be entitled to any
reimbursement or repayment for any work performed upon the Property pursuant to this
Agreement.
(g) The Contractor shall take all necessary precautions to prevent the import
and/or release into the environment of any hazardous materials which are imported to, in, on or
under the Property during the Construction Staging. If hazardous materials are imported onto the
Property as a result of the Construction Staging, the Contractor shall be solely responsible for
removing such imported hazardous materials in conformance with all governmental
requirements. The Contractor shall report to the City, as soon as possible after each incident, any
unusual or potentially important incidents with respect to the environmental condition of the
Property.
3. Indemnity. Contractor hereby agrees to defend, indemnify and hold the City,
itsofficers, officials, members, employees, agents and representatives, harmless from and against
any and all loss, damage, injury, liability, claim, cost or expense (including, without limitation,
reasonable attorneys' fees, expert witness fees, court costs, and expenses) arising from or
attributable to the activities of Contractor or any of its employees, agents, consultants or
contractors upon the Property pursuant to this Agreement. All use of and entry upon the
Property shall be at the sole cost, risk and expense of the Contractor.
4. License Payment Upon execution of this Agreement, and the first of each month
so long as this Agreement is in effect, Contractor shall pay to City a monthly license fee of
$1,000.00. First and last month's fee may be prorated, if for a partial month.
5. Miscellaneous.
(a) Choice of Law. This Agreement is to be governed by, and construed in
accordance with, the laws of the State of California.
(b) Remedies. Either party shall, in addition to all other rights provided
herein or as may be provided by law, be entitled to the remedies of specific performance and
injunction to enforce its rights hereunder, except to the extent expressly provided to the contrary
in this Agreement. All rights and remedies under this Agreement are cumulative and no one of
them shall be exclusive of any other, and each party shall have the right to pursue any one or all
of such rights and remedies or any other remedy which may be provided by law, whether or not
stated in this Agreement, except to the extent expressly provided to the contrary in this
Agreement.
(c) Counterparts. This Agreement may be executed in two (2) or more
counterparts, each of which shall be deemed an original but all of which together shall constitute
one and the same instrument.
(d) Non-Liability of Public Officials. No officer, employee, member, agent
or representative of the City shall be personally liable to Contractor, or any successor in interest,
in the event of any default or breach by the City, or for any amount which may become due to
Contractor or its successor, or for any breach of any obligation of the terms of this Agreement.
3
DOCSOC\872119v2X,22782.0022
IN WITNESS WHEREOF, the parties hereto have entered into this Agreement as of the date
first set forth above.
ATTEST:
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By: .J~_~.,'c ~ ~
Lisa E. Storck
Assistant City Attorney
CITY OF SANTA ANA:/
City Manager
CONTRACTOR:
R'.~/Noble l~mpany
By: l~I±chael 3. Carver
Title: ?res±den'c
EmployerlD# 33-0866299
4
DOCSOC\872119v2~22782.0022
EXHIBIT A
SITE MAP
MoFADDEN
AVE.
(OLD)
HARWOOD
Exhibit A
DOCSOC\872119v2~22782.0022
'ACORD,, CERTIFICATS; OF LIABILITY INSURANCE I DATEIMM, OD )
02/18/2003
IJRODUCER J (949)857-4300 FAX (9,,~-]o57-4800 THIS CERTIFICATE IS Ib'~l~D AS A MATTER OF INFORMATION
Millenni.um Risk Management & Tnsurance Services ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5~O0 Trabuco Road
Zrvine, CA 92620
INSURED R. 3. Noble Co.
15505 Lincoln Ave.
P. O. Box 620
Orange, CA 92865-1015
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURERA: Tnterstate Fire & Casualty Co./CRC
INSURERB: First National Tnsurance Co. of A~erica/Saf
~NSURERC: Tnsurance Co. of the State of PA/CRC
~NSURERD: Pacific Eagle Tnsurance/Pointsure
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BF~N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED· NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY COI~ITRACT 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS·
INSR POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE P¢)LICY NUMBER DATE IMM/DD/YY) DATE (MM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL~LIABILITY FIRE DAMAGE (Any one fire) $ 50,000
I
CLAIMS MADE I~,1 OCCUR MHD EXP (Any one person) $ EXCluded
A X XCU GLl1110259 07/01/2002 07/01/2003 PERSONAL&ADVINJURY $ 1,0001000
GENERAL AGGREGATE $ 2,000 ! 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/DP AGG $ 1,000,000
I POLICY ~'-~PRO'
JECT [~ LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
X ANY AUTO (La accident) $
1,000,000
ALL OWNED AUTOS
BODILY INJURY
B SCHEDULED AUTOS F~A8160306C 07/01/2002 07/01/2003 (Per person) $
X HIRED AUTOS
BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITYr~ EACH OCCURRENCE $ 5,000,00(]
X
I
OCCUR
I I CLAIMS MADE AGGREGATE $ 5! 000! 00~
C 4202 9032 07/01/2002 07/01/2003 $
J DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND XToRyWC STATU-LiMiTS I OTH-ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $ 110OO, 000
D 4S0200287 07/01/2002 07/01/2003 E,L. DISEASE-EAEMPLOYEE $ A,OOOlO00
E.L. DISEASE- POLICY LIMIT $ 1,,000,000
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
£ertificate Holder is named Additional Znsured as respects General Liability per special forms ~ttached
P,E: 3ob #90844, 1112-1114 S. Cypress St., Santa Aha, CA
~10-day notice of CANCELLATION in event of non-payment of premium .
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER:
The City of Santa Ana, its officers,
employees, agents, volunteers
and representatives
20 Civic Center Plaza
Santa Ana, CA 92702
ACORD 25-S (7/97)
CANCELLATION Y ~
SHOULD ANY OF THE ABOV-E~D'~RI~P~I~I~ ~A6"CELLED BEFORE THE
~ I
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WI~-L ENDEAVOR TO MA L
w~O DAYS WRITTEN NOTICE TO THE CERTIFICATE ~L~R NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE ~'O OBLIGATION OR LIABILITY
OF ANY KI~D UPON THE COMPLY, ITS AGENTS O~ REPRESENTATIVES.
~ '- ' ~ACORD CORPO~TION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 2S-S (7~97)
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY
Insurance Company: Interstate Fire & Casualty Company
This endorsement modifies such insurance as is afforded by the provisions of
Policy #GL11110259 relating to the following:
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
92701; its officers, employees, agents, volunteers and
representatives are named as additional insureds ("additional
insured") with regard to liability and defense of suits arising from
the operations and uSes performed by or on behalf of the named
insured.
With respect to claims arising out of the operations and uses
performed by or on behalf of the named insured, such insurance as
is afforded by this policy is primary and is not additional to or
contributing with any other insurance carried by or for the benefit of
the additional insureds.
This insurance applies separately to each insured against whom
claim is made or suit is brought except with respect to the
company's limits of liability. The inclusion of any person or
organization as an insured shall not affect any right which such
person or organization would have as a claimant if not so included.
m
With respect to the additional insureds, this insurance shall not be
cancelled, or materially reduced in coverage or limits except after
thirty (30) days written notice has been given to the City of Santa
Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective:
Policy #:
Issued to
July 2, 2002 , this endorsement forms a part of
GLl1110259
R.J. Noble Company
Named Insured ('
Countersigned by: ,~--' ," ,~ '~ ~.
';~ A~uthorized I~present~tive
PRODUCER (949)857-4500
Millenni..ii1 Risk Management
L;cense ,# OC13480
5530 Trabuco Road
Irvine, CA 92620
INSURED
FAX (949)857-4800
& Insurance Services
DATE (MMIDDIYY)
12/06/2007
THIS CERTIFiCATE is ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C. If',
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR L Il/
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ACORDm C~RTIFICATE OF LIABILITY INSURANCE
R. J. Noble Co.
P. O. Box 620
Orange, CA 92856-9020
INSURER A:
INSURER B:
INSURER c:
INSURER 0:
INSURER E
INSURERS AFFORDING COVERAGE
Travelers Property Casualty Co. of America
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONOlTlON 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER P8k~~:~~g8;W\E PgkW/~~~~N LIMITS
LTR
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL UABIUTY EXGL5273Cl6707 07/01/2007 07/01/2008 FIRE DAMAGE (Anyone f;ra) $ 300,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,000
A f-x SIR PERSONAL & ADV INJURY . 1,000,000
$50,000 GENERAL AGGREGATE $ 2,000,000
f-- 2,000,000
~'L AGG:ffiE UMIT AP~tIPER PRODUCTS - COMP/OP AGG $
POLICY X jr2T LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT .
~ ANY AUTO CAP9322B42607 07/01/2007 07/01/2008 (Eaaccidant) 1,000,000
ALL OWNED AUTOS BODlL Y INJURY
~ (Per person) $
A - SCHEDULED AUTOS
- HIRED AUTOS IL Y INJURY
<tO~ (Peraccidant) .
NON-OWNED AUTOS
- ~ ~ DAMAGE
f--- h1-~~ $
,eraccldent)
~~GE LIABILITY O'll ~~ Au:J4l ONLY - EAACCIOENT $
ANY AUTO .~~~JJ . )\,. $
OTHER THAN EA ACC
.." "!'- ~'(':\'I.'l ':. AUTO ONLY: AGG $
EXCESS LiABILITY Y'i ~\~'I.~) Y EACH OCCURRENCE .
~-OCCUR D CLAIMS MADE AGGREGATE .
/ .
~ ~EDUCTIBLE I \ .
RETENTION . .
WORKERS COMPENSATION AND X [ro~m,ws I [UJt
EMPLOYERS' LIABILITY UB4786C3107 07/01/2007 07/01/2008 E,L. EACH ACCIDENT . l,OOO,O()~
A
EL DISEASE - EA EMPLOYEE $ 1,000,000
EL DISEASE - POUCY LIMIT . l,OOO,OOC
OTHER
DESCRIPTION OF OPERATIONSflOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Liablility per endorsement
Certificate Holder is named as Additonal Insured as respects General
attached.
RE: RJN Job# 91132, proj #06-1717 and #06-1019, Fourth St. Rehabilitation: 1-5 Fwy to SR-55 and
ustin Ave. Rehabilitation:17th St. to North City Limit Fed Proj. No. 's STPL-5063(108) & STPL-5063(110)
*10 day notice of cancellation in the event of non-payment of premium.
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Santa Ana, Public Works EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ~~ MAIL
Department of Transportation ~':30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: William Albright ~IlKI0OOCOOIIXJlOOliItll)(KIl(IIIl1l0i1tJ@llXl1iX~XX
20 Civic Center Plaza
Ross Annex (M-22) IOOOOOOt>X)IIIl( K1@tIVX<<XXXXXXXX
Santa Ana, CA 92701 AUTHORIZED R:;~AT1VE v_c- L.A .L. /"....
Leonard Z f~' /\
ACORD 25-S (7/97) , -iJfACORD CORPO~I/:JN 1988
~
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the poiicy, 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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies iisted thereon.
ACORD 25-5 (7/97)
'.
saF-INSURED EXCESS
THIS ENDORSElvlENT CHANGES THE POLICY. PLE:ASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
SElf-INSURED I'iXcess COMMERCIAL GENERAL LIABILITY COVERAGE FORM
1. WHO IS AN INSURED - (section II) is amended to include any person or organization that you agree In a
"written contract requiring insurance" to Include as an additional insured on this Coverage Part, but:
a) Only whh respect to liabnlty for "bodily injury", "property damage" or "personal Injury"; and
b) If, and only to the extent that. the injury or demage is caused by aels or omissions of you or your
subcOntractor In the performance of "your work" to which the "wrttten contract requiring insurance'
applies. The pe1'$On Or organization does not qualifY as an addhlonallnsured with respect to the
Independent aels or omissions of $Uch person or organization,
2. The Insurance provided to the addhlon"llnsured by this endorsement Is limited as follows:
a) in the event that the Limits of Insurance of this Coverage Part shown in the Declerations ""ceed the
limits of liability required by the "Written contract requirtng Insurance", the insurance provided to the
addiijonallnsured shall be limited to the limits of liability required by that "written c(>ntract requiTing
insuranceN. This endorsement shall not increase the limits of insurance described in Sectlon III ~
Limits Of Insurance.
b) The Insurance prOvided to the addilionallnsured does not apply to "bodily injury", ''property damage"
or "personal Injury" atising out of !he rendering 'of, or failure to render, any professional archi\ectural.
engineering or surveying services, inclUding;
I. The preparing, approving, or failing 10 prepare or approve, maps, ahop drawmgs, opinions,
reports, surveys, field orders or change orders, or !he preparing, approving, or failing to prep"re
or approve, drawings and speclflcalions; and
n. SUpervisory, inspection, architectural or engineertng actiVittes.
8) 1'\1$ Insurance provided to the additional insured does not apply 1D "bodily injury" or "property
damage" caused by "your work" and Included in the "produots-completed operations h;lZSrd"
unless !he "Written contract requlr1ng lnsurancIl" specifically requires you to provide such
coverage for that additional il>sured, end then \he InslJflInce provided to the additional insured
eppliea only to such "badDy Injury" or 'property damage" that oCOlll'S before the end of the period
of time for which the "WllIlen contraol requiTing Insurance" requires you to Pr<1>llde such
coverage or the and of the policy period, whichever is earlier.
3. Subp~h (1naj of the Pollullon exclusion under ParElgraph 2., Exclusions of Coverage A. Bodily
Injury and Property Damage Uabtlity (SecIioI'\ 1- CoveragB$) does not epply to you if the "bodlly Injury" or
"property damage" is caused by '')ioUr work" performed at any premises, site or location which is owned bY,
or rented to, the additional insured at the time 'your work" is performed thera.
4, The Insurance provided to the addlUOI1allnsured by this endorsement is excess over any valid end
collectible "other insurance", whether primary, excess, contingent or 011 eny other basis, that Is available to
the additional Insured for a loss we cover under this endorsement. However, if the "wrlIten contract
requiring insurance' speolfioeny requi1'e$ that this insurance apply on a primary basiS or a primary and non-
contributory baSls, thIs insurance will apply IS If .other Insurance' available to the addllional insured WhIch
covers that person or orgen~n as a named insured for such loss does not exlsl, "nd we Will not $hare
with that "other Insuranca", But.the Insurance provlded to the sddillonallnsured by thIs endorsement stili Is
excess over any valid and collectible "oltler ;ll$UI'anc:e", Whether primary, exoess, oonllngenl or on any
other basis, that is available to the additional insured when that person cr org!li!~on Is an additional
insured under such "other insurElnce'. O"fS'.
5. As a cOndition of ooverage provided to the additional insured by this~ement:
EXG373 01 00
A~ ~
0""" o,,!-V ~(\0'l
1Ill2006. The Sl PauL'Wii-~rs Compo ~?J.lic'f.>/!.O rv'
~. ,<:,'?- c;~'l C / J
'- '1;(\'1. /')
~<,i,\.,,,, ~?-- f)
Page 1 012
SELF-INSURED EXCESS
The addi\1onallnsured mu..i give uS written notice as soon as practlcable of an "occurrence" or an
offense which may result In a claim under this Insurance, To the extel1t possible, such notice shoul(!
include:
i. How, when and where the "ocourrence" or offense took place;
il. The names and addresses of l;1ny injured parsons and wiu'e$ses; and
iii. The nature and looation of any Injury or damage atislng out or the "occurrence" or offense.
b) If a claim Is made or "auif' ia brought against the additional insured which may resu~ in a claim against
this Insurance, the additional insured must:
i. Immediately record the specifics 07 ~ :~'lirTf.~r ''suit'' and the date received; and
Ii. Notify us a9 soon as pracHcabte.
The additional insured must see to it that we receive wlitten notice of the claim or "suit" as soon as
practicable.
c) If a claim is made or 'sult" Is brought against the additional insured which may reaullln a claim against
this Insurance, the addidonal insured must immedialely send us copies of all legal papers received in
connectlon with tha claim or "suit", cooperate with us in the investigation or settlement of the claim or
defense against !he "suit", and otherwise comply with all policy conoitions.
d) The addilional insured must tendar the defense and Indemnity of any claim or "suil' to any provider of
'other insurance" which woUld cover the additional iMured for a loss we cover under this
endorsement However, this condition does not affect whether. as descrlbed in paragraph 4. above,
the insurance provided to tbe additional insured by this endorsement Will apply as if 'other insurance"
available to the additionallnsurad which covers that person or organization as a named insure" does
not e,;st.
6. The following deflnillon Is added to SECTION V. - DEFINITiONS:
'Wntten contract requlnng insurance" means that pert of any written contract or. agreement under which
you llre required to inciude a person Of organiution as an additional insured 00 this Coveraga Part,
provided that the "bodily injury" and "property damage" occurs and the "personal injury" is C$used by an
offense committed:
a. After the signing and execution of the contract or agreement by you;
b. While tnet part of the contract or agreement Is In affect; and
c. Before the end of the policy penod,
a)
EX G3 73 0106
~ 2006, The St Paul Travelers Companies. Inc.
Page2012
ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE {MMJDI;I/'(J'l
02/08/2008
PRODUCER (949)857-4500 FAX (949)857-4800 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Millennium Risk Management & Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
License # OC13480 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
5530 Trabuco Road INSURERS AFFORDING COVERAGE
Irvine, CA 92620
INSURED iNSURER A: Travelers Property Casualty Co. of Ame ri ca
R. J. Noble CO. INSURER B:
P. O. Box 620 INSURER c:
Orange, CA 92856-9020 INSURER 0:
I INSURER E:
tJ, ;;2CCf3-0 3'-1
COVERAGES
THE POLICIES OF INSUR!\NCE 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 rMY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lNSR TYPE OF INSURANCE POLICY NUMBER ~4~~::~~E Pgi'fllt~~N LIMITS
LTR
~NERAL LlABILlTY EACH OCCURRENCE , 1 000,000
X COMMERCIAL GENERALllA81l1TY EXGL5273C16707 07/01/2007 07/01/2008 FIRE DAMAGE (Any one fire) , 300,000
I CLAIMS MADE m OCCUR MED EXP (Anyone person) , 5 000
A PERSONAL & ADV INJURY , l,OOO,Oon
-
- GENERAL AGGREGATE , 2.000,000
~'~ AGG:EME ~lIMIT AP~tLPER PRODUCTS ~ COMPIOP AGG , 2,000,000
POLICY X m?i LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT ,
~ ANY AUTO CAP9322B42607 07/01/2007 07/01/2008 (EaaccidenL) 1,000,000
- ALL OWNED AUTOS BODILY INJURY
(Per person) ,
A - SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(PeraccidanL) ,
- NON-OWNED AUTOS
PROPERTY DAMAGE ,
(ParaccidenL)
GARAGE LIABILITY AUTO ONLY -EAACCJDENT ,
=i ANY AUTO OTHER THAN EAACC ,
AUTO ONLY: AGG ,
EXCESS LIABILITY EACH OCCURRENCE , 5,000 000
tkrOCCUR 0 CLAIMS MADE CUP9322B43807 07/01/2007 07/01/2008 AGGREGATE , 5,000,000
A ,
R DEDUCTIBLE ,
RETENTION , ,
WORKERS COMPENSATION AND xlfo~n~J,~sl IUER'
EMPLOYERS' LIABILITY UB4786C3107 07/01/2007 07/01/2008 l,OOO,oon
A E. L EACH ACCIDENT .
E.L DISEASE - EA EMPLOYEE $ 1,000,000
I E.L DISEASE - POLICY LIMIT , 1,000,000
I OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESJEXCLUSIONSADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder, its officers, employees, agents, volunteers & representatives are named as
Additional Insured as respects General Liability per endorsement EXG3730106 & EXG3740106.
RE: Project #06-7906 & 07-7507; Oelhi & Willard Neighborhood Improvements
*10 day notice of cancellation in the event of non-payment of premium.
CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER,
CANCELLATION
Ci ty of Santa Ana "
20 Civic Center Plaza ~
Santa Ana, CA 92701
'--;I:J:}(, c (i l / I Jr
f" '/ I
SHOUI.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL. ~ MAIl.
":30 DAYSWRlnEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE L.EFT,
," 1;.~1l1(JOO0.)Il1Q~)(x<<lOO0@tXillXl1lXlOOUXJO(X
JtltIllC<<XXXXXXXX
}. A L /,...,
,F ..... A
@AC(9l'lD CORPORATIO't;Jl88
AUTHORIZED REPRESEN~
L<!lllIard Zimirl.Jfv h
,
/') C.
ACORD 25-5 (7/97)
/' "..J.L.".
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificete does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORO 25-5 (7/97)
SELF-INSURED F..xCr=SS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONtRACTORS)
This endorsement modifies Insurance provided uncler the followfng:
SELf.INSURED f!!XCeSS COMMERCIAL GENERAL LIABILITY COVERAGE FORM
1. WHO IS AN iNSURED - (Sectlon II) is amencled to Include any person or organiza~on that you agree in a
"written oontraot n>qulring insurance" to Include as an additional Insured on this Coverage Part, but:
a} Only with respect to liability for "bodily Injury", "property damage" or "personal Injury"; and
h} If, end only to the extant thet. the Il\IuI)I or demage 1$ oaused by aols or omissions of you or your
subcontractor in the performance of ''your work" to which the "written contract requiring insurance"
applies. The person Or organization does not qual/1Y Q$ an aclditionallnsured With respect to the
Independent acts or omlSSllmS of $U<;h person or organization.
2. The Insuranos provided to the add~lonallnsured by this endorsement Is limited as follows:
a} In the event that the Limits of Insuranae of this Coverege Part shown In the Decleralions exceed the
limits of liabiNty raqulred by the "written oontract requiring Insuranos", the insurance provided to li1e
additionallnsurG>ct shall be limited to the limits of liability required by that .WI'it1en oontract requiring
insuranceN. This endorsement shall not Irrcre8se the limits of insurance described In Section Iff...
LimTls Of Insurance.
b) The insurance provided to the additional Insured does not appiy to ''bodily illlury". "properly damage"
or "personal Injury" arising out of the rendering 'of, or fallura to render, any professional archllecturel.
engineering or surveying services, InClUding:
I,. The preparing, approving, or lalilng to prepare or approve, meps, shop drElWings, opinions,
reports, surveys, fleld orders or change orders, or tha preparing, approving, or falling to prepare
or approve, drawings and speclllcations; and
ii, Supervisory, inspection, architectural or engineering aclMties.
a} Th& Insutance provided to the addlflOnal hisunad does not apply to "bodily Injury" or "property
damage" caused by "your worre' and Inoluded In the "produots-completed operatiOI1$ hazard"
unless the "wrftlen contract requiring Insurance" specltlcally requires you to provide such
coverage for that addltlonalll'$urad, end then \11", 1l1$vrance provided to the additional Insured
applies oniy to such "bodily Injury" or 'property damage' that occutS before the end of the period
of time for which the "wriUen contract requiring Insurance" requIres yOU to provide such
coverage or the end oftJhe policy psrlod, whichever rs earlier,
3. SubparagraPh (1)(a) of the Pollution exclusion under Pllregreph 2" excfualons of COverage A. Bodily
Injury and Property Damage liability (Section 1- CoversgO$) does not apply to you If the "bodily Injury" or
'property damage' Is causad by "YoUr work" performed at any preml$l!I$, slta or location whlch Is owned by,
or rented to, the additional insured at the time "your work" Is performed thare.
4, The Insurance provkJed to the additional Insured by this endoraement is ~ over any valid end
cclleolible 'other Insurance". whether primary, excess, contingent or on any other basis, that Is available to
the acIdllional insured for a loss we cover under thls endorselnlmt, However, If the '"wrItlen contract
requlrtng insurance' spaolficallY requlree that this lnauraJlGfl apply on a primary basis or s primary and non-
contributory basis, this insurance will apply" If "other Insurance" avallabla to the add~lonallnsured which
COV8IS that person or organl;wtfon as a named insured for such loss does no! exist, $/ld we Will net shara
with that "other Insurance", But"the Insurance provided to Ihe additlonsllnsured by thfs endorsement atIl1ls
excess over any valid and collectible 'olher insurance", whether primary, """"'ss, contingent or on any
other basis, that is available to the addltionellnsurad when lhat parson or organ~lIon Is an additional
Insured under such "other Insurllnce',
5. AA EO cOIldllion of ooverage provided to 1I,e addillonallnsurad by this endorsement:
ex 03 73 01 oe
Cl2006, The Sf Paul Travelo", Companies, inc.
Pag&1012
SELF-INSURED EXCESS
"'I The additional insuree! must give tJ$ written notice as soon as praclloable of an "occurrence' or an
offense which may result in a claim under this Insuronce. To the extent pOssible, suCh noUce shaUIe!
Include:
i. How. when and where the "oocurrenoe" or offense took place;
if. The names and add~sses of :;lny InjureCI pel$Ons :;lne! WI~lesses; and
m. The nature and location of any Injury or damage arlslng out of the "occurrencs" or offense. .
b) If a claim Is mae!e or "sulf' Is brought against Ihe additional insuree! whiclh may resuK in " claim against
lhis insurance, lhe additional insured must:
i. Immediately record the epec;ftcs 'tr ~:~I~Ihf.?F''sUlr' and the date received; and
Ii, Nolily us e. soon as praoticable. '.' ~
The addiUonallnsured musl see to It that we recel"" written noflce of the oialm or "suil" as soon as
practicable.
c) If a olelm Is made or 'suit" Is brought agalnstlhe additional Insured whloh may result In a claim agains!
this Insurance, l~ addiUonal in81.lred must immediately send Us copies of all legal papers received In
connection wilh the claim or "suit", cooperate with us In the invesllgaflon or settlement of the claim or
defense agalnsllhe 'suir', and olhSlWlse comply wlth sll policy condTtions.
d) The addilfonai Insured must tender the defense and Indemnity of any claim or "suiI' to any provider of
"other insurance" which WOUld cover the additional insured lor a 10$s we cover under this
endorsemenl However, lI1i$ condition doea not ,,!feel whether, as described In paragraph 4. above,
the insurance provided 10 the additional Insured by thl> endorsemenl Will apply as if "other insure nee"
available to the addiflonallnsured which covers lhal parson or organlzsllon as a named insured does
not e,;s!. .
6. The following deflnlflon is added to SECTION V. - DEFINITIONS:
'Written conlract requiring insurance' means !hat part of any written contract or.agreemenl under which
you are required to Include a Plilrson or organ~ as an addllional insured on lhls Coverage Part,
provided thalthe "bodlly injury' and 'property damage' ocoors tll'ld the "personal injUry" is C$used by an
offense commItted:
.. Aller the signing and execution of the contract or agreement by you;
b. While that Part of the contract or agreement Is in affeot; and
c. Before the end of the policy perloe!.
EXG3'1'3U1 06
@2006, The 51 Paul Travelers Companl.>, Inc,
Pege 2012
SELF-INSURED EXCESS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
This endorsement modifies insurance provided under the following:
SELF-INSURED EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE FORM
GENERAL DESCRIPTION OF COVERAGE - Provisions A-H. and J.-N. of this endorsement broaden
coverage, and provision I. of this endorsement may limit coverage. The following listing is a general coverage
description only. limitations and exclusions may apply to these coverages. Read all the PROVISIONS of this
endorsement carefully to determine rights, duties, and what is and is not covered.
A Broadened Named Insured G. Contractual liability - Railroads
B. Extension of Coverage - Damage To Premises H. Additional Insured - State or Political Subdivisions
Rented To You
. Perils of fire, explosion, lightning, smoke, water
. limit increased to $300,000
C. Blanket Waiver of Subrogation
I. Other Insurance Condition
J. Knowledge and Notice of Occurrence or Offense
K. Unintentional Omission .
D. Blanket Additional Insured - Managers or lessors
of Premises
L. Personal Injury - Assumed by Contract
M. Blanket Additional Insured -Lessor of leased
Equipment
E. Incidental Medical Malpractice
F. Extension of Coverage - Bodily Injury
PROVISIONS
A BROADENED NAMED INSURED
1. The Named Insured in Item 1. of the Declarations is as follows:
The person or organization named in Item 1. of the Declarations and any organization, other than a
partnership, joint venture or limited liability company, of which you maintain ownership or in which you
maintain the majority interest on the effective date of the policy. However, coverage for any such
additional organization will cease as of the date, If any. during the policy period, that you no longer
maintain ownership of, or the majority interest in, such organization.
2. WHO IS AN INSURED (Section II) Item 4.a. is deleted and replaced by the following:
a. Coverage under this provision is afforded only until the 1 BOth day after you acquire or form the
organization or the end of the policy period, whichever is earlier.
3. This Provision A does not apply to any person or organization for which coverage is excluded by
endorsement.
B. EXTENSION OF COVERAGE - DAMAGE TO PREMISES RENTED TO YOU
1. The last paragraph of COVERAGE A. BODilY INJURY AND PROPERTY DAMAGE LIABILITY (Section
I - Coverages) is deleted and replaced by the following:
Exclusions c. through n. do not apply to damage to premises while rented to you, or temporarily
occupied by you with permission of the owner, caused by:
a. Fire;
b. Explosion;
c. lightning;
d. Smoke resulting from such fire, explosion, or iightning; or
e. Water.
A separate limit of insurance applies to this coverage as described in Section lit limits Of Insurance.
2. This insurance does not apply to damage to premises while rented to you, or temporariiy occupied by
you WITh permission of the owner, caused by:
a. Rupture, bursting, or operation of pressure relief devices;
b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused
by or resulting from water;
EX G3 74 0106
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SELF-INSURED EXCESS
c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines.
3. Paragraph 6. of LIMITS OF INSURANCE (Section III) is deleted and replaced by the followi ng:
Subjecl to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under
COVERAGE A for the sum of all damages because of "property damage" to anyone premises while
rented to you, or lemporarily occupied by you w~h permission of the owner, caused by: fire; explosion;
lightning; smoke resultlng from such fire, explosion, or lightning; or water. The Damage To Premises
Rented To You Limit will apply to all 'property damage" proximately caused by the same "occurrence",
whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, expiosion,
or lightning; or water; or any combination of any of these causes.
The Damage To Premises Rented ToY ou Limit will be the higher of:
a. $300,000; or
b. The amount shown on the Declarations for Damage To Premises Rented ToY ou Lim~.
4. Paragraph a. of the definition of "insured contract" (DEFINITIONS - Section V) is deleted and replaced by
the following: ' '
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage to premises while rented to you, or temporariiy
occupied by you with permission of the owner, caused by: fire; explosion; lightning; smoke resu~ing
from such fire, explosion, or lightning; or water, is not an "insured contract";
5. This Provision B. does not apply- if coverage for Damage To Premises Rented To You of COVERAGE A.
BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section 1- Coverages) is excluded by
endorsement.
C. BLANKET WAIVER OF SUBROGATION -
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: premises owned or occupied by or rented or loaned to you; ongoing
operations performed by you or on your behalf, done under a contract with that person or organization; "your
work"; or "your products", We waive this right where you have agreed to do so as part of a written contract,
executed by you before the "bodily injury" or 'property damage" occurs or the "personal injury" or "advertising
injury" offense is committed.
D. BLANKET ADDIT10NAL INSURED.. MANAGERS OR LESSORS OF PREMISES
WHO IS AN INSURED (Section II) is amended to include as an insured any perSon or organization (referred
to below as "additional insured") with whom you have agreed in a written oontract, executed before the
"bodily injury" or "property damage" occurs or the "personal injury" or "advertising Injury" offense is
committed, to name as an additional insured, but only with respect to liability arising out of the ownership,
maintenance or use of that part of any premises leased to you, subject to the following provisions:
1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which
you agreed to provide in the written contract, or the limits shown on the Declarations, whichever are less.
2. The insurance afforded to the additional insured does not apply to:
a. Any "bodily injury" or "property damage" that occurs, or "personal injury" or "advertising injury"
caused by an offense which is committed, after you cease to be a tenant in that premises;
b. Any premises for which coverage is excluded by endorsement; or
c. Structural alterations, new construction or demolition operations performed by or on behalf of such
additional insured.
3. The insurance afforded to the additional insured shall be excess over any valid and collectible "other
insurance" available to the additional insured unless you have agreed in a written contract for this
insurance to apply before any valid and collectible "other insurance" available to the additional insured, in
which case, any valid and collectibie "other insurance" available to the additional Insured for the
coverage provided by this endorsement shall be noncontributory with and excess of both the:
a. "Retained limit" stated in the Declarations of the policy to which this endorsement is attached; and
b. The Limits Of Insurance provided in PROVISION 0.1. above.
E. INCIDENTAL MEDICAL MAI.PRACTICE
EX G3 740106
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Page 2of5
,
SELF-INSURED EXCESS
1. The following is added to paragraph 1. Insuring Agreement of COVERAGE A. - BODILY INJURY AND
PROPERTY DAMAGE LIABILITY (Section I - Coverages):
"Bodily injury" arising out of the rendering of, or failure to render, the following will be deemed to be
caused by an "occurrence":
a. Medical, surgical, dental, laboratory, >Hay or nursing service, advice or instruction, or the related
furnishing of food or beverages:
b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances:
c. First aid; or
d. "Good Samaritan services." As used in this Provision E., "Good Samaritan services" are those
medical services rendered or provided in an emergency and for which no remuneration is demanded
or received. -
2. Paragraph 2.a.(1)(d) of WHO IS AN INSURED (Seelion IQ does not apply to any registered nurse,
licensed practical nurse, emergency medical technician or paramedic employed by you, but only while
performing the services described in paragraph 1. above and while acting within the scope of their
employment by you. Any "employees" rendering "Good Samaritan services" will be deemed \0 be acting
within the scope of their employment by you.
3. The following exclusion is added to paragraph 2. Exclusions of COVERAGE A. - BODILY INJURY AND
PROPERTY DAMAGE LIABILITY (Section I - Coverages):
(This insurance does not apply to:) "Bodily injury" or "property damage" arising out of the willful violation
of a penal statute or ordinance relating to the sale of pharmaceuticals committed by or with the
knowledge or consent of the insured.
4. For the purposes of determining the applicable limits of insurance, any act or omission together with all
related acts or omissions in the furnishing of the services described in paragraph 1. above to anyone
person will be deemed one "occurrence".
5. This Provision E. does not apply if you are in the business or occupation of providing any of the services
described in paragraph 1. above.
6. The insurance provided by this Provision E. shall be excess over any valid and collectible "other
insurance" available to the insured, whether primary, excess, contingent or on any other basis, except for
insurance that you bought specifically to apply in excess of the Limits of Insurance shown on the
Declarations of this Coverage Part.
F. EXTENSION OF COVERAGE - BODILY INJURY
The definition of "bodily injury" (DEFINITIONS - Section V) is deleted and replaced by the following:
"Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation,
sickness or disease sustained by a person, including death resulting from any of these at any time.
G. CONTRACTUAL LIABILITY - RAILROADS
1. Paragraph c. of the definition of "insured contracf (DEFINITIONS - Section V) is deleted and replaced by
the following:
c. Any easement or license agreement;
2. Paragraph f.(1) of the definition of "insured contract" (DEFINITIONS - Section V) is deleted.
H. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS
WHO IS AN INSURED (Section II) is amended to include as an insured any state or political subdivision,
subject to the following provisions:
1. This insurance applies only when required to be provided by you by an ordinance, law or building code
and oniy with respect to operations performed by you or on your behalf for which the state or political
subdivision has issued a permit.
2. This insurance does not apply to:
a. "Bodily injury," "property damage," "personal injury" or "advertising injury" arising out of operations
performed for the state or political subdivision; or
b. "Bodily injury" or "property damage" included in the "products-completed operations hazard".
I. OTHER INSURANCE CONDITION
A COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph 4. (Other Insurance) Is
deleted and replaced by the following:
EX Gl74 0106
@ 2006, The St Paul Travelers Companies, Inc.
Page 3 of 5
"
SELF-INSURED EXCESS
4, Other Insurance
This insurance is excess over any of the "other insurance", whether primary, excess, contingent
or on any other basis,
This condition does not apply to insurance purchased specifically to be e~her quota share with
this Coverage Part or excess of this Coverage Part.
B. The following definition is added to DEFINITIONS (Section V):
"Other insurance" means insurance, or the funding of losses, that is provided by, through or on behalf
of:
a. Another insurance company;
b. Us or any of our affiliated insurance companies, except when the Non cumulation of Each
Occurrence Limit section of Paragraph 5 of LIMITS OF INSURANCE (Section III) or the Non
cumulation of Personal and Advertising Injury Iim~ sections of Paragraph 4 of LIMITS OF
INSURANCE (Section III) applies;
c. Any risk retention group;
d. Any self-insurance method or program, other than any funded by you and over which this
Coverage Part applies; or
e. Any similar risk transfer or risk management method.
J. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE
1. The following is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph 2.
(Duties In The Event of Occurrence, Offense, Clai m or Suit):
Notice of an "occurrence" or of an offense which may result in a ciaim must be given as soon as
practicable after knowledge of the "occumence" or offense has been reported to you, one of your
"executive officers" (if you are a corporation), one of your partners who is an individual (if you are a
partnership). one of your managers (if you are a Iim~ed liability company), or an "employee" (such as an
insurance, loss control or risk manager or administrator) designated by you to give such notice.
Knowledge by any other "employee" of an "occumence" or offense does not imply that you also have
such knowledge.
2. Notice of an "occurrence" or of an offense which may result in a claim will be deemed to be given as
soon as practicable to us if it is given in good fa~ as soon as practicable to your workers' compensation
insurer. This applies only if you subsequently give notice of the "occurrence" or offense to us as soon as
practicable after you, one of your "executive officers" (if you are a corporation), one of your partners who
is an individual (if you are a partnership), one of your managers (if you are a limited liability company), or
an "employee" (such as an insurance, loss control or risk manager or administrator) designated by you to
give such notice discovers that the .occurrence" or offense may involve this policy.
3. This Provision J. does not apply as respects the specific number of days within which you are required to
notify us in writing of the abrupt commencement of a discharge, release or escape of "pollutants" that
causes "bodily injury" or "property damage" which may otherwise be covered under this policy.
K. UNINTENTIONAL OMISSION
The following is added to COMMERCIAL GENERAl LIABILITY CONDiTIONS (Section IV), paragraph 6.
(Representations):
The unintentional omission of, or unintentional error in, any information provided by you which we relied upon
in issuing this policy shall not prejudice your rights under this insurance. However, this Provision L. does not
affect our right to collect add~ional premium or to exercise our right of cancellation or nonrenewal in
accordance with applicable state insurance laws, codes or regulations.
L. PERSONAL INJURY "ASSUMED BY CONTRACT
1. The following is added to Exclusion b. (1) of Paragraph 2., Exclusions of Coverage B. Personal Injury,
Advertising Injury, and Web Site Injury Liability of the Web XTEND Liability endorsement:
Solely for the purposes of liability assumed in an "insured contrad', reasonable attorney fees and
necessary I~igation expenses incurred by or for a party oth'er than an insured are deemed to be
damages because of "personal injury" provided:
EXG3 74 0106
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.
SELF-INSURED EXCESS
(a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same
"insured contract"; and
(b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative
dispute resolution proceeding in which damages to which this insurance applies are alleged.
2. This provision L. does not apply if coverage for "personal injury" liability is excluded by endorsement.
M. BLANKET ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT
WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (referred
to below as "additional insured") with whom you have agreed in a written contract, executed before the
"bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is
committed, to name as an additional ~nsured, but only with respect to their liability for "bodily injury", "property
damage", "personal injury" or "advertising injury" caused, in whole or in part, by your acts or omissions in the
maintenance, operation or use of equipment leased to you by such additional insured, subject to the
following provisions:
1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the Iimils which
you agreed to provide in the written contract, or the limits shown on the Declarations, whichever are less.
2. The insurance afforded to the additional insured does not apply to any "bodily injury" or "property
damage" that occurs, or "personal injury" or "advertising injury" caused by an offense which is committed,
after the equipment lease expires.
3. The insurance afforded to the additional insured is excess over any valid and collectible "other
insurance" available to such additional insured, unless you have agreed in the written contract that this
insurance must be primary to, or non-contributory with, such "other insurance".
EX G3 74 0106
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