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Policy Number:
2455 The Alameda
Suite 200
Santa Clara, CA 95050
Barnard & Associates Ins Agency, Inc.
2190 Stokes Street
Suite 201
San Jose, CA 95128
(408)286-1334
Date Entered:
(408)286-6425
[email protected]
Verde Design, Inc.
6/13/2024
A
605016326
06/13/2024
06/13/2025
2,000,000
2,000,000
1,000,000
1,000,000
100,000
5,000
982474641
06/13/2024
06/13/2025
1,000,000
B
C
605016330
06/13/2024
06/13/2025
5,000,000
5,000,000
D
57WECAD1AHA
06/13/2024
06/13/2025
1,000,000
1,000,000
1,000,000
30 days notice of cancellation; 10 days notice for nonpayment of premium UMBRELLA LIABILITY IS FOLLOW FORM OVER GENERAL LIABILITY/AUTO LIABILITY and EMPLOYERS LIABILITY.
THE CITY, ITS CITY COUNCIL, BOARDS, COMMISSIONS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE NAMED AS City of Alameda
Public Works Department
950 W. Mall Square, Room 110
Alameda, Ca 94501
ADDITIONAL INSUREDS. WAIVER OF SUBROGATION APPLIES.
21709
11770
21709
29424
2/26/2025
ATTN: Jack Dybas, Project Manager
Jennie Maltese
A
Business Property
605016326
06/13/2024
06/13/2025
$773,000
BPP Limit
$00
Deductible
Truck Insurance Exchange
UNITED FINANCIAL CASUALTY COMPANY
Truck Insurance Exchange
Hartford Casualty Insurance Co.
Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81 3/20/2025
The City of Alameda, its City council, boards, commissions, officials, employees, and volunteers
Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81 �
FARMERS
INSURANCE
Effective Date
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
Name of Person or Organization:
BUSINESSOWNERS COMMON POLICY CONDITIONS - BP 00 09
SCHEDULE
E3306
1st Edition
60501-63-26
Policy Number
(If no entry appears above, information required to complete this Endorsement must be shown in the Declarations as applicable to this endorsement.)
The provisions of the Businessowners Common Policy Conditions are modified by this endorsement as follows:
Condition K. Transfer Of Rights Of Recovery Against Others To Us in the Businessowners Common Policy Conditions is amended by the addition of the following:
3. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the
"products-completed operations hazard." This waiver applies only to the person or organization shown in the Schedule above.
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy.
91-3306 1ST EDITION 6-97 Includes Copyright Material Insurance Services Office, Inc., 1992 E3306101 PAGE 1 OF 1 6/13/2024
Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81 Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81 Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81 POLICY NUMBER: 982474641 COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
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: Verde Design Inc.
Endorsement Effective Date: 6/13/2024
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Any and all jobs/projects of the insured, where required by written contract, executed prior to a claim.
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.
Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Countersigned by
Authorized Representative
(1) Printed in U.S.A.Form WC 04 03 06
Process Date: 05/04/24 Policy Expiration Date: 06/13/24
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Endorsement Number:Policy Number: 57 WEC AD1AHA
Effective Date: 06/13/24Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: Verde Design Inc
2455 THE ALAMEDA STE 200
SANTA CLARA CA 95050
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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us
Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
2/25/2025
AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230
Lafayette CA 94549
Helen Jang
(510) 272-1499
[email protected]
License#: 6003745
Travelers Casualty and Surety Co of America
31194
VERDDES-01
Verde Design, Inc.
2455 The Alameda, Suite 200
Santa Clara CA 95050
261591589
A
Professional Liability
Claims Made form
Y
107647481
6/13/2024
6/13/2025
$5,000,000 per Claim
$5,000,000 Annl Aggr
Additional Insured Status is not available on Professional Liability Policy. CANCELLATION: 30 day notice will be sent to the certificate holder.
Project: Estuary Park, Amendment I, Phase II.
30 Day NOC
City of Alameda
Public Works Department
Attn: Jack Dybas
950 W. Mall Square, Room 110
Alameda CA 94501
Docusign Envelope ID: 79DD75BF-A85F-412A-8F3D-A9D44737DD81