ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?
INSR ADDLSUBRLTR INSDWVD
PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURED INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :
POLICY NUMBERPOLICY EFFPOLICY EXPTYPE OF INSURANCELIMITS(MM/DD/YYYY)(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIABEXCESS LIABWORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE$DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY$GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$PRO-POLICYLOC PRODUCTS - COMP/OP AGGJECT OTHER: $COMBINED SINGLE LIMIT$(Ea accident)ANY AUTO BODILY INJURY (Per person)$OWNEDSCHEDULEDBODILY INJURY (Per accident)$AUTOS ONLYAUTOSHIREDNON-OWNEDPROPERTY DAMAGE$AUTOS ONLYAUTOS ONLY(Per accident)$OCCUR EACH OCCURRENCECLAIMS-MADEAGGREGATE$DEDRETENTION$ PEROTH-STATUTEERE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEE$If yes, describe underE.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGENAIC #
COMMERCIAL GENERAL LIABILITY
Y / NN / A(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDERCANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
$
$$$$
The ACORD name and logo are registered marks of ACORD
4/16/2025
License # 0305584(805) 543-6887(805) 543-306412537S & S Homes of the Central Coast &Palmetto Estates LLC532 Camino MercadoArroyo Grande, CA 9342014907346301A 1,000,000XXATN241187295/23/20245/23/202550,0005,0001,000,0002,000,0002,000,0001,000,000B CMO39255265/18/20245/18/2025 C XSSWC56589711/1/202411/1/20251,000,0001,000,0001,000,000 RE: Tract 7186If required by written contract, The City of Bakersfield, its mayor, council, officers, agents, employees and volunteers are Additionally Insured on a Primary basis with Waiver of Subrogation per forms CG2012 0413, VEN05100 0115, and CG2404 0509 on General Liability, and Workers Comp Waiver of Subrogation WC990410C 0119.
City of BakersfieldPublic Works Department1501 Truxton AvenueBakersfield, CA 93301 S&SHOME-01MCHEW
Morris & Garritano Insurance Agency, Inc.PO Drawer 1189San Luis Obispo, CA 93406United Specialty Insurance CompanyOregon Mutual Insurance CompanyOak River Insurance Company X
X XXX XX
POLICY NUMBER:
ATN24118729 COMMERCIAL GENERAL LIABILITY
CG 20 12 04 13
THIS
ENDORSEMENT CHANGES THE POLICY. PL
EASE READ IT CAREFULLY.
ADDITIONAL INSURED – STATE OR GOVERNMENTAL
AGENCY OR
SUBDIVISION OR POLITICAL
SUBDIVISION
–
PERMITS
OR AUTHORIZ
ATIONS
This
endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHE
DULE
State Or Govern mental Agency Or S ubdivision Or P olitical Subdivision:
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Secti
on II
–
Who Is An
Insured
is amended
to include as an
additional
insured any state or
governmental agency or
subdivision
or
political su bdivision shown in the Schedule,
subject to the following provisions:
1. This insurance applies only with respect to
operations performed by you or on your
behalf for which the state
or governmental
agency or
subdivision
or political
subdivision has issued a permit or
autho
rization
.
However:
a. The insurance afforded to such
additional insured only applies to the
extent permitted by law; and
b. If coverage provided to the additional
in
sured is re
quired by a contract or
agreement, the insu
r
ance 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.
2. This insurance does not apply to:
a. "Bodily injury" , "property damage" or
"personal and
advertising injury" arising
out of operations performed for the
federal go vernment, state or
municipality; or
b. "Bodily injury" or "property damage"
included within the "products -
completed operations hazard".
B. 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 shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 As Required By Written Contract With The Named Insured, Fully Executed Prior To The Named Insured's Work
VEN 051 00 (01/15)
THIS ENDORSEMENT CHANGES THE POLICY
. PLEASE READ IT CAREFULLY.
VEN 051 00 (01/15)
PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT
This endorsement modifies the Condi
tions provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Any coverage provided to an Additional Insu
red shall be excess over any other valid
and collectible insurance avai
lable to such Additional Insured whether primary, excess, contingent or on any other basis unless:
1) a written contract or written agreement
specifically requires that this insurance
apply on a primary and non-contributory basis; or
2) prior to a loss, you request in writing and
we agree that this insurance shall apply
on a primary and non-contributory basis.
All other terms, conditions and exclusions
under this policy are
applicable to this
Endorsement and remain unchanged.
Name Of Person(s) Or Organization(s)
United Specialty Insurance Company
As Required By Written Contract, Fully Executed Prior To The Named Insured’s Work.
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
CG 24 04 05 09
© In
surance Services Office, Inc.,
2008
Page
1 of
1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
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.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
ATN24118729
As Required By Written Contract With The Named Insured, Fully Executed Prior To The Named Insured's Work
Endorsement Effective
:
Policy
No.
:
Insured
:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 99 04 10 C
(Ed. 01-19)
WAIVER OF OUR RIGHT TO
RECOVER FROM OTHERS ENDORSEMENT
-
CALIFORNIA
BLANKET BASIS
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 wor
k under a written contract that
requires you to obtain this agreement from us.)
The
additional
premium for this endorsement shall be
calculated
by applying a factor of 2% to the total manual
premium, with a minimum
initial
charge of $350,
then applying
all other pricing factors for the policy to this calculated
charge to derive the final cost of this endorsement.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Blan
ket Waiver
Person/Organization
Blanket W
aiver
–
Any person or organization for whom the Named Insured has
agreed by written contract to
furnish this waiver.
Waiver Premium (prior to ad
j
ustments)
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.)
Endorsement No.
:
Premium $
Insurance Company
:
WC 99 04 10 C
Countersigned by ________________________________
______
(Ed. 01-19)
Job Description
All CA Operations
Oak River Insurance Company
SSWC565897
350.00
11/01/2024