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
10/6/2020
License # 0E67768(925) 660-3514 50008(925) 416-786913056Fehr & Peers100 Pringle Avenue, Suite 600Walnut Creek, CA 945962712019917 A 2,000,000XXPSB000668312/6/201912/6/20201,000,00010,0002,000,0004,000,0004,000,0001,000,000A XXPSA000227612/6/201912/6/20205,000,000A PSE000288912/6/201912/6/20205,000,000B X57WEGZJ19895/1/20205/1/20211,000,0001,000,0001,000,000CProfessional Liab.AEXNYABEFJ200412/6/2019Per Claim5,000,000CProfessional Liab.AEXNYABEFJ200412/6/201912/6/2020Aggregate5,000,000RE: Project Number/Name: City of Richmond On-Call WC20-RI25.01All Operations of the Named Insured, including the aforementioned project, if any.General Liability: Please see blanket Additional Insured endorsement attached; such coverage is Primary and Non-Contributory with Waiver of Subrogationincluded, as required per written contract.Auto Liability: No company owned vehicles. Please see blanket Additional Insured endorsement with Waiver of Subrogation included, as required per writtencontract.Workers' Compensation: Waiver of Subrogation is included as per attached blanket Waiver of Subrogation endorsement, as required per written contract.SEE ATTACHED ACORD 101 City of RichmondAttention: Public WorksPO Box 4046Richmond, CA 94804-0046 FEHR&PE-01THOMASR
IOA Insurance Services3875 Hopyard RoadSuite 200Pleasanton, CA 94588Gigi [email protected] Insurance CompanyTrumbull Insurance CompanyLiberty Insurance Underwriters, Inc X12/6/2020
X XXX XX X
FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01)
AGENCY CUSTOMER ID:LOC #:
AGENCY NAMED INSUREDPOLICY NUMBERCARRIER NAIC CODE
© 2008 ACORD CORPORATION. All rights reserved.
IOA Insurance Services
FEHR&PE-01
SEE PAGE 1
1 SEE PAGE 1ACORD 25Certificate of Liability Insurance
License # 0E677681
SEE P 1Fehr & Peers100 Pringle Avenue, Suite 600Walnut Creek, CA 94596SEE PAGE 1 THOMASR1
Description of Operations/Locations/Vehicles:GENERAL LIABILITY & AUTO LIABILITY INCLUDE THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of Richmond, as required per written contract.30 day notice of cancellation is included in the policy provisions.
Policy Number: RLI Insurance Company
Named Insured:
PPB 304 02 12 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack® FOR PROFESSIONALS
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM - SECTION II – LIABILITY
1. C. WHO IS AN INSURED is amended to include as
an additional insured any person or organization that
you agree in a contract or agreement requiring
insurance to include as an additional insured on this
policy, but only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" caused in whole or in part by you
or those acting on your behalf:
a. In the performance of your ongoing operations;
b. In connection with premises owned by or rented
to you; or
c. In connection with “your work” and included
within the “product-completed operations
hazard”.
2. The insurance provided to the additional insured by
this endorsement is limited as follows:
a. This insurance does not apply on any basis to
any person or organization for which coverage
as an additional insured specifically is added by
another endorsement to this policy.
b. This insurance does not apply to the rendering
of or failure to render any "professional
services".
c. This endorsement does not increase any of the
limits of insurance stated in D. Liability And
Medical Expenses Limits of Insurance .
3. The following is added to SECTION III H.2. Other
Insurance – COMMON POLICY CONDITIONS
(BUT APPLICABLE ONLY TO SECTION II –
LIABILITY)
However, if you specifically agree in a contract or
agreement that the insurance provided to an
additional insured under this policy must apply on a
primary basis, or a primary and non-contributory
basis, this insurance is primary to other insurance
that is available to such additional insured which
covers such additional insured as a named insured,
and we will not share with that other insurance,
provided that:
a. The "bodily injury" or "property damage" for
which coverage is sought occurs after you have
entered into that contract or agreement; or
b. The "personal and advertising injury" for which
coverage is sought arises out of an offense
committed after you have entered into that
contract or agreement.
4. The following is added to SECTION III K. 2.
Transfer of Rights of Recovery Against Others to
Us – COMMON POLICY CONDITIONS (BUT
APPLICABLE TO ONLY TO SECTION II –
LIABILITY)
We waive any rights of recovery we may have
against any person or organization because of
payments we make for "bodily injury", "property
damage" or "personal and advertising injury" arising
out of "your work" performed by you, or on your
behalf, under a contract or agreement with that
person or organization. We waive these rights only
where you have agreed to do so as part of a
contract or agreement with such person or
organization entered into by you before the "bodily
injury" or "property damage" occurs, or the "personal
and advertising injury" offense is committed.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PSB0006683
Fehr & Peers
LIABILITY)
4. The following is added to SECTION III K. 2 .g
Transfer of Ri ghts of Recover y Against Others t ogy g Us – COMMON POLICY CONDITIONS (BUT(
APPLICABLE TO ONLY TO SECTION II –
1. C. WHO IS AN INSURE D isa mended to include as
an additional insured anyp erson or organization thatyp g you a gr e ei nac o n t r a c to ra greement re quiringyg g q g insurance to include as an additionali nsured ont h is
policy, but only with respect to liability for "bodilypy injury",
y
"property
p
damage" or
y
"personal
y
andjy pp y g p
advertising injury" caused in whole or in part by you
or those acting on your behalf:
gj y
However, if you specifically agree in a contract oryp y g agreement that the insurance provided to a n
additional insured under this policy must apply on a
primary basis, or a primary and non-contributory
py p p y
py py y
basis, this insurance is primary to other insuranc epy
thati sa vailable tos u ch additionali n sured which
covers such additional insured as a named insured,
and we will not share with that other insurance,
provided that:
Policy Number: RLI Insurance Company
Named Insured:
PPA 300 03 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack® BUSINESS AUTO ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A. Broad Form Named Insured
B. Employees As Insureds
C. Blanket Additional Insured
D. Blanket Waiver Of Subrogation
E. Employee Hired Autos
F. Fellow Employee Coverage
G. Auto Loan Lease Gap Coverage
H. Glass Repair – Waiver Of Deductible
I. Personal Effects Coverage
J. Hired Auto Physical Damage Coverage
K. Hired Auto Physical Damage – Loss Of Use
L. Hired Car – Worldwide Coverage
M. Temporary Transportation Expenses
N. Amended Bodily Injury Definition – Mental Anguish
O. Airbag Coverage
P. Amended Insured Contract Definition – Railroad Easement Q. Coverage Extensions – Audio, Visual And Data Electronic Equipment Not Designed Solely For The Production Of Sound
R. Notice Of And Knowledge Of Occurrence
S. Unintentional Errors Or Omissions
T. Towing Coverage
PSA0002276
Fehr & Peers
C. Blanket Additional Insured
D. Blanket Waiver Of Subro gation
PPA 300 03 13
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. Broad Form Named Insured
The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE, Para-
graph A.1. Who Is An Insured Provision:
Any business entity newly acquired or formed by you
during the policy period, provided you own fifty
percent (50%) or more of the business entity and the
business entity is not separately insured for Bus-
iness Auto Coverage. Coverage is extended up to a
maximum of one hundred eighty (180) days
following the acquisition or formation of the business
entity.
This provision does not apply to any person or
organization for which coverage is excluded by
endorsement.
B. Employees As Insureds
The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE, Para-
graph A.1. Who Is An Insured Provision:
Any “employee” of yours is an “insured” while using
a covered “auto” you don't own, hire or borrow in
your business or your personal affairs.
C. Blanket Additional Insured
The following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE, Para-
graph A.1. Who Is An Insured Provision:
Any person or organization that you are required to
include as an additional insured on this coverage
form in a contract or agreement that is executed by
you before the “bodily injury ” or “property damage ”
occurs is an “insured” for liability coverage, but only for damages to which this insurance applies and
only to the extent that person or organization
qualifies as an “insured” under the Who Is An
Insured provision contained in SECTION II –
COVERED AUTOS LIABILITY COVERAGE.
The insurance provided to the additional insured will
be on a primary and non-contributory basis to the
additional insured’s own business auto coverage if
you are required to do so in a contract or agreement
that is executed by you before the “bodily injury” or
“property damage” occurs.
D. Blanket Waiver Of Subrogation
The following is added to the SECTION IV – BUSI-
NESS AUTO CONDITIONS, A. Loss Conditions,
5. T
ransfer Of Rights Of Recovery Agains t
Others To Us:
We waive any right of recovery we may have against
any person or organization to the extent required of
you by a contract executed prior to any “accident” or
“loss”, provided that the “accident” or “loss” arises
out of the operations contemplated by such contract.
The waiver applies only to the person or
organization designated in such contract.
E. Employee Hired Autos
1.T he following is added to the SECTION II –
COVERED AUTOS LIABILITY COVERAGE,
Paragraph A.1. Who Is An Insured Provision:
An “employee” of yours is an “insured” while
operating an “auto” hired or rented under a
contract or agreement in that “employee's”
name, with your permission, while performing
duties related to the conduct of your business.
2. Changes In General Conditions:
Paragraph 5.b. of the Other Insurance Con-
dition in the BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:
b. For Hired Auto Physical Damage Coverage,
the following are deemed to be covered
“autos” you own:
(1) Any covered “auto” you lease, hire, rent
or borrow; and
(2) Any covered “auto” hired or rented by
your “employee” under a contract in that
individual “employee's” name, with your
permission, while performing duties
related to the conduct of your business.
However, any “
auto” that is leased,
hired, rented or borrowed with a driver is
not a covered “auto”.
F. Fellow Employee Coverage
SECTION II – COVERED AUTOS LIABILITY
COVERAGE, Exclusion B.5. does not apply if you
have workers compensation insurance in-force
covering all of your employees.
G. Auto Loan Lease Gap Coverage
SECTION III – PHYSICAL DAMAGE COVERAGE,
C. Limit Of Insurance, is amended by the addition
of the following:
In the event of a total “loss” to a covered “auto”
shown in the Schedule of Declarations, we will pay
any unpaid amount due on the lease or loan for a
covered “auto”, less:
1. The amount paid under the PHYSICAL
DAMAGE COVERAGE section of the policy;
and
2. Any:
a. Overdue lease/loan payments at the time of
the “loss”;
C. Blanket Additional Insured
D. Blanket Waiver Of Subro gation
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 03/16/20 Policy Expiration Date: 05/01/21
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 57 WEG ZJ1989 Endorsement Number:
Effective Date: 05/01/20 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: FEHR & PEERS
100 PRINGLE AVE STE 600
WALNUT CREEK CA 94596
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 from whom you are required by written contract or agreement to obtain this waiver of rights from us