HomeMy WebLinkAboutC-3460(W) - Back Bay Science Center, Bid package #15 (Steel Lab Casework)Recorded in Offici• "ecords, Orange County l
Tom Daly, Clerk -Re order
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�- RECORDING REQUESTED BY AND 2007000386663 09:40am 06118107
WHEN RECORDED RETURN TO:. --212n �
d bo o700-00 0.00 0 00 0.00 0.00 0.00
City Clerk
City of Newport Beach --
3300 Newport Boulevard Y_
Newport Beach, CA 92663 CIT`r
"Exempt from recording fees
pursuant to Government Code Section 27383" I
1
NOTICE OF COMPLETION
NOTICE IS HEREBY GIVEN that the City of Newport Beach, 3300 Newport Boulevard,
Newport Beach, California, 92663, as Owner, and Kewaunee Scientific Corporation of
Statesville, North Carolina, as Contractor, entered into a Contract on March 1, 2006. Said
Contract set forth certain improvements, as follows:
Back Bay Science Center (C-3460)
Work on said Contract was completed, and was found to be acceptable on June 12.
2007, by the City Council. Title to said property is vested in the Owner, and the Surety for
said Contract is Liberty Mutual Insurance Company.
Works Director
Newport Beach
VERIFICATION
I certify, under penalty of perjury, that the foregoing is true and correct to the best of my
knowledge.
Executed on
BY v ,fi(�
City Clerk
aoo 7
at Newport Beach, California.
June 12, 2008
CITY OF NEWPORT BEACH
Mr. David Rausch
Kewaunee Scientific Corporation
2700 West Front Street
Statesville, NC 98687
OFFICE OF THE CITY CLERK
LaVonne M. Harkless, MMC
Subject: Back Bay Science Center (C-3460) - Bid Package #15 (Steel Lab
Casework)
To Whom It May Concern:
On June 12, 2007, the City Council of Newport Beach accepted the work of the
subject project and authorized the City Clerk to file a Notice of Completion, to
release the Labor & Materials Bond 35 days after the Notice of Completion had
been recorded in accordance with applicable portions of the Civil Code, and to
release the Faithful Performance Bond one year after Council acceptance.
The Labor & Materials Bond was released on July 23, 2007. The Surety for the
contract is Liberty Mutual Insurance Company and the bond number is 018013232.
Enclosed is the Faithful Performance Bond.
Sincerely,
LaVonne M. Harkless, MMC
City Clerk
enclosure
3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915
Telephone: (949) 644-3005 • Fax: (949) 644-3039 • www. city. newport-beach. ca. us
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
MASTER FORMAL CONTRACT
CONTRACT NO. 3460
BOND NO. 018013232
FAITHFUL PERFORMANCE BOND
The premium charges on this Bond is $ 768.00
being at the rate of $ 10.80 per Thousand thousand of the Contract price.
WHEREAS, the City Council of the City of Newport Beach, State of California, by motion
adopted, awarded to Kewaunee Scientific Corporation. hereinafter designated as the "Principal",
a contract for construction Back Bay Science Centeontract No. 3460 in the City of
Newport Beach, in strict con ormi wispecifications, and other Contract
Documents maintained in the Public Works Department of the City of Newport Beach, all of which
are incorporated herein by this reference.
WHEREAS, Principal has executed or is about to execute Contract No. 3460 and the
terms thereof require the furnishing of a Bond for the faithful performance of the Contract;
NOW, THEREFORE, we, the Principal, and Liberty Mutual Insurance Company
, duly authorized to transact business under the laws of the State of
California as Surety (hereinafter "Surety"), are held and firmly bound unto the City of Newport
Beach, in the sum of ($71,080.00) lawful money of the United States of America, said sum being
equal to 100% of the estimated amount of the Contract, to be paid to the City of Newport Beach, its
successors, and assigns; for which payment well and truly to be made, we bind ourselves, our
heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these
present.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal, or the Principal's
heirs, executors, administrators, successors, or assigns, fail to abide by, and well and truly keep
and perform any or all the work, covenants, conditions, and agreements in the Contract
Documents and any alteration thereof made as therein provided on its part, to be kept and
performed at the time and in the manner therein specified, and in all respects according to its true
intent and meaning, or fails to indemnify, defend, and save harmless the City of Newport Beach, its
officers, employees and agents, as therein stipulated, then, Surety will faithfully perform the same,
in an amount not exceeding the sum specified in this Bond; otherwise this obligation shall become
null and void.
0
As a part of the obligation secured hereby, and in addition to the face amount specified in
this Performance Bond, there shall be included costs and reasonable expenses and fees, including
reasonable attorneys fees, incurred by the City, only in the event the City is required to bring an
action in law or equity against Surety to enforce the obligations of this Bond.
Surety, for value received, stipulates and agrees that no change, extension of time,
alterations or additions to the terms of the Contract or to the work to be performed thereunder or to
the specifications accompanying the same shall in any way affect its obligations on this Bond, and
it does hereby waive notice of any such change, extension of time, alterations or additions of the
Contract or to the work or to the specifications.
This Faithful Performance Bond shall be extended and maintained by the Principal in full
force and effect for one (1) year following the date of formal acceptance of the Project by the City.
In the event that the Principal executed this bond as an individual, it is agreed that the
death of any such Principal shall not exonerate the Surety from its obligations under this Bond.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and
Surety above named, on the 26th day of May 2006.
f
Kewaunee Scientific Corporation f,ffi
Name of Contractor (Principal) Authorized Signature4itle
Liberty Mutual Insurance Company
Name of Surety Auth6rizeent Signature
6230 Fairview Rd., Suite 300
Charlotte, NC 28210 Ramona Fewell, Attorney -In -Fact
Address of Surety Print Name and Title
(704) 367-3472
Telephone/Fax
NOTARY ACKNOWLEDGMENTS OF CONTRACTOR AND SURETY MUST BE ATTACHED
10
STATE OF North Carolina
COUNTY OF Iredell
I, Deborah L. Henderson , a Notary Public in and for the County
and State aforesaid, do certify that Dana L. Dahlgren
who signed the writing above, bearing date the -96 day of
May 20 _06, for _ Kewaunee Scientific Corporation
(Corporation --Principal)
has this day acknowledged the said writing to be the act and deed
of said corporation.
Given under my hand this 26 day of _ May 20 0
\\\\1111111
My commission expird&- COMMISSION EXPIRESMARCH 18, _
2UU9 Not Public: � y�''• �4
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STATE OF North Carolina COUNTY OF Mecklenburg �ii0Ut4-r( o'
1, Debra S. Ritter , a Notary Public in and for the County
and State aforesaid, do certify that Ramona Fewell
who signed the writing above, bearing date the 26th
day of May , 20 06, as Attorney -in -Fact for
Liberty Mutual Insurance Company had this day acknowledged the same
(Surety)
before me in my said County_
Given under my hand this 26th
My commission expires: 10-5-09
day f May , 20 06
Notary Public
THIS POWER OF ATTORNEY IS NOT VALIL, UNLESS IT IS PRINTED ON RED BACKGROUND. 1776528
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to
the extent herein stated.
LIBERTY MUTUAL INSURANCE COMPANY
BOSTON, MASSACHUSETTS
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS: That Liberty Mutual Insurance Company (the "Company"), a Massachusetts stock insurance
company, pursuant to and by authority of the By-law and Authorization hereinafter set forth, does hereby
name, constitute and appoint
RAYMOND J. GARRUTO, DEBRA S. RITTER, RAMONA FEWELL, ARTHUR COLLEY, ALL OF THE CITY OF CHARLOTTE,
STATE OF NORTH CAROLINA ............... ........ ......... ................... ......... .......: ................,........................................
................................................... ... ...... ... ........ .......;.....................................
each individually if there be more than one named, its true and lawful attorney -in fact to make execute, seal, acknowledge and deliver, for and on its
behalf as surety and as its act and deed, any. and all undertakings, bonds, recognizances and other.surety obligations in the penal sum not exceeding
THIRTY-FIVE MILLION AND 00/1:00**** ***************
DOLLARS ($ 35,000,000.00*****
( each, and the
execution of such undertakings bonds, recognizances and other surety obligations, in pursuance of- these presents; shall be as binding upon the
Company as if they had been duly signed by the president and attested by the secretary the Company
of in their own proper persons.
That this power is made and executed pursuant to and by authority of 1he following By-law and Authorization
ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the
chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to in behalf
act of the Company to make,
execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such
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attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their
signature and execution of any such instruments and to attach thereto the the Company.
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seal of When so executed such instruments shall be
as binding as if signed by the president and attested by the secretary.
GI
G
.y
By the following instrument the chairman or the president has authorized the officer or other official named therein to appoint attorneys -in -fact:
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Pursuant to Article XIII, Section 5 of the By -Laws, Garnet W. Elliott, Assistant Secretary of Liberty Mutual Insurance Company, is hereby =
authorized to appoint such attorneys -in -fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and r_
_
deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Ta O
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That the By-law and the Authorization set forth above are true copies thereof and are now in full force and effect. >.U)
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IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of G Q.
Liberty Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this 14th day of July
2005 Q M
e et
LIBERTY MUTUAL INSURANCECOMPANYL a
fx By(y�a , /.c/i4 OG. E
i .
Garnet W. Elliott, Assistant Secretaryy c
COMMONWEALTH OF PENNSYLVANIA ss * t p
COUNTY OF MONTGOMERY
On this 14th day of July 2005 , before me, a Notary Public, personally came Garnet W. Elliott, to me known, and acknowledged 2 d
that he is an Assistant Secretary of Liberty Mutual Insurance Company; that he knows the seal of said corporation; and that he executed the above :$ 3
Power of Attorney and affixed the corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said corporation. > 4'
IN TESTIMONY WH A unto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year t 0
first above written.
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COMMONwEALTROFR NN YLVANIA E 00
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OF T,�pm PWeta o ary Putgk By c OP
ilh Twp., Mutgatnary Cs O*
M;rCorrgrds4WF-presMar.28. Ter sa Pastella, Notary Public 0 o
CERTIFICATE �
° ,Mem3w. POM%4vanla AuWia lan Of Notart" O CO
I, the undersigned, Assistant ecretary of Liberty Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing
is a full, true and correct copy, is in full force and effect on the date of this certificate; and I do further:certify that the officer or official who executed the
said power of attorney is an Assistant Secretary specially authorized by the chairman or the president to appoint attorneys -in -fact as provided in Article
XIII, Section 5 of the By-laws of Liberty Mutual Insurance Company.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the
following vote of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980.
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a
certified copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company
with the same force and effect as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said company, this 26th day of
May , 2006.
By
:/ David M. Carey, AssigirTit Secretary
July 23, 2007
CITY OF NEWPORT BEACH
Mr. David Rausch
Kewaunee Scientific Corporation
2700 West Front Street
Statesville, NC 28687
OFFICE OF THE CITY CLERK
LaVonne M. Harkless, MMC
Subject: Back Bay Science Center (C-3460) - Bid Package #15 (Steel Lab
Casework)
Dear Mr. Rausch:
On June 12, 2007, the City Council of Newport Beach accepted the work of the
subject project and authorized the City Clerk to file a Notice of Completion, to
release the Labor & Materials Bond 35 days after the Notice of Completion had
been recorded in accordance with applicable portions of the Civil Code, and to
release the Faithful Performance Bond one year after Council acceptance.
The Notice of Completion was recorded by the Orange County Recorder on
June 18, 2007, Reference No. 2007000386663. The Surety for the contract is
Liberty Mutual Insurance Company, and the bond number is 018013232.
Enclosed is the Labor & Materials Payment Bond.
Sincerely,
C/
LaVonne M. Harkless, MMC
City Clerk
cc: Public Works Department
encl.
3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915
Telephone: (949) 644-3005 • Fax: (949) 644-3039 • www. city. newport-beach. ca. us
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
MASTER FORMAL CONTRACT
CONTRACT NO. 3460
BOND NO. 018013232
LABOR AND MATERIALS PAYMENT BOND
WHEREAS, the City Council of the City of Newport Beach, State of California, by motion
adopted, has awarded to Kewaunee Scientific Corporation, hereinafter designated as the
"Principal," a contract for constructionBack Bay Science Center, Contract No. 3460 in
the City of Newport Beach, in strict contormity witn the pians, arawmgs, specifications and other
Contract Documents in the office of the Public Works Department of the City of Newport Beach, all
of which are incorporated herein by this reference.
WHEREAS, Principal has executed or is about to execute Contract No. 3460 and the
terms thereof require the furnishing of a bond, providing that if Principal or any of Principal's
subcontractors, shall fail to pay for any materials, provisions, or other supplies used in, upon,
for, or about the performance of the work agreed to be done, or for any work or labor done
thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth:
NOW, THEREFORE, We the undersigned Principal, and,
Liberty Mutual Insurance Company duly authorized to transact
business under the laws of the State of California, as Surety, (referred to herein as "Surety') are
held firmly bound unto the City of Newport Beach, in the sum of ($71,080.00) lawful money of the
United States of America, said sum being equal to 100% of the estimated amount payable by the
City of Newport Beach under the terms of the Contract; for which payment well and truly to be
made, we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly
and severally, firmly by these present.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal or the Principal's
subcontractors, fail to pay for any materials, provisions, or other supplies, implements or machinery
used in, upon, for, or about the performance of the work contracted to be done, or for any other
work or labor thereon of any kind, or for amounts due under the Unemployment Insurance Code
with respect to such work or labor, or for any amounts required to be deducted, withheld and paid
over to the Employment Development Department from the wages of employees of the Principal
and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect
to such work and labor, then the Surety will pay for the same, in an amount not exceeding the sum
specified in this Bond, and also, in case suit is brought to enforce the obligations of this Bond, a
reasonable attorney's fee, to be fixed by the Court as required by the provisions of Section 3250 of
the Civil Code of the State of California.
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The Bond shall inure to the benefit of any and all persons, companies, and corporations
entitled to file claims under Section 3181 of the California Civil Code so as to give a right of action
to them or their assigns in any suit brought upon this Bond, as required by and in accordance with
the provisions of Sections 3247 et. seq. of the Civil Code of the State of California.
And Surety, for value received, hereby stipulates and agrees that no change, extension of
time, alterations or additions to the terms of the Contract or to the work to be performed thereunder
or the specifications accompanying the same shall in any wise affect its obligations on this Bond,
and it does hereby waive notice of any such change, extension of time, alterations or additions to
the terms of the Contract or to the work or to the specifications.
In the event that any principal above named executed this Bond as an individual, it is
agreed that the death of any such principal shall not exonerate the Surety from its obligations under
this Bond.
IN WITNESS WHEREOF, this instrument has been duly executed by the above named
Principal and Surety, on the 26th day of May , 2006.
Kewaunee Scientific Corporation
Name of Contractor (Principal) Authorized Sidnature/Title
Liberty Mutual Insurance Company
Name of Surety uth riz Agent Signatur
6230 Fairview Rd., Suite 300
Charlotte, NC 28210 Ramona Fewell, Attorney -In -Fact
Address of Surety Print Name and Title
(704) 367-3472
Telephone/Fax
NOTARY ACKNOWLEDGMENTS OF CONTRACTOR AND SURETY MUST BE ATTACHED
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
MASTER FORMAL CONTRACT
CONTRACT NO. 3460
CONTRACT
THIS AGREEMENT, entered into this 1s' day of March, 2006, by and between the CITY OF
NEWPORT BEACH, hereinafter "City," and Kewaunee Scientific Corporation, hereinafter
"Contractor," is made with reference to the following facts:
WHEREAS, City has advertised for bids for the following described public work:
MASTER FORMAL CONTRACT
BACK BAY SCIENCE CENTER, BID PACKAGE #15 — (STEEL LAB CASEWORK
Contract No. 3460
WHEREAS, Contractor has been determined by City to be the lowest responsible bidder and
Contractor's bid, and the compensation set forth in this Contract, is based upon Contractor's
careful examination of all Contract documents, plans and specifications.
NOW, THEREFORE, City and Contractor agree as follows:
A. CONTRACT DOCUMENTS The complete Contract for the Project includes all of the
following documents: Notice Inviting Bids, Instructions to Bidders, Proposal, Bidder's Bond,
Non -Collusion Affidavit, Faithful Performance Bond, Labor and Materials Payment Bond,
Permits, General Conditions, Standard Special Provisions and Standard Drawings, Plans
and Special Provisions for Contract No. 3460, Standard Specifications for Public Works
Construction (current adopted edition and all supplements) and this Agreement, and all
modifications and amendments thereto (collectively the "Contract Documents"). The
Contract Documents comprise the sole agreement between the parties as to the subject
matter therein. Any representations or agreements not specifically contained in the
Contract Documents are null and void. Any amendments must be made in writing, and
signed by both parties in the manner specified in the Contract Documents.
B. SCOPE OF WORK Contractor shall perform everything required to be performed, and
shall provide and furnish all the labor, materials, necessary tools, expendable equipment
and all utility and transportation services required for the Project.
All of the work to be performed and materials to be furnished shall be in strict accordance
with the provisions of the Contract Documents. Contractor is required to perform all
activities, at no extra cost to City, which are reasonably inferable from the Contract
Documents as being necessary to produce the intended results.
C. COMPENSATION As full compensation for the performance and completion of the
Project as required by the Contract Documents, City shall pay to Contractor and Contractor
accepts as full payment the sum of ($71,080.00).
This compensation includes:
(1) Any loss or damage arising from the nature of the work,
(2) Any loss or damage arising from any unforeseen difficulties or obstructions in the
performance of the work,
(3) Any expense incurred as a result of any suspension or discontinuance of the work, but
excludes any loss resulting from earthquakes of a magnitude in excess of 3.5 on the
Richter Scale and tidal waves, and which loss or expense occurs prior to acceptance of
the work by City.
D. NOTICE OF CLAIMS Unless a shorter time is specified elsewhere in this Contract, before
making its final request for payment under the Contract Documents, Contractor shall submit
to City, in writing, all claims for compensation under or arising out of this Contract.
Contractor's acceptance of the final payment shall constitute a waiver of all claims for
compensation under or arising out of this Contract except those previously made in writing
and identified by Contractor in writing as unsettled at the time of its final request for
payment.
E. WRITTEN NOTICE Any written notice required to be given under the Contract
Documents shall be performed by depositing the same in the U.S. Mail, postage prepaid,
directed to the address of Contractor and to City, addressed as follows:
CITY
City of Newport Beach
Public Works Department
3300 Newport Boulevard
Newport Beach, CA 92663
Attention: Stephen G. Badum
(949) 644-0000
CONTRACTOR
Kewaunee Scientific Corporation
2700 West Front Street
Statesville, NC 28687
Attention: David Rausch
(704) 873-7202
Margot De Ramirez (949)499-7334
F. LABOR CODE 3700 LIABILITY INSURANCEContractor, by executing this Contract,
hereby certifies:
"I am aware of the provisions of Section 3700 of the Labor Code which requires every
employer to be insured against liability for Workers' Compensation or undertake self-
insurance in accordance with the provisions of the Code, and I will comply with such
provisions before commencing the performance of the work of this Contract."
G. INSURANCE Insurance is to be placed with insurers with a Best's rating of no less
than A:VII and insurers must be a California Admitted Insurance Company.
Contractor shall furnish City with original certificates of insurance and with original
endorsements effecting coverage required by this Contract. The certificates and
endorsements for each insurance policy are to be signed by a person authorized by that
2
insurer to bind coverage on its behalf. All certificates and endorsements are to be
received and approved by City before work commences. City reserves the right to
require complete, certified copies of all required insurance policies, at any time.
Contractor shall procure and maintain for the duration of the contract insurance against
claims for injuries to persons or damages to property, which may arise from or in
connection with the performance of the work hereunder by Contractor, his agents,
representatives, employees or subcontractors. The cost of such insurance shall be
included in Contractor's bid.
1. Minimum Scope of Insurance
Coverage shall be at least as broad as:
a) Insurance Services Office Commercial General Liability coverage "occurrence"
form number CG 0002 (Edition 11/85) or Insurance Services Office form number
GL 0002 (Edition 1/73) covering Comprehensive General Liability and Insurance
Services Office form number GL 0404 covering Broad Form Comprehensive
General Liability.
b) Insurance Services Office Business Auto Coverage form number CA 0002 0287
covering Automobile Liability, code 1 "any auto" and endorsement CA 0029 1288
Changes in Business Auto and Truckers Coverage forms - Insured Contract.
c) Workers' Compensation insurance as required by the Labor Code of the State of
California and Employers Liability insurance.
2. Minimum Limits of Insurance
Coverage limits shall be no less than:
a) General Liability: $1,000,000.00 combined single limit per occurrence for bodily
injury, personal injury and property damage. If Commercial Liability Insurance or
other form with a general aggregate limit is used, either the general aggregate
limit shall apply separately to this project/location or the general aggregate limit
shall be twice the required occurrence limit.
b) Automobile Liability: $1,000,000.00 combined single limit per accident for bodily
injury and property damage.
c) Workers' Compensation and Employers Liability: Workers' compensation limits
as required by the Labor Code of the State of California and Employers Liability.
3. Deductibles and Self -Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by City.
At the option of City, either: the insurer shall reduce or eliminate such deductibles or
self-insured retentions as respects City, its officers, officials, employees and
volunteers; or Contractor shall procure a bond guaranteeing payment of losses and
related investigations, claim administration and defense expenses.
3
4. Other Insurance Provisions
The policies are to contain, or be endorsed to contain, the following provisions:
a) General Liability and Automobile Liability Coverages
City, its officers, agents, officials, employees and volunteers and Construction
Manager are to be covered as additional insureds as respects: liability arising
out of activities performed by or on behalf of Contractor, including the
insured's general supervision of Contractor; products and completed
operations of Contractor; premises owned, occupied or used by Contractor;
or automobiles owned, leased, hired or borrowed by Contractor. The
coverage shall contain no special limitations on the scope of protection
afforded to City, its officers, officials, employees or volunteers and
Construction Manager.
ii. Contractor's insurance coverage shall be primary insurance and/or primary
source of recovery as respects City, its officers, officials, employees and
volunteers and Construction Manager. Any insurance or self-insurance
maintained by City, its officers, officials, employees and volunteers and
Construction Manager shall be excess of the Contractor's insurance and shall
not contribute with it.
iii. Any failure to comply with reporting provisions of the policies shall not affect
coverage provided to City, its officers, agents, officials, employees and
volunteers and Construction Manager.
iv. Contractor's insurance shall apply separately to each insured against whom
claim is made or suit is brought, except with respect to the limits of the
insurer's liability.
v. The insurance afforded by the policy for contractual liability shall include
liability assumed by contractor under the indemnification/hold harmless
provision contained in this Contract.
b) Workers' Compensation and Employers Liability Coverage
The insurer shall agree to waive all rights of subrogation against City, its officers,
agents, officials, employees and volunteers and Construction Manager for losses
arising from work performed by Contractor for City.
c) All Coverages
Each insurance policy required by this clause shall be endorsed to state that
coverage shall not be suspended, voided, canceled, rescinded by either party,
reduced in coverage or in limits except after thirty (30) days' prior written notice
by certified mail, return receipt requested, has been given to City.
All of the executed documents referenced in this contract must be returned within ten
(10) working days after the date on the "Notification of Award," so that the City may
review and approve all insurance and bonds documentation.
5. Acts of God
4
Pursuant to Public Contract Code Section 7105, Contractor shall not be responsible for
the repairing and restoring damage to Work, when damage is determined to have been
proximately caused by an Act of God, in excess of 5 percent of the Contract amount
provided that the Work damaged is built in accordance with the plans and
specifications.
6. Right to Stop Work for Non -Compliance
City shall have the right to direct the Contractor to stop work under this Agreement
and/or withhold any payment(s), which become due to Contractor hereunder until
Contractor demonstrates compliance with the requirements of this article.
H. RESPONSIBILITY FOR DAMAGES OR INJURY
City and all officers, employees and representatives thereof, including Construction
Manager, shall not be responsible in any manner: for any loss or damages that may
happen to the Work or any part thereof; for any loss or damage to any of the materials
or other things used or employed in performing the Work, for injury to or death of any
person either workers or the public; or for damage to property from any cause arising
from the construction of the work by Contractor, or its subcontractors, or its workers, or
anyone employed by it.
2. Contractor shall be responsible for any liability imposed by law and for injuries to or
death of any person or damage to property resulting from defects, obstructions or from
any cause arising from Contractor's work on the Project, or the work of any
subcontractor or supplier selected by the Contractor.
3. Contractor shall indemnify, hold harmless, and defend City, its officers and employees
and Construction Manager from and against (1) any and all loss, damages, liability,
claims, allegations of liability, suits, costs and expenses for damages of any nature
whatsoever, including, but not limited to, bodily injury, death, personal injury, property
damages, or any other claims arising from any and all acts or omissions of Contractor,
its employees, agents or subcontractors in the performance of services or work
conducted or performed pursuant to this Contract; (2) use of improper materials in
construction of the Work; or, (3) any and all claims asserted by Contractor's
subcontractors or suppliers on the project, and shall include reasonable attorneys' fees
and all other costs incurred in defending any such claim. Contractor shall not be
required to indemnify City or Construction Manager from the sole negligence or willful
misconduct of City, its officers or employees or Construction Manager.
4. To the extent authorized by law, as much of the money due Contractor under and by
virtue of the Contract as shall be considered necessary by City may be retained by it
until disposition has been made of such suits or claims for damages as aforesaid.
5. Nothing in this article, nor any other portion of the Contract Documents shall be
construed as authorizing any award of attorneys' fees in any action to enforce the terms
of this Contract, except to the extent provided for in H.3, above.
6. The rights and obligations set forth in this Article shall survive the termination of this
Contract.
EFFECT OF CONTRACTOR'S EXECUTION Execution of this Contract and all other
Contract Documents by Contractor is a representation that Contractor has visited the
Project Site, has become familiar with the local conditions under which the work is to be
5
performed, and has correlated all relevant observations with the requirements of the
Contract Documents.
J. CONFLICT If there is a conflict between provisions of this Contract and any other
Contract Document, the provisions of this Contract shall prevail.
K. WAIVER A waiver by City or any term, covenant, or condition in the Contract
Documents shall not be deemed to be a waiver of any subsequent breach of the same or
any other term, covenant or condition.
IN WITNESS WHEREOF, the parties hereto have caused this contract to be executed the day
CITY CLERK
APPROVED AS TO FORM:
C �'- ,C
(fc-
CIYY'ATTORNEY
R
CITY OF NEWPORT BEACH
A Municipal Corporation
By:f
Mayor
CONT"CTOR
B1.
�—
(Corp `rate Officer)
Title: VP, Sales & Marketing
Print Name: Dana L. Dahlqren
(Financial Officer)
Title: Sr. VP Finance/CFO
Print Name: D. Michael Parker
ACORDr~
DATE(MM DD/Yy)
08/14/06
PRODUCER
Aon Risk services inc of the Carolinas
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
1100 Reynolds Boui evard
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Winston-Salem NC 27105 USA
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
PHONE -(866) 283-7124 Fax -(866) 430-1035
INSURED
INSURER k* The American Insurance Company
Kewaunee scientific Corp.
INSURER B: National surety Corporation
PO Box 1842
Statesville NC 286871842 USA
INSURER C:
m
w
INSURER D:
C
INSURER E:
'
b
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
llVSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM\DD\YY)
POLICY EXPIRATION
DATE(MMWDWY)
LIMITS
A
GENERAL LIABILITY
Mxx80857326
04/30/06
04/30/07
EACH OCCURRENCE $1,000,000
�
X COMMERCIAL GENERAL LIABILITY
01
FIRE DAMAGE(Any one fire) $1,000,0
CLAIMS MADE ❑X OCCUR
O
n
MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO $2,000,000
PRO-
POLICY � n LOC
G
JECT
P
z
4t
A
AUTOMOBILE LIABILITY
MXx80857326
04/30/06
04/30/07
COMBINED SINGLE LIMIT
u
X ANY AUTO
(Ea accident) $1,000,000
'C
m
ALL OWNED AUTOS
V
BODILY INJURY
SCHEDULED AUTOS
( Per person)
HIRED AUTOS
BODILY INJURY
NON OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGG
B
EXCESSLIABILFPY
xA000 771 4
04/30/06
04/30/07
EACH OCCURRENCE $2,000,000
)( OCCUR ❑ CLAIMS MADE
AGGREGATE $2,000,000
DEDUCTIBLE
RETENTION
B
WORKERS COMPENSATION AND
w34wP80940910
04/30/06
04/30/07X
WC STATU- OTH-
EMPLOYERS' LIABILITY
TORY LIMITS ER
E.L. EACH ACCIDENT $500,000
E.L. DISEASE -POLICY LIMIT $500,000
E.L. DISEASE -EA EMPLOYEE $5001000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Laboratory Casework: Back Bay science center, Bid Package #15. Ksc Job #30180. city of Newport Beach, its
officers, agents, officials, employees and volunteers and construction manager are added as Additional Insureds
a_
excluding Workers' Compensation and Employers' Liability as required by written contract (per Blanket Multi Cover
Ci tx of Newport Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Pub I i c Works Department DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Attn: Stephen G. Badum 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
3 300 Newport Boulevard BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
Newport Beach CA 92663 USA OF ANY KIND UPON THE COMPANY, ITS AGEN S OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
te
i<: AW',J's� l �#+' II d��G ,.t via v ua' '�wt�v �:z €s,� �3 `-€ h `t' �$ - %- �aau « ae - a�a ` -rem ��4%two] RO"TIM-90MM&
KEWAUNEE SCIENTIFIC CORP
POLICY NO. MXX80857326
MultiCover® - CG 71 58 12 03
Policy Amendment(s) Commercial General Liability Coverage Form
Your Commercial General Liability Coverage Form is
(3) Coverage B does not apply to per -
M__ revised as follows:
sonal and advertising injury arising
f=�
out of an offense committed before
1. Broadened Named Insured
you acquired or formed the organ -
_
nation.
A. SECTION 11 - WHO. IS AN INSURED,
item 3., is replaced by the following:
B. SECTION 11- WHO IS AN INSURED, the
BEER
last paragraph, is replaced by the following:
tem 3. Any organization that you own at the
i inception of this policy, or newly acquire
No person or organization is an insured with
or form during the policy period, and
respect to the conduct of any current or past
over which you maintain during the pol-
partnership, joint venture, or limited liability
® icy period majority ownership or major-
company that is not shown as a Named In-
ity interest, will qualify as a Named
cured in the Declarations. However, this does
Insured if:
not apply to a limited liability company that
meets all of the conditions in Section II -
a. There is no other similar insurance
Who Is An Insured, item 3., above,
available to that organization; and
2 Additional Insured
b. The first Named Insured shown in
SECTION If - WHO IS AN INSURED, sub -
the Declarations has the responsi-
section 2-e. is added as follows:
bility of placing insurance for that
W organization; and
e. Any person or organization is included as an
additional insured but only to the extent such
c. That organization is incorporated or
person or organization is held liable for
organized under the laws of the
bodily injury, property damage or personal and
United States of America.
advertising Injury caused by your acts or
o
However
omissions. With respect to the insurance af-
forded to such insured, all of the following
`
(1) Coverage under this provision 3 is
additional provisions apply:
afforded only until the next occur-
(1) You and such person or organization
ring annual anniversary of the be-
have agreed in a written insured contract
ginning of the policy period shown
that such person or organization be
in the Declarations, or the end of the
added as an additional insured under this
policy period, whichever is earlier;
policy;
and
(2) The bodily injury, property damage or
(2) Coverage A does not apply to bodily
personal and advertising injury for which
injury or property damage that oc-
said person or organization is held liable
— curred before you acquired or
occurs subsequent to the execution of
formed the organization; and
such insured contract;
This Form trust be attached to Change Endarsement when issued after the policy is written.
One of the Fireman's Fund huuranee Companies as named in the policy
S etary
President
C07158 12.03R
tndude, copyrighted materia or Insurance services office, Inc. with its permission. Page I of 6
(3) The most we will pay is the lesser of
either the Limits of Insurance shown in
the Declarations or the limits of insur-
ance required by the insured contract;
(4) Such person or organization is an insured
only with respect to:
(a) Their ownership, maintenance, or
use of that part of the premises, or
land, owned by, rented to, or leased
to you, except such person or or-
ganization is not an insured with re-
spect to structural alterations, new
construction or demolition oper-
ations performed by or on behalf of
such person or organization;
(b) Your ongoing operations performed
for that insured;
(c) Their financial control of you, ex-
cept such person or organization is
not an insured with respect to struc-
tural alterations, new construction
or demolition operations performed
by or on behalf of such person or
organization;
(d) The maintenance, operation or use
by you of equipment leased to you
by such person or organization;
(e) Operations performed by you or on
your behalf and for which a state or
political subdivision has issued a
permit, provided such operations are
not performed for such state or pol-
itical subdivision, and are not in-
cluded within the products -completed
operations hazard;
(5) This insurance does not apply to bodily
injury, property damage, personal and
advertising injury, occurrence or offense:
(a) Which takes place at a particular
premises after you cease to be a
tenant of that premises;
(b) Which takes place after all work, in-
cluding materials, parts or equip-
ment furnished in connection with
such work to be performed by or on
Coll 53 11.098
tnduda copyrighted material of Inn mm Services office, ire. with its permission.
behalf of the additional insured at
the site of the covered operations,
has been completed;
(c) Which takes place after that portion
of your work out of which the injury
or damage arises has been put to its
intended use by any other person or
organization other than another
contractor or subcontractor engaged
in performing operations for a prin-
cipal as part of the same project;
(d) Which takes place after the expira-
tion of any equipment lease to
which (4)(d) above applies;
(6) With respect to architects, engineers or
surveyors, coverage does not apply to
bodily injury, property damage or per-
sonal and advertising injury arising out
of the rendering or failure to render any
professional services by or for you, in-
cluding:
(a) The preparing, approving, or failing
to prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change order;, or draw-
ings and specifications;
(b) Supervisory, inspection, architec-
tural, or engineering services.
However, if an Additional Insured endorsement is
attached to this policy that specifically names a
person or organization as an insured, then this
subsection 2.e. does not apply to such person or
organization.
3. Additional Insured - Vendors
Unless the products -completed operations hazard
is excluded from this policy, SECTION 11 - WHO
IS AN INSURED, item 21 is added as follows:
f. Any vendor of yours is included as an addi-
tional insured, but only with respect to bodily
injury or property damage caused by your
products which are distributed or sold in the
regular course of the vendor's business, sub-
ject to the following additional exclusions:
(1) The insurance afforded the vendor does
not apply to:
Page 2 of 6
(a) Bodily injury or property damage for
p ying or containing such
into accompanying g
r� which the vendor is obligated to pay
products.
damages by reason of the assump-
tion of liability in a contract or
However, if an Additional Insured - Vendors
agreement. This exclusion does not
endorsement is attached to this policy that
t� apply to liability for damages that
specifically names a person or organization as
the vendor would have in the ab-
an insured, then this subsection 21 does not
®a sence of the contract or agreement;
apply to that person or organization.
(b) Any express warranty unauthorized 4.
Waiver of Subrogation
by you;
SECTION IV - COMMERCIAL GENERAL
-"� (c) Any physical or chemical change in
LIABILITY CONDITIONS, item g., is replaced
the product made intentionally by
by the following:
the vendor;
8. Transfer of Rights of
gh Recovery Against Oth-
ers to Us and Blanket Waiver of Subrogation
for the purpose of inspection, dem-
a. If the insured has rights to recover all or
onstration, testing, or the substi-
part of any payment we have made under
tution of parts under instructions
this Coverage Part, those rights are
from the manufacturer, and then re-
transferred to us. The insured must do
packaged in the original container;
nothing after the loss to impair those
(e) Any failure to make such in-
rights. At our request, the insured will
spections, adjustments, tests or ser-
bring suit or transfer those rights to us
vicing as the vendor has agreed to
and help us enforce them.
amake or normally undertakes to
b. If required by a written insured contract
make in the usual course of busi-
executed prior to the occurrence or of-
$ ness, in connection with the distrib-
fense, we waive any right of recovery we
$ ution or sale of the products;
may have against any person or organ -
(f) Demonstration, installation, servic-
ization named in such insured contract,
ing or repair operations, except such
because of payments we make for injury
or damage arising out of your operations
operations performed by the vendor
or your -work for that person or organ -
in full compliance with the man-
ization.
iz
ufacturer's written instructions at the
vendor's premises in connection S.
Cancellation - 120 Days
• with the We of the product;
Common Policy Conditions endorsement IL0017,
(g) Products which, after distribution
A. Cancellation, item 2.b. is replaced by the fol -
or We by you, have been labeled or
lowing:
er relabeled or used as a container, part
_ or ingredient of any other thing or
b. 120 days before the effective date of cancella-
substance by or for the vendor, or
tion if we cancel for any other reason.
(h) Bodily injury or property damage 6.
Liberalization
§ arising out of the liability of the
SECTION IV - COMMERCIAL GENERAL
gvendor for its own acts or omissions
LIABILITY CONDITIONS, the following is ad -
or those of its employees or anyone
ded:
o else acting on its behalf.
Liberalization
W (2) This insurance does not apply to any in-
sured person or organization from whom
If we adopt a change in our forms or rules which
you have acquired such products or any
would broaden the coverage provided by any form
N
u ingredient, part or container, entering
that is a part of this policy without an extra
CG7I58 I2•03R
�_ Includes copyrighted rrutertiat of Insurance Services Office, Inc. with ib permission.
Page 3 of 6
premium charge, the broader coverage will apply
while rented to you, temporarily occu-
to this policy. This extension is effective upon the
pied by you with permission of the
approval of such broader coverage in your state.
owner, or managed by you under a writ-
ten agreement with the owner;
7. Fire, Explosion, Sprinkler Leakage, or Lightning
Legal Liability Coverage
(c) That is insurance purchased by you to
cover your liability as a tenant for
A. SECTION 1 - COVERAGES COVERAGE
property damage to premises rented to
A BODILY INJURY AND PROPERTY
you, temporarily occupied by you with
DAMAGE LIABILITY, 2. Exclusions, the
the permission of the owner, or managed
last paragraph, is replaced by the following:
by you under a written agreement with
Exclusions c. through n. do not apply to
the owner; or
damage by fire, explosion, sprinkler leakage,
D. SECTION V - DEFINITIONS, 9. Insured
or lightning to premises while:
Contract, 'stem a., is replaced by the following:
1. Rented to you;
a. A contract for a lease of premises.
2. Temporarily occupied by you with the
However, that portion of the contract for
permission of the owner; or
a lease of premises that indemnifies any
person or organization for damage by
3. Managed by you under a written agree-
fire, explosion, sprinkler leakage, or
ment with the owner.
lightning to premises while rented to you,
temporarily occupied by you with per -
A separate limit of insurance applies to this
mission of the owner, or managed by you
coverage as described in Section ill - LIMITS
under a written agreement with the
OF INSURANCE.
owner, is not an insured contract;
B. SECTION III - LIMITS OF INSURANCE, g.
Non -Owned or Chartered Watercraft
item 6., is replaced by the following:
SECTION I -COVERAGES, COVERAGE A
6. Subject to 5. above, the Damage to
BODILY INJURY AND PROPERTY DAM.
Premises Rented To You Limit shown
AGE LIABILITY, 2. Exclusions, item g. Aircraft,
in the Declarations, for property damage
Auto Or Watercraft, item (2), is replaced by the
to any one premises while rented to you,
following:
or in the case of damage by fine, explo-
sion, sprinkler leakage, or lightning while
(2) A watercraft you do not own that is:
rented to you, temporarily occupied by
(a) Less than 51 feet long; and
you with the permission of the owner,
or managed by you under a written
(b) Not being used for public transportation
agreement with the owner, is the greater
or as a common carrier;
of:
9.
Chartered Aircraft
a. $1,000,000 Any One Premises; or
SECTION I - COVERAGES, COVERAGE A
b. The Damage To Premises Rented
BODILY INJURY AND PROPERTY DAM -
To You Limit shown in the Decla-
AGE LIABILITY, 2. Exclusions, g. Aircraft,
rations.
Auto Or Watercraft, item (6), is added as follows:
C. SECTION IV - COMMERCIAL GEN-
(6) An aircraft in which you have no ownership
ERAL LIABILITY CONDITIONS, 4.
interest and that you have chartered with
Other Insurance, b. Excess Insurance, (1),
Irv,
items (b) and (c), are replaced by the follow-
ing: 10.
Coverage Territory - Broadened
(b) That is Fire, Explosion, Sprinkler Leak-
SECTION V - DEFINITIONS, item Ca., is re -
age, or Lightning insurance for premises
placed by the following:
CG71 SE 12.038
Includes copyrighted matcrial of Imuran« services office, Inc. with its pamisaon.
Page 4 of 6
a. The United States of America (including its
territories and possessions), Puerto Rico,
>! Canada, Bermuda, the Bahamas, The Cayman
Islands, and the British Virgin Islands;
11. Personal and Advertising Injury - Contractual
Unless personal and advertising injury is excluded
from this policy the following applies:
SECTION I - COVERAGES, COVERAGE B,
2. Exclusions, item e., is deleted.
i 12. Fellow Employee Coverage
SECTION 11 - WHO IS AN INSURED, 2.a.,
:✓ item (1) is replaced by the following:
(1) Personal and advertising injury:
However, subsections (a), (b), (c) and (d) of item
(1) remain unchanged.
13. Bodily Injury Definition - Broadened
SECTION V - DEFINITIONS, 3. Bodily injury
is replaced by the following:
Bodily injury means bodily injury, sickness, or di-
sease sustained by a person including death or
mental anguish resulting from any of these at any
o time. Mental anguish means any type of mental
or emotional illness or disease.
14. Unintentional Failure to Disclose Hazards
SECTION 1V - COMMERCIAL GENERAL
LIABILITY CONDITIONS, item 6. Representa-
tions, the following is added:
d. If you unintentionally fail to disclose any ha-
zards existing at the inception date of this
policy, we will not deny coverage under this
Coverage Form because of such failure.
N However, this provision does not affect our
Z right to collect additional premium or exercise
our right of cancellation or non -renewal.
s 15. Supplementary Payments - Increased Limits
e
W SECTION I - COVERAGES, SUPPLEMEN-
TARY PAYMENTS - COVERAGES A AND
o B, items l.b. and I.d., are replaced by the follow-
ing:
w
g b. The cost of bail bonds required because of
N accidents or traffic law violations arising out
of the use of any vehicle to which the Bodily
C07158 1 Y•D3R
Indudes topyriphted ma"al of Insurance Services Of11et, Inc. with its permission.
Injury Liability Coverage applies. We do not
have to furnish these bonds.
d. All reasonable expenses incurred by the in-
sured at our request to assist us in the inves-
tigation or defense of the claim or suit,
including substantiated loss of earnings' up to
$500 a day because of time off from work.
16. Duties in the Event of an Occurrence, Offense,
Claim, or Suit - Amended
SECTION IV - COMMERCIAL GENERAL
LIABILITY CONDITIONS, items 2.a. and 2.b.,
are replaced with the following:
a. You must see to it that we or any licensed
agent of ours are notified of a General
liability occurrence or offense which may re-
sult in a claim as soon as practicable after it
becomes known to:
(1) You, if you are an individual;
(2) Your partner or member, if you are a
partnership or joint venture;
(3) Your member, if you are a limited labil-
ity company;
(4) Your executive officer if you are an or-
ganization other than a partnership, joint
venture or limited liability company; or
(5) Your authorized representative or insur-
ance manager.
Knowledge of an occurrence or offense by
persons other than those listed above does not
imply that those listed above also have such
knowledge.
b. To the extent possible, notice should include:
(1) How, when, and where the occurrence
. or offense took place;
(2) The names and addresses of any injured
persons and witnesses; and
(3) The nature and location of any injury or
damage arising out of the occurrence or
offense.
17. Non Employment Discrimination Liability
Unless personal and advertising injury is excluded
from this policy the following applies:
Page 5 of 6
A. SECTION V - DEFINITIONS, 14. Personal
and advertising injury, item h. is added as fol-
lows:
h. Discrimination.
B. SECTION V - DEFINITIONS, item 23. is
added as follows:
23. Discrimination means the unlawful treat-
ment of a person or class of persons be-
cause of their specific race, color, religion,
gender, age, or national origin in com-
parison to one or more persons who are
not members of the specified class.
C. SECTION I - COVERAGES, COVERAGE
B PERSONAL AND ADVERTISING
INJURY LIABILITY, 2. Exclusions, the
following are added:
p. Disaimination directly or indirectly re-
lated to the past employment, employ-
ment or prospective employment of any
person or class of persons by any insured;
q. Discrimination directly or indirectly re-
lated to the sale, rental, lease or sublease
or prospective sale, rental, lease or sub-
lease of any dwelling, permanent lodging,
or premises by or at the direction of any
insured;
r. Discrimination, if insurance thereof is
prohibited by law; or
CG7151 12-03R
Includes copyrighted material of [nutans ScMtes Offi", be. with its permission.
s. Fines, penalties, specific performance, or
injunctions levied or imposed by a gov-
ernmental entity, governmental code,
law, or statute because of discrimination.
18. Medical Payments
Unless COVERAGE C MEDICAL PAY-
MENTS, or the products -completed operations
hazard has been excluded from this policy the fol-
lowing applies:
A. SECTION I - COVERAGES, COVERAGE
C MEDICAL PAYMENTS, 2. Exclusions,
item f., is replaced by the following:
f. Products -Completed Operations Hazard
Included within the products -completed
operations hazard. However, this exclu-
sion does not apply to expenses for den-
tal services.
B. Section I - COVERAGES, COVERAGE C
MEDICAL PAYMENTS, is amended to in-
clude item 3. as follows:
3. Limit of Insurance
The Medical Expense Limit of Insurance
shall be the greater of-
a.
f
a. $10,000 Any One Person; or
b. The amount shown in the Declara-
tions.
Page 6 of 6
KEWAUNEE SCIENTIFIC CORP
POLICY N0. MXX80857326
FleetCover® Endorsement CA 70 18 10 01
Policy Amendment(s) Commercial Business Auto Coverage Form - Truckers Coverage Form
A. Broadened Named Insured as an insured under any other automobile li-
ability insurance policy whose limits of insur-
SECTION II -LIABILITY COVERAGE, A. ante have been exhausted or whose insurer
Coverage, 1. Who Is An Insured, the following is
has become insolvent.
added:
Any organization you own on the inception of this
policy, or newly acquire or form during the policy
period, and over which you maintain during the
policy period, majority ownership or majority in-
terest will qualify as a Named Insured if:
(1) There is no other similar insurance available
to that organization; and
(2) The first Named Insured shown in the Dec-
larations of this policy has the responsibility
of placing insurance for that organization; and
(3) The organization is incorporated or organized
under the laws of the United States of Amer-
ica.
However:
(a) Coverage under this provision is afforded only
until the next occurring 12 month anniversary
of the beginning of the policy period shown
in the Declarations, or the end of the policy
period, whichever is earlier; and
B. Broadened Who Is an Insured
(b) Coverage under this provision does not apply
to bodily injury or property damage that re- C
sults from an accident that occurred before
you acquired or formed the organization; and
(c) No person or organization is an insured with
respect to any current or past partnership, or
joint venture that is not shown as a Named
Insured in the Declarations; and
(d) Coverage under A.(I), (2) and (3) above does
not apply to any organization that is covered
1. Form CA0001 (if attached to this policy),
SECTION II - LIABILITY COVERAGE,
1. Who Is An Insured, item b.(2) is deleted,
and d. is added as follows:
d. Your employee while using his owned
auto, or an auto owned by a member of
his or her household, in your business
or your personal affairs, provided you do
not own, hire or borrow that auto.
2. Form CA0012 (if attached to this policy),
SECTION II - LIABILTI'Y COVERAGE,
1. Who Is An Insured, item b.(2) is deleted,
and f. is added as follows:
Your employee or agent while using his
owned private passenger type auto, or a
private passenger type auto owned by a
member of his or her household, in your
business or personal affairs, provided you
do not own, hire, or borrow that auto.
Additional Insured Coverage and Waiver of
Subrogation
Form CA0001 (if attached to this policy),
SECTION It - LIABILITY COVERAGE,
I. Who Is An Insured, the following is added
as item e.; and form CA0012 (if attached to
this policy), SECTION 11 - LIABILITY
COVERAGE, 1. Who Is An Insured; the
following is added as item g.:
This Form must be attached to Change Endorsement when issued after the policy is written.
One of the Firernan's Fund tnsurana Companies as named in the policy
se rotary President
CA7012 10-OIT Page 1 of 6
s=
Any person or organization with respect to
t
the operation, maintenance, or use, of a cov-
ered auto, provided that you and such person
or organization have agreed under an ex-
pressed provision in a written insured contract
or written agreement, or a written permit is-
sued to you by a governmental oi public au -
9==
thority, to add such person, organization, or
governmental orpublic authority to this pol-
icy as an insured.
However, such person or organization is an
insured:
(1) Only with respect to the operation,
r�
maintenance, or use, of a covered auto;
and
(2) Only for bodily injury or property dam-
age caused by an acddent which takes
place after:
(a) You executed the insured contract
or written agreement; or
(b) The permit has been issued to you.
0
2. Form CA0001 (if attached to this policy),
SECTION IV - BUSINESS AUTO CON-
DITIONS, A. Loss Conditions, item 5.; and
o
form CA0012 (if attached to this policy),
8
SECTION V - TRUCKERS CONDI-
TIONS, A. Loss Conditions, item S.; the fol-
lowing is added:
Waiver or Subrogation
If required by a:
a. Written insured contract or written
agreement executed prior to the accident;
or
N
b. Written permit issued to you by a gov-
ernmental or public authority prior to the
accident;
we waive any right of recovery we may have
against any person or organization named in
such contract, agreement or permit, because
of payments we make for injury or damage
°
arising out of a covered auto.
W
D. Auto Medical Payments - Increased Limit
g
N
For each covered auto described in the Declara-
U
tions or shown in the Schedule as having Auto
11
CA701810.0{T
Medical Payments Coverage, the Medical Pay-
ments Limit of Insurance for those autos is revised
to the greater of:
1. 55,000; or
2. The limit shown in the Declarations
E. Hired Auto Physical Damage Coverage
If PHYSICAL DAMAGE COVERAGE is pro-
vided by this policy on your owned covered
autos, the following applies:
Any auto that you lease, hire, rent or borrow
without a driver, will be covered under this policy
for PHYSICAL DAMAGE COVERAGE.
However any such auto:
1. Will be covered only for the same PHYS-
ICAL DAMAGE COVERAGE that applies
to your owned covered autos;
2. Will be subject to the same applicable
deductible shown in the Declarations that
applies to your most similar owned covered
auto, except any Comprehensive Coverage
deductible does not apply to loss caused by
fire or lightning; and
3. The most we will pay for any one loss in any
one accident is the lesser of the following:
a. Actual Cash Value of the damaged or
stolen property as of the time of the loss
as determined by us; or
b. The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
In addition, we will pay costs and fees associated
with such covered loss only for a maximum time
period of seven days beginning with the date of
loss, subject to a maximum of $500.
However:
1. If form CA0001 is attached to this policy, this
coverage does not apply to autos you lease,
hire, rent . or borrow from any of your
employees, partners (if you are a partnership),
members (if you are a limited liability com-
pany) or members of their households; and
2. If form CA0012 is attached to this policy, this
coverage does not apply to any private
Page 2 of 6
passenger type auto you lease, hire, rent or
borrow from any member of your household,
any of your employees, partners (if you are a
partnership), members (if you are a limited
liability company), or agents or members of
their households.
F. Communication Equipment Coverage
Form CA0001 (if attached to this policy),
SECTION III - PHYSICAL DAMAGE
COVERAGE, B. Exclusions, item 4., the
following is added:
Exclusions 4.c. and 4.d. do not apply to elec-
tronic equipment that is permanently installed
in the covered auto at the time of the loss or
such equipment which is removable from a
housing unit which is permanently installed
in the covered auto at the time of the loss, and
such equipment is designed to be solely oper-
ated by use of power from the auto's electrical
system in or upon the covered auto. This
coverage also applies to antennas and other
accessories necessary for the use of the elec-
tronic equipment. However, the most we will
pay for loss is $1,500 and no deductible ap-
plies to this coverage.
2. Form CA0012 (if attached to this policy),
SECTION IV - PHYSICAL DAMAGE
COVERAGE, B. Exclusions, Item 2., the
following is added:
Exclusions 4.e, and 41 do not apply to elec-
tronic equipment that is permanently installed
in the covered auto at the time of the toss or
such equipment which is removable from a
housing unit which is permanently installed
in the covered auto at the time of the loss, and
such equipment is designed to be solely oper-
ated by use of power from the autos electrical
system in or upon the covered auto. This
coverage also applies to antennas and other
accessories necessary for the use of the elec-
tronic equipment. However, the most we will
pay for loss is $1,500 and no deductible ap-
plies to this coverage.
G. Tapes and Compact Discs Coverage
A. Under Comprehensive Coverage, we will pay
for loss to tapes, records, discs or other similar
devices used with audio, visual or data elec-
tronic equipment. We will pay only if the
tapes, records, discs or other similar audio,
visual or data electronic devices:
Are your property, or that of a family
member; and
2. Are in a covered auto at the time of a
loss.
B. The most we will pay for loss is $250.
C. PHYSICAL DAMAGE COVERAGE pro-
visions apply to this coverage, except that no
deductible applies.
H. Airbag Coverage
Form CA0001 (if attached to this policy),
SECTION III - PHYSICAL DAMAGE
COVERAGE, B. Exclusions, 3.a., the fol-
lowing is added:
However, "mechanical breakdown' does not
mean the unintended discharge of an airbag,
provided that any loss covered under this
provision is excess over any other collectable
insurance or warranty designed to cover such
unintended discharge.
2. Form CA0012 (if attached to this policy),
SECTION IV - PHYSICAL DAMAGE
COVERAGE, B. Exclusions, 3.a., the fol-
lowing is added:
However, 'mechanical breakdown' does not
mean the unintended discharge of an airbag,
provided that any loss covered under this
provision is excess over any other collectable
insurance or warranty designed to cover such
unintended discharge.
I. Rental Reimbursement
Form CA0001 (if attached to this policy), SEC-
TION 111 - PHYSICAL DAMAGE COVER-
AGE, A. Coverage, 4. Coverage Extensions; and
form CA0012 (if attached to this policy), SEC-
TION IV - PHYSICAL DAMAGE COVER-
AGE, A. Coverage, 4. Coverage Extensions; item
c. is added as follows:
c. Rental Reimbursement or Transportation
Expenses
If loss occurs to a covered auto described or
designated in the Declarations or Schedule
and covered for PHYSICAL DAMAGE
CA7018 MIT Page 3 of 6
COVERAGE, we will pay for rental expenses
for the rental of a similar replacement auto
and additional transportation expenses, in-
curred by you. This payment applies in ad-
dition to the otherwise applicable amount of
each coverage you have on the covered auto.
No deductible applies to this coverage.
However:
i= (1) We will pay only for those expenses in-
curred by you that begin 24 hours after
the covered loss.
(2) We will cease paying for those expenses,
regardless of the policy's expiration date,
at the earlier of the following dates:
(a) The number of days reasonably re-
quired to repair or replace the cov-
ered auto. If loss is caused by theft,
this number of days is added to the
number of days it takes to locate and
return the covered auto to you; or
2. Extended Towing
We will pay up to $750 per disablement
for towing and labor costs you incur each
time your covered auto is disabled.
However,
a. All labor must be performed at the
place of disablement; and
b. If the covered auto is of the private
passenger type no deductible applies;
and
c. If the covered auto is not of the pri-
vate passenger type our obligation
to pay will be reduced by a $250
deductible per disablement.
2. Form CA0012 (if attached to this policy),
SECTION IV - PHYSICAL DAMAGE
COVERAGE, A. Coverage, 2. Towing - Pri-
vate Passenger Autos, is replaced by the fol-
lowing-
2.
ol-
lowing
2. Extended Towing
We will pay up to $750 per disablement
for towing and labor costs you incur each
time your covered auto is disabled.
However.
a. All labor must be performed at the
place of disablement; and
b. If the covered auto is of the private
passenger type no deductible applies;
and
c. if the covered auto is not of the
private passenger type our obligation
to pay will be reduced by a $250
deductible per disablement.
K. Cancellation - 120 Days Notice
If we cancel this policy for any reason other than
nonpayment of premium, we will mail or deliver
to the first Named Insured at the last mailing ad-
dress known to us, written notice of cancellation
at least 120 days prior to the effective date of can-
cellation.
L. Supplementary Payments - increased Limits
SECTION II - LIABILITY COVERAGE, 2.
Coverage Extensions, a. Supplementary Payments,
items (2) and (4) are replaced by the following:
Page 4 of 6
(b) 45 days from the date this coverage
begins.
(3) Our payment is limited to the lesser of
the following amounts:
(a) Necessary and actual expenses in -
4
curred by you; or
(b) $1,500.
(4) This coverage does not apply while there
are spare or reserve autos available to you
for your operations.
(5) If loss results from the total theft of a
covered private passenger type auto (if
CA0012 is attached to this policy), or a
covered private passenger auto (if
CA0001 is attached to this policy), we
—
will pay under this coverage only that
amount of your covered rental expenses
or additional transportation expenses
which are not already provided for under
0
the PHYSICAL DAMAGE COVER-
tV
AGE Extensions.
n
a
J. Extended Towing Coverage
ei
h
W
1. Form CA0001 (if attached to this policy),
SECTION III - PHYSICAL DAMAGE
N
COVERAGE, A. Coverage, 2. Towing, is re-
placed by the following:
CA 7018 10-01T
2. Extended Towing
We will pay up to $750 per disablement
for towing and labor costs you incur each
time your covered auto is disabled.
However,
a. All labor must be performed at the
place of disablement; and
b. If the covered auto is of the private
passenger type no deductible applies;
and
c. If the covered auto is not of the pri-
vate passenger type our obligation
to pay will be reduced by a $250
deductible per disablement.
2. Form CA0012 (if attached to this policy),
SECTION IV - PHYSICAL DAMAGE
COVERAGE, A. Coverage, 2. Towing - Pri-
vate Passenger Autos, is replaced by the fol-
lowing-
2.
ol-
lowing
2. Extended Towing
We will pay up to $750 per disablement
for towing and labor costs you incur each
time your covered auto is disabled.
However.
a. All labor must be performed at the
place of disablement; and
b. If the covered auto is of the private
passenger type no deductible applies;
and
c. if the covered auto is not of the
private passenger type our obligation
to pay will be reduced by a $250
deductible per disablement.
K. Cancellation - 120 Days Notice
If we cancel this policy for any reason other than
nonpayment of premium, we will mail or deliver
to the first Named Insured at the last mailing ad-
dress known to us, written notice of cancellation
at least 120 days prior to the effective date of can-
cellation.
L. Supplementary Payments - increased Limits
SECTION II - LIABILITY COVERAGE, 2.
Coverage Extensions, a. Supplementary Payments,
items (2) and (4) are replaced by the following:
Page 4 of 6
(2) Up to $2,500 for the cost of bail bonds (in-
cluding bonds for related traffic law vio-
lations) required because of an accident we
cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the
insured at our request, including substantiated
loss of earnings up to $500 a day, because of
time off from work.
M. Duties in the Event of Accident, Claim, Suit or
Loss - Amended
Form CA0001 (if attached to this policy) SEC-
TION IV - BUSINESS AUTO CONDITIONS,
A. Loss Conditions, item 2. a.; and form CA0012
(if attached to this policy) SECTION V -
TRUCKERS CONDITIONS, A. Loss Condi-
tions, item 2. a.; is replaced by the following:
a. In the event of accident, claim, suit or loss,
you must promptly notify us or our
authorized representative when it becomes
known to:
(1) You, if you are an individual;
(2) Your partner or member, if you are a
partnership or joint venture;
(3) Your member, if you are a limited liabil-
ity company;
(4) Your executive officer if you are an or-
ganization other than a partnership, joint
venture or limited liability company; or
(5) Your authorized representative or insur-
ance manager.
Knowledge of an accident, claim, suit or loss by
other persons does not imply that the persons
fisted above have such knowledge.
Notice should include:
(1) How, when and where the accident or loss
occurred; and
(2) The insured's name and address; and
(3) To the extent possible, the names and address
of any injured persons and witnesses.
N. Unintentional Failure to Disclose Hazards
Form CA0001 (if attached to this policy), SEC-
TION IV - BUSINESS AUTO CONDITIONS,
B. General Conditions, item 2.; and form CA0012
(if attached to this policy), SECTION V -
TRUCKERS CONDITIONS, B. General Condi-
tions, item 2.; the following is added:
However, if you unintentionally fail to disclose any
hazards existing at the inception date of this policy,
we will not deny coverage under this Coverage
Form because of such failure. Ilowever, this pro-
vision does not affect our right to collect additional
premium or exercise our right of cancellation or
non -renewal.
O. Fellow Employee Coverage
Section II - Liability Coverage, B. Exclusions, S.
Fellow Employee, the following is added:
However, this exclusion does not apply if the
bodily injury results from the use of a covered
auto you own or hire, and provided that any
coverage under this provision only applies in ex-
cess over any other collectable insurance.
P. Limited Mexico Coverage
WARNING
AUTO ACCIDENTS IN MEXICO ARE SUB-
JECT TO THE LAWS OF MEXICO ONLY -
NOT THE LAWS OF THE UNITED STATES
OF AMERICA. THE REPUBLIC OF MEX-
ICO CONSIDERS ANY AUTO ACCIDENT A
CRIMINAL OFFENSE AS WELL AS A CIVIL
MATTER.
IN SOME CASES THE' COVERAGE PRO-
VIDED HERE MAY NOT BE RECOGNIZED
BY THE MEXICAN AUTHORITIES AND
WE MAY NOT BE ALLOWED TO IMPLE-
MENT THIS COVERAGE AT ALL IN
MEXICO. YOU SHOULD CONSIDER PUR-
CHASING AUTO COVERAGE FROM A
LICENSED MEXICAN INSURANCE COM-
PANY BEFORE DRIVING IN MEXICO.
THIS ENDORSEMENT DOES NOT APPLY
TO ACCIDENTS OR ' LOSSES WHICH OC-
CUR OUTSIDE OF 25 MILES FROM THE
BOUNDARY OF THE UNITED STATES OF
AMERICA.
Form CA0001 (if attached to this policy), SEC-
TION IV - BUSINESS AUTO CONDITIONS,
B. General Conditions, item 7.; and form CA0012
(if attached to this policy), SECTION V -
TRUCKERS CONDITIONS, B. General Condi-
tions, item 7.; the following is added:
CA7018 iaOIT Page 5 of 6
The coverage territory is extended to include
S. Customer Lease or Loan Physical Damage Cover -
Mexico, but only:
age Extension
a. For accidents or losses occurring within 25
Force CA0001 (if attached to this policy), SEC -
miles of the United States border; and
TION III - PHYSICAL DAMAGE COVER-
AGE, C. Limit Of Insurance; and form CA0012
i�
b. For trips into Mexico of 10 days or less; and
(if attached to this policy), SECTION IV - PHY-
C. If the covered auto is principally garaged and
SICAL DAMAGE COVERAGE, C, Limits Of
principally used in the United States; and
Insurance; item 4. is added as follows:
d. If the insured is a resident of the United
4. If your covered owned auto is:
am=
States.
(1) Shown in the Schedule and designated
If a loss to a covered auto occurs in Mexico, we
as covered for Physical Damage Cover-
pay for such loss in the United States. If the cov-
ered auto must be repaired in Mexico in order to
(2) Shown in this policy as having a loss
be driven, we will not pay for more than the actual
payee or additional -insured -lessor; and
E=
cash value of such lass as determined by us at the
nearest United States point where the repairs can
(3) Incurs a covered total loss;
be made.
we will pay the greater of:
Any insurance provided under this provision will
be excess over any other collectible insurance.
(a) The actual cash value, as determined by
us, of the damaged or stolen property as
Q. Extended Glass Coverage
of the time of the total loss; or
Form CA0001 (if attached to this policy), SEC-
III DAMAGE
(b) The outstanding indebtedness under the
TION - PHYSICAL COVER-
initial finance agreement for the covered
AGE, A. Coverage, item 3.a.; and form CA0012
auto and its equipment.
(if attached to this policy), SECTION IV - PHY-
SICAL DAMAGE COVERAGE, A. Coverage,
As used here, outstanding indebtedness means
item 3.a.; is replaced by the following:
the amount you owe on the finance agree.
meet at the time of total toss:
a. Glass breakage. If glass must be replaced, the
deductible will be $ 100 or the deductible
(i) Liss any amounts representing taxes,
shown in the Declarations, whichever is less.
overdue payments, penalties, interest, or
If glass can be repaired and is actually repaired
charges resulting from overdue payments,
rather than replaced, the deductible will be
additional mileage, excess wear and tear,
waived. You have the option of having the
or lease termination fees; and
glass repaired rather than replaced.
(ii) Less any administrative costs or overhead
R. Broadened Del-arition of Bodily Injury
fees assessed by the finance company
Form CA0001 (if attached to this policy), SEC-
who has leased the covered solo to you;
TION V - DEFINITIONS, item C.; and Form
and
z
CA0012 (if attached to this policy), SECTION VI
(iii) Less security deposits not returned by the
- DEFINITIONS, item C.; is replaced by the fol-
lessor; and
lowing:
(iv) Less costs for extended warranties, Credit
WC.
m
Bodily Injury means bodily injury,
y I ry y ' jury, sickness
Life Insurance, Health, Accident or Dis-
a
or disease sustained by a person including
ability insurance purchased with the loan
n
death or menial anguish resulting from any
or lease; and
zi
of these at any time. Mental anguish means
any type of mental or emotional illness or di-
(v) Less carry-over balances from previous
sease.
loans or leases.
Q
N
U
CA7019 ia01T
Page 6 of 6
gn
Z
Z
Additional Insured - Owners, Lessees or Contractors - Completed
Operations - CG 20 37 07 04
Policy Amendments) Commercial General Liability
Insured: KEWAUNEE SCIENTIFIC CORPORATION Policy Number: S 34 MXX 80857326
Producer: AON RISK SVCS Or THE CAROLINAS Effective Date: 04-30-06
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
Schedule
Name Of Additional Insured Person(s)
Or Organization(s)
City of Newport Beach, its Officers
agents, offic.ials,employees.and
volunteers
Public Works Department
P 0 Box 1768
Newport Beach, CA 92658-8915
Location And Description Of
Completed Operations
Laboratory Casework: Back Bay
Science Center, Bid Package #15,
Contract #3460
(If no entry appears above, information required to complete this Endorsement will be shown in the Declarations
as applicable to this Endorsement.)
Section II - Who Is An Insured is amended to include
as an additional insured the person(s) or organization(s)
shown in the Schedule, but only with respect to liability
for bodily injury or property damage caused, in whole
or in part, by your work at the location designated and
described in the schedule of this endorsement per-
formed for that additional insured and included in the
products -completed operations hazard.
This Form must be attached to Change Fndorsement when issued after the. policy is written.
One of the Fireman's Fund Insurance Companies as named in the policy
S etuy
CG2037 7-04
�_ Copyright, ISO Propcites, Inc., 2004
President
Attachment to ACORD Certificate for Kewaunee scientific Corp.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the
coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the
policy.
INSURER
INSURER
INSURER
INSURER
INSURER
it information. refer to the corresnondine Dolicv on the ACORD
INSURED
Kewaunee scientific Corp.
PO Box 1842
Statesville NC 286871842 USA
ADDITIONAL POLICIES If a policy below does not include lim
certificate form for policy limits.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY DESCRIPTION
POLICY
EFFECTIVE
DATE
POLICY
EXPIRATION
DATE
LIMITS
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL. PROVISIONS
Form #CG 71 58 12 03 and CG 20 37 07 04 attached) but limited to the operations of the Insured under
said contract, and always subject to the policy terms, conditions and exclusions. The General Liability
and Auto Liability policies certified hereon are primary to other insurance available to the certificate
holder, but only to the extent required by written contract with the Insured, and always subject to the
policy terms, conditions and exclusions (this is not provided by a separate endorsement, but is part of
the coverage forms CA0001 for auto and CG 00 01 for GL.
waiver of subrogation is granted in favor of Certificate Holder as required by written contract but
limited to the operations of the Insured under said contract, and always subject to the policy terms,
conditions and exclusions (see attached forms).
Cancellation Provision shown herein is sub7'ect to shorter or longer time periods depending on the
jurisdiction of, and reason for, the cancellation.
Certificate No : 570019067651
SEP -06-2006 12:50 FROM: TO:819496443318 P.1/1
p fd -0' 9VIb +33l�
CERTIFICATE OF INSURANCE
CHECKLIST
CITY OF NNEWPORT BEACH
THIS CHECKLIST IS COMPRISED OF REQUIItEMENTS AS OUTLINED ABY THE CITY OF
BEAC.K
DATE RECEIVED:
-1-U(0
DEPARTMENT/CONTACT RECEIVED FROM: ACL 'r .q
DATE COMPLETED:-�''U SENTTO: sect BY;
COMPANY/PERSON REQUIRED TO HAVE CERTIFICATE; Tle
T
.I_ GENERAL LIABILITY: t
A. INSURANCE COMPANY: lVs vvteV c 4VLs — - CO
e:� AM BEST RATING (A VII or greater): A x z
C. ADMITTED COMPANY: ( Must be California Admitted) Is company dmitted in California? Yes NO
D. LIMITS: (Must be $1,000,000 or greater) What is limit provided? T t o 00,0& v
E. PRODUCTS AND COMPLETED OPERATIONS: (Must Include) Is it included? Yes No
F_ ADDITIONAL INSURDED WORDIN TO INCLUDE: (The City its officers, agents, officials, employeEs and
volunteers). Is it included? Yes ,G
G_ PRfMARY AND NON CONTRIBUTORY WORDING: (Must be included) Is it included? Yes_jNo ►/_ _ _ /
H. CAUTION! ( Confirm that loss or liability of the Named insured is not limited solely by their negligence.)
Does endorsement include "solely by negligence" wording? Yes No
I_ NOTIFICATION OF CANCELLATION: Although there is a provision that requires notification of =ceilatyon. by
ccrtificd snail; per lAuren Farley the Citywill accept the endeavor wording,
II. AUTOMOBILE LIABILITY:
A. INSURANCE COMPANY; `�-,��-,ii C 4�.� �� Y� S
B. AM BEST RATING (A VII or greater):
C. ADMITTED COMPANY: ( MUST BE CALIFORNIA AD.MYM-ED) is cotnpany admitted? Yes_ No
D. LRv11'fS: ( Must be $1,000,000 minimum BI & PD and $500,000 UM) What is limits provided? 1 tj
E.
F.
G
ADDITIONAL INSURED WORDIN TO INCLUDE: (The City its officers ,agents, officials, employees and
volunteers). Is it included? Yes V No 0 % (y
PRIMARY AND NON CONTRIBUTORY WORDING: (Must be included). 'Is it included? Yes I No
NOTIFICATION OF CANCELLATION: Although there is a provision that: requires notification of cancellation by
certified mail; per Lauren Farley the City will accept the endeavor wording. I
III. WORKERS COMPENSATION.-
A-
OMPENSATION:A_ INSURANCE COMPANY: C� o,h m
B. AM BEST RATING (A VII or greater)
C_ LIMITS; Statutory
D. WAVIER OF SUBROGATION: (To include). Is it included? Yes No
HAVE ALL ABOVE REQUIREMENTS BEEN MET? Yes No�
IF NO, VVI-IICH ITEMS NEED TO BE COMPLETED? C.s P rt t-►-�,.
r10�-� Gam d ✓t-�iT�,n1 .,n 5 5 S i ri c.