2024-10-01_COI.pdf
PDF 688 KB Posted
- Attached to
- Master Agreement AZ|CTR069178
- Contract number
- CTR069178
- Issued by
- Arizona
About this file
This document is a comprehensive insurance certificate package for Granite Construction Company, issued by multiple insurers including Steadfast Insurance Company, Transportation Insurance Company, and Valley Forge Insurance Company. The policies cover various insurance types including Commercial General Liability, Automobile Liability, Workers' Compensation, and Professional Liability, with The State of Arizona/ADOT as the primary certificate holder. The insurance is specifically related to a contract (CTR069178) for On-Call Pipelining and Drainage Repair Services.
The contract appears to be a state-level indefinite delivery vehicle for pipelining and drainage repair services, with coverage limits ranging from $2,000,000 to $5,000,000 across different policy types. The policy period runs from 10/01/2023 to 10/01/2024, with provisions for primary and non-contributory coverage, additional insured status for the State of Arizona/ADOT, and waivers of subrogation. The Professional Liability policy includes a $5,000,000 limit per claim and aggregate, designed to meet specific contract requirements for the pipelining and drainage repair services.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2024 Q2 Usage Reports.xlsx | XLSX spreadsheet | |
| 2024 Q3 Usage Report.xlsx | XLSX spreadsheet | |
| 2024 Q4 Usage Report.xlsx | XLSX spreadsheet | |
| CTR069178_Contract_Amendment_Summary_3.pdf | ||
| CTR069178_Contract_Amendment_Summary_Two__2_.pdf | ||
| Ordering_Guidelines_for_Contracts_with_Not_to_Exceed_Pricing.pdf | ||
| 2025 Q1 Usage Report.xlsx | XLSX spreadsheet | |
| CTR069178_Contract_Amendment_Summary_4.pdf | ||
| 2023 Q4 Usage Report.xlsx | XLSX spreadsheet | |
| 2024 Q1 Usage Report.xlsx | XLSX spreadsheet | |
| 2025 Q2 Usage Report.xlsx | XLSX spreadsheet | |
| CTR069178_Contract_Amendment_Summary_One__1_.pdf | ||
| CTR069178_Contract_Documents.pdf |
Show all 13
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Text version
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
kleikam@alliant.com
N
01/17/2024
2,000,000
VALLEY FORGE INS CO
10/01/23
TRANSPORTATION INS CO
10/01/24 2,000,000 10/01/24
X
WC274978644 (AOS/Stop Gap)A
WC274978630 (CA)B
Nil
Kimberly Leikam
70445608
70445608
Alliant Insurance Services, Inc.
2,000,000
Granite Construction Company
X
GL2074978689
10/01/23
X
10/01/23
2,000,000
X
10/01/26
Contractual
X
20508
20494
1-415-403-1491
X
415-403-1491
Phoenix, AZ 85007
2,000,000
X
USA
2,000,000
X
X
San Francisco, CA 94105
The State of Arizona/ADOT
X
10/01/23
A
Watsonville, CA 95076
BUA2074978692
206 S. 17th Ave.
ttaganap
10/01/26
X
X
415-874-4818
10,000,000
X
X
GL Per ISO Form CG0001 10/01; AL Per ISO Form CA0001 10/13 30 Days Written Notice of Cancellation for Non-Renewal and 10 Days Notice of Cancellation for Non-Payment of Premiums
X attached endorsements. Coverage is primary & non-contributory and waivers of subrogation apply.
The State of Arizona/ADOT is included as Additional Insured as required by written and executed agreement per the
Re: Contract No. CTR069178 / On-Call Pipelining and Drainage Repair Services
B
LIC #0C36861
XCU Hazards
Contractual Liability
X
2,000,000
X
585 West Beach Street
560 Mission Street, 6th Floor
2,000,000
F0950 Accepted
SUPP (10/00)
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
NAME OF INSURED:
Granite Construction Company expressly negotiated for by contract.
The named insured reserves its rights to provide any additional coverages under the policies above to only those
01/17/2024
G-140331-D (Ed. 01/13)
G-140331-D (Ed. 01/13)
POLICY #: GL2074978689
EFFECTIVE: 10/01/2023
Copyright, CNA All Rights Reserved.
BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS –
WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows:
SCHEDULE (OPTIONAL)
Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.)
Locations of Covered Operations
(As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.)
A. Section II - Who Is An Insured is amended to include as an additional insured:
1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and
2. The particular person or organization, if any, scheduled above.
B. The insurance provided to the additional insured is limited as follows:
1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the "written contract"; or
b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage" included in the "products-completed operations hazard," and only if:
(1) The "written contract" requires you to provide the additional insured such coverage; and
(2) This Coverage Part provides such coverage.
2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.1. above, the words 'caused in whole or in part by' are replaced by the words 'arising out of'.
3. We will not provide the additional insured any broader coverage or any higher limit of insurance than:
a. The maximum permitted by law;
b. That required by the "written contract";
c. That described in B.1. above; or
d. That afforded to you under this policy, whichever is less.
4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or
G-140331-D (Ed. 01/13)
G-140331-D (Ed. 01/13)
POLICY #: GL2074978689
EFFECTIVE: 10/01/2023
Copyright, CNA All Rights Reserved.
any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured.
5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of:
a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and
(2) Supervisory, inspection, architectural or engineering activities; or
b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part.
C. SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:
1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured:
An additional insured under this endorsement will as soon as practicable:
(1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result;
(2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part;
(3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit"; and
(4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured.
We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit."
D. Only for the purpose of the insurance provided by this endorsement, SECTION V – DEFINITIONS is amended to add the following definition:
"Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement:
1. Is currently in effect or becomes effective during the term of this policy; and
2. Was executed prior to:
a. The "bodily injury" or "property damage"; or
b. The offense that caused the "personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part.
All other terms and conditions of the Policy remain unchanged.
Material used with permission of ISO Properties, Inc.
POLICY NUMBER: GL2074978689
EFFECTIVE: 10/01/2023
COMMERCIAL GENERAL LIABILITY
CG 25 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 25 03 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 2
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Project(s):
Any construction project as required by a written contract or agreement that was executed prior to the date of loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above:
1. A separate Designated Construction Project
General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations.
2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard," and for medical expenses under Coverage C regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits."
3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above.
4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply.
However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit.
Page 2 of 2 Copyright, Insurance Services Office, Inc., 2008 CG 25 03 05 09
B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above:
1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit.
C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit.
D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project.
E. The provisions of Section III – Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Waiver of Transfer of Rights of Recovery Against Others to Us
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Form
Under SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following:
We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of:
1. Your ongoing operations; or
2. "Your work" included in the "products completed operations hazard."
However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement:
1. Is in effect or becomes effective during the term of this policy; and
2. Was executed prior to loss.
This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below.
Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy
ENDT. NO. POLICY NO.
GL 2074978689
ISSUED TO:
Granite Construction Incorporated
EFFECTIVE DATE OF THIS
ENDORSEMENT:
10/01/23
G-15115-A (Ed. 10/89)
G-15115-A Page 1 of 1 (Ed. 10/89)
POLICY NUMBER: GL2074978689
EFFECTIVE: 10/01/2023
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CHANGES – NOTICE OF CANCELLATION
OR MATERIAL COVERAGE CHANGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of can-cellation or material change to:
SCHEDULE
1. Name: Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change.
2. Address: Per Certificates of Insurance on file with the broker.
3. Number of days advance notice:
For non-payment of premium, the greater of:
• the number of days required by state statute or
• the number of days required by written contract
For any other reason, the lesser of:
• 60 days or
• the number of days required in a written contract
CNA71527XX
(Ed. 10/12)
CNA71527XX (10/12) Policy No: BUA2074978692 Page 1 of 1 Endorsement No:
Effective Date: 10/01/2023 Insured Name: Granite Construction Incorporated
Copyright CNA All Rights Reserved.
ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:
SCHEDULE
Name of Additional Insured Persons Or Organizations
Any person or organization whom the named insured is required by written contract to add as an additional insured on this policy.
1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II – LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy.
2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy.
All other terms and conditions of the Policy remain unchanged.
POLICY NUMBER: BUA2074978692 COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 Copyright, Insurance Services Office, Inc., 2011 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured: Granite Construction Incorporated
Endorsement Effective Date: 10/01/2023
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
Any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.
Granite Construction Incorporated 10/01/2023
Workers Compensation And Employers Liability Insurance
Policy Endorsement
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers’ Compensation Insurance G. Recovery From Others and Part Two - Employers’ Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
Endorsement No: 6; Page: 1 of 1 Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606
Form No: G-19160-B (11-1997) Endorsement Effective Date:
Policy No: WC 2 74978630 Policy Effective Date: 10/01/2023 Policy Page: 53 of 83
Endorsement Expiration Date:
© Copyright CNA All Rights Reserved.
Workers Compensation And Employers Liability Insurance
Policy Endorsement
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
Policy No: WC 2 74978644 Policy Effective Date: 3 Policy Page: 296 of 442
Form No: WC 00 03 13 (04-1984) Endorsement Effective Date: Endorsement Expiration Date:
Endorsement No: 32; Page: 1 of 1 Underwriting Company:
Copyright 1983 National Council on Compensation Insurance.
C'NA
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
NOTICE OF CANCELLATION OR MATERIAL CHANGE ENDORSEMENT
G-20472-A (Ed. 10/93)
In the event of cancellation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number of days advance notice is shown in the Schedule.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
1. Number of days advance notice:
For non-payment of premium, the greater of:
Schedule
• the number of days required by state statute or
• the number of days required by written contract
For any other reason, the lesser of:
• 60 days or
• the number of days required in a written contract
2. Notice will be mailed to:
Any person or organization you are required by written contract or agreement to mail prior written notice of cancellation or material change.
Address: Per Certificates of Insurance on file with the broker
This endorsement changes the policy to which II ls attached and is effective on the date Issued unless otherwise stated.
(The inrormation below Is required only when this endorsement Is issued subsequent to preparation or the policy,)
Endorsement Effective 10·1-23 Policy No. WC274978630 Valley Forge Insurance Company
WC 99 06 06
G-20472-A (Ed. 10/93)
WC274978644 Transportation Insurance Company
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
26387
10/01/23EOC508792219
560 Mission Street, 6th Floor
Kimberly Leikam
USA
Evidence of Professional Liability per contract requirements.
Re: Contract No. CTR069178 / On-Call Pipelining and Drainage Repair Services
415-403-1491
10/01/24
206 S. 17th Ave.
San Francisco, CA 94105
1-415-403-1491
Watsonville, CA 95076 kleikam@alliant.com
585 West Beach Street
Granite Construction Company
Phoenix, AZ 85007
Professional Liability Each Claim/ Agg.
Alliant Insurance Services, Inc.
STEADFAST INS CO
ttaganap
5,000,000
70260381
70260381
415-874-4818
12/22/2023
LIC #0C36861
The State of Arizona/ADOT
A
SUPP (10/00)
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
NAME OF INSURED:
Granite Construction Company
12/22/2023 expressly negotiated for by contract.
The named insured reserves its rights to provide any additional coverages under the policies above to only those
| 1470260365.pdf |
| 0270260381.pdf |
File details come from the government source that posted it. Updated .