Common use of Endorsement Forms Clause in Contracts

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSURED

Appears in 7 contracts

Samples: Community Benefits Agreement, Community Benefits Agreement, Community Benefits Agreement

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Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-X.doc PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 SGENERAL LIABILITAY [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. MP LE GENERAL AGGREGATE $6,000,000 PRODUCTS COMP/OP AGG. $2,000,000 3,000,000 PERSONAL & ADV. INJURY $2,000,000 3,000,000 EACH OCCURRENCE $2,000,000 3,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ person)$ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 2,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Property insurance against all risks of loss to any tenant improvements or betterments Crime/Employee Dishonesty Policy LIMIT OF INSURANCE $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE . P.O. Box 100085 – OX Xxxxxx, XX 00000 AUTHORIZED REPRESENTATIVE Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ (to)  Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY OTHER PROVISIONS  COMMERCIAL GENERAL LIABILITY  Claims Made  COMPREHENSIVE GENERAL LIABILITY Retroactive Date  OWNERS & CONTRACTORS PROTECTIVE  Occurrence COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE  GENERAL  PRODUCTS/COMPLETED OPERATIONS CLAIMS: Underwriter’s representative for claims pursuant to this insurance.  PERSONAL & ADVERTISING INJURY Name:  FIRE DAMAGE Address:   Telephone: ( )

Appears in 2 contracts

Samples: Performing Arts and Convention Center Rooms, Agreement

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you the Consultant/insurer use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-A.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGGAGG . $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No. P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 12/17 INS-A.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.Telephone: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible r Self-Insured Retention (check which) of $ with an Aggregate of $ ffffff applies to NAMED INSURED coverage. r Per Occurrence r Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS  COMPREHENSIVE GENERAL LIABILITY  OWNERS & CONTRACTORS PROTECTIVE Retroactive Date  Occurrence COVERAGES  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Agreement for Professional Services

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ No A-8220 AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 5/20 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATIONTelephone: Insurance Company: Policy No.: NAMED INSURED Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered: TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS  COMPREHENSIVE GENERAL LIABILITY  OWNERS & CONTRACTORS PROTECTIVE COVERAGES  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   Retroactive Date  Occurrence LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc XXXXX CERTIFICATE OF INSURANCE ISSUE (MM/DD/YY) DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $1,000,000 $ $ $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ No AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 2/21 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@City ) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made  COMPREHENSIVE GENERAL LIABILITY Retroactive Date  OWNERS & CONTRACTORS PROTECTIVE  Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   CLAIMS: Underwriter s representative for claims pursuant to this insurance. Name: Address: Telephone: ( )

Appears in 1 contract

Samples: civicclerk.blob.core.windows.net

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-S.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession; if architectural, engineering or electrical work will be performed under the Contract, Course of Construction Insurance Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant Course of Construction— Completed Value of Project DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No. A-8298 P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) LOSS ADJUSTMENT EXPENSE (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits In Addition to Limits Telephone: Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSURED

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you the Consultant/insurer use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-A.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGGAGG . $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No._ _ P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 2/21 INS-A.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) Telephone: NAMED INSURED LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here ❒ in which case only the following specific agreements and permits with the City are covered TYPE OF INSURANCE GENERAL LIABILITY ❒ COMMERCIAL GENERAL LIABILITY ❒ Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS ❒ COMPREHENSIVE GENERAL LIABILITY ❒ OWNERS & CONTRACTORS PROTECTIVE Retroactive Date ❒ Occurrence COVERAGES ❒ GENERAL ❒ PRODUCTS/COMPLETED OPERATIONS ❒ PERSONAL & ADVERTISING INJURY ❒ FIRE DAMAGE ❒ ❒ LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Agreement for Trade Services

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-G.doc XXXXX CERTIFICATE OF INSURANCE ISSUE (MM/DD/YY) DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $1,000,000 $ $ $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ . AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 10/19 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATIONTelephone: Insurance Company: Policy No.: NAMED INSURED Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSUREDTYPE OF INSURANCE GENERAL LIABILITY ❒ COMMERCIAL GENERAL LIABILITY ❒ Claims Made APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here ❒ in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS OTHER PROVISIONS ❒ COMPREHENSIVE GENERAL LIABILITY ❒ OWNERS & CONTRACTORS PROTECTIVE COVERAGES ❒ GENERAL ❒ PRODUCTS/COMPLETED OPERATIONS ❒ PERSONAL & ADVERTISING INJURY ❒ FIRE DAMAGE ❒ ❒ Retroactive Date ❒ Occurrence LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-M.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY SA [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY MP LE COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD City of Oxnard Attn: Insurance Compliance Risk Manager Reference Xx. 000 X. Xxxxx Xxxxxx, Xxxxx 000 Xxxxxx XX 00000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X B GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made  COMPREHENSIVE GENERAL LIABILITY Retroactive Date  OWNERS & CONTRACTORS PROTECTIVE  Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   Underwriter’s representative for claims pursuant to this insurance. CLAIMS: Name: Address: Telephone: ( )

Appears in 1 contract

Samples: License Agreement

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-S.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession; if architectural, engineering or electrical work will be performed under the Contract, Course of Construction Insurance Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant Course of Construction— Completed Value of Project DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No. A-8298 P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) LOSS ADJUSTMENT EXPENSE (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits In Addition to Limits Telephone: Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSURED

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSURED

Appears in 1 contract

Samples: Community Benefits Agreement

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-C.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $4,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS GARAGE LIABILITY SA MP L ECOMBINED SINGLE $1,000,000 LIMIT BODILY INJURY $ (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Contractors Pollution Liability and/or Asbestos Pollution Liability Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant Course of Construction Completed Value of Project DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No._FD 19-89 P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here □ in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY □ COMMERCIAL GENERAL LIABILITY □ Claims Made □ COMPREHENSIVE GENERAL LIABILITY Retroactive Date □ OWNERS & CONTRACTORS PROTECTIVE □ Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE □ GENERAL □ PRODUCTS/COMPLETED OPERATIONS □ PERSONAL & ADVERTISING INJURYS □ FIRE DAMAGE □ □ AMP Underwriter=s representative for claims pursuant to this insurance. CLAIMS: Name:LE Address: Telephone: ( )

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-G.doc XXXXX CERTIFICATE OF INSURANCE ISSUE (MM/DD/YY) DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $1,000,000 $ $ $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ . PW 18-58(R) AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 2/20 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made  COMPREHENSIVE GENERAL LIABILITY Retroactive Date  OWNERS & CONTRACTORS PROTECTIVE  Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( )

Appears in 1 contract

Samples: civicclerk.blob.core.windows.net

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you the Consultant/insurer use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-A.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGGAGG . $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No._ _ P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 12/19 INS-A.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) Telephone: NAMED INSURED LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS  COMPREHENSIVE GENERAL LIABILITY  OWNERS & CONTRACTORS PROTECTIVE Retroactive Date  Occurrence COVERAGES  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Agreement for Professional Services

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-C.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY SA [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY MP LE COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession; if architectural, engineering or electrical work will be performed under the Contract, Course of Construction Insurance Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant Course of Construction Completed Value of Project DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ . AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here □ in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY □ COMMERCIAL GENERAL LIABILITY □ Claims Made □ COMPREHENSIVE GENERAL LIABILITY Retroactive Date □ OWNERS & CONTRACTORS PROTECTIVE □ Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE □ GENERAL □ PRODUCTS/COMPLETED OPERATIONS □ PERSONAL & ADVERTISING INJURY □ FIRE DAMAGE □ □ Underwriter=s representative for claims pursuant to this insurance. CLAIMS: Name: Address: Telephone: ( )

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-D.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ 1,000,000 [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY SA MP LE COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession; if architectural, engineering or electrical work will be performed under the Agreement Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Attn: Insurance Compliance AUTHORIZED REPRESENTATIVE Reference No._ _ AUTHORIZED REPRESENTATIVE . P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X SUBMIT IN DUPLICATE GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) LOSS ADJUSTMENT EXPENSE □ (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits In Addition to Limits Telephone: Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here □ in which case only the following specific agreements and permits with the City are covered: TYPE OF INSURANCE CITY AGREEMENTS/PERMITS GENERAL LIABILITY □ COMMERCIAL GENERAL LIABILITY □ COMPREHENSIVE GENERAL LIABILITY □ OWNERS & CONTRACTORS PROTECTIVE □ Claims Made Retroactive Date □ Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE □ GENERAL Underwriter=s representative for claims pursuant to this insurance. CLAIMS: Name: Address: Telephone: ( ) □ PRODUCTS/COMPLETED OPERATIONS □ PERSONAL & ADVERTISING INJURY □ FIRE DAMAGE □

Appears in 1 contract

Samples: Contract

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Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-C.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS GARAGE LIABILITY SA MP L ECOMBINED SINGLE $1,000,000 LIMIT BODILY INJURY $ (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession; if architectural, engineering or electrical work will be performed under the Contract, Course of Construction Insurance Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant Course of Construction Completed Value of Project DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ . AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here □ in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY □ COMMERCIAL GENERAL LIABILITY □ Claims Made □ COMPREHENSIVE GENERAL LIABILITY Retroactive Date □ OWNERS & CONTRACTORS PROTECTIVE □ Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE □ GENERAL □ PRODUCTS/COMPLETED OPERATIONS □ PERSONAL & ADVERTISING INJURY □ FIRE DAMAGE □ □ Underwriter=s representative for claims pursuant to this insurance. CLAIMS: Name: Address: Telephone: ( )

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-C.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $4,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY SA [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY MP LE COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Contractors Pollution Liability and/or Asbestos Pollution Liability Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant Course of Construction Completed Value of Project DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference Xx._XX 00-00 X.X. Xxx 000000 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATIONTelephone: Insurance Company: Policy No.: NAMED INSURED Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDAPPLICABILITY This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here □ in which case only the following specific agreements and permits with the City are covered: TYPE OF INSURANCE GENERAL LIABILITY □ COMMERCIAL GENERAL LIABILITY □ Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS □ COMPREHENSIVE GENERAL LIABILITY □ OWNERS & CONTRACTORS PROTECTIVE COVERAGES □ GENERAL □ PRODUCTS/COMPLETED OPERATIONS Retroactive Date □ Occurrence LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE Underwriter=s representative for claims pursuant to this insurance. CLAIMS: □ FIRE DAMAGE □ □ Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows: □ PERSONAL & ADVERTISING INJURYSAMPName:LE

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ [x] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGG. $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO SA ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY MP LE COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No. PW 20-65R P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSURED)

Appears in 1 contract

Samples: civicclerk.blob.core.windows.net

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-G.doc XXXXX CERTIFICATE OF INSURANCE ISSUE (MM/DD/YY) DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $1,000,000 $ $ $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ . AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 10/19 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made  COMPREHENSIVE GENERAL LIABILITY Retroactive Date  OWNERS & CONTRACTORS PROTECTIVE  Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( )

Appears in 1 contract

Samples: Contract

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you the Consultant/insurer use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-A.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGGAGG . $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No. P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 12/17 INS-A.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.Telephone: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ ffffff applies to NAMED INSURED coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here ❒ in which case only the following specific agreements and permits with the City are covered TYPE OF INSURANCE GENERAL LIABILITY ❒ COMMERCIAL GENERAL LIABILITY ❒ Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS ❒ COMPREHENSIVE GENERAL LIABILITY ❒ OWNERS & CONTRACTORS PROTECTIVE Retroactive Date ❒ Occurrence COVERAGES ❒ GENERAL ❒ PRODUCTS/COMPLETED OPERATIONS ❒ PERSONAL & ADVERTISING INJURY ❒ FIRE DAMAGE ❒ ❒ LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Agreement for Professional Services

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you the Consultant/insurer use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-A.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGGAGG . $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No._ _ P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 1/21 INS-A.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) Telephone: NAMED INSURED LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here ❒ in which case only the following specific agreements and permits with the City are covered TYPE OF INSURANCE GENERAL LIABILITY ❒ COMMERCIAL GENERAL LIABILITY ❒ Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS ❒ COMPREHENSIVE GENERAL LIABILITY ❒ OWNERS & CONTRACTORS PROTECTIVE Retroactive Date ❒ Occurrence COVERAGES ❒ GENERAL ❒ PRODUCTS/COMPLETED OPERATIONS ❒ PERSONAL & ADVERTISING INJURY ❒ FIRE DAMAGE ❒ ❒ LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Agreement for On

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you the Consultant/insurer use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attachedsample accord form. INS-P.doc INS-A.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODE SUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER A SPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $1,000,000 PRODUCTS COMP/OP AGGAGG . $2,000,000 1,000,000 PERSONAL & ADV. INJURY $2,000,000 1,000,000 EACH OCCURRENCE $2,000,000 1,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured's profession Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance Reference No._ _ P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 9/19 INS-A.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY“City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) Telephone: NAMED INSURED LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDAPPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made CITY AGREEMENTS/PERMITS OTHER PROVISIONS  COMPREHENSIVE GENERAL LIABILITY  OWNERS & CONTRACTORS PROTECTIVE Retroactive Date  Occurrence COVERAGES  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: Agreement for Professional Services

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-G.doc XXXXX CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ . A-8241 AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 9/20 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATIONTelephone: Insurance Company: Policy No.: NAMED INSURED Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSUREDTYPE OF INSURANCE GENERAL LIABILITY ❒ COMMERCIAL GENERAL LIABILITY ❒ Claims Made APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here ❒ in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS OTHER PROVISIONS ❒ COMPREHENSIVE GENERAL LIABILITY ❒ OWNERS & CONTRACTORS PROTECTIVE COVERAGES ❒ GENERAL ❒ PRODUCTS/COMPLETED OPERATIONS ❒ PERSONAL & ADVERTISING INJURY ❒ FIRE DAMAGE ❒ ❒ Retroactive Date ❒ Occurrence LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: civicclerk.blob.core.windows.net

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-G.doc XXXXX CERTIFICATE OF INSURANCE ISSUE (MM/DD/YY) DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $1,000,000 $ $ $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ No._A-8261 AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 10/20 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: ❒ Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSUREDINSURED APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here  in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  Claims Made  COMPREHENSIVE GENERAL LIABILITY Retroactive Date  OWNERS & CONTRACTORS PROTECTIVE  Occurrence OTHER PROVISIONS COVERAGES LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE  GENERAL  PRODUCTS/COMPLETED OPERATIONS  PERSONAL & ADVERTISING INJURY  FIRE DAMAGE   CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( )

Appears in 1 contract

Samples: oxnardca.civicclerk.com

Endorsement Forms. Original endorsements are required for commercial general liability and business automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached. INS-P.doc INS-G.doc XXXXX CERTIFICATE OF INSURANCE ISSUE (MM/DD/YY) DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CODESUB-CODE COMPANIES AFFORDING INSURANCE COVERAGE INSURED COMPANY LETTER ASPECIFY COMPANY NAMES IN THIS SPACE COMPANY LETTER B COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY [x] COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 [ ] CLAIMS MADE [x] OCCUR. [x] OWNER'S ’S & CONTRACTOR'S ’S PROT. GENERAL AGGREGATE $2,000,000 PRODUCTS COMP/OP AGG. $2,000,000 PERSONAL & ADV. INJURY $2,000,000 EACH OCCURRENCE $2,000,000 FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ A AUTOMOBILE LIABILITY [x] ANY AUTO COMBINED SINGLE $1,000,000 ALL OWNED AUTOS LIMIT SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per person) GARAGE LIABILITY BODILY INJURY $ (Per accident) PROPERTY DAMAGE $1,000,000 $ $ $ [x] ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY A EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ AGGREGATE $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $1,000,000 DISEASE-POLICY LIMIT $1,000,000 DISEASE-EACH EMPLOYEE $1,000,000 A OTHER Errors and omissions insurance or malpractice insurance available for the insured’s profession; if architectural, engineering or electrical work will be performed under the Contract Minimum coverage $1,000,000 Each consultant/ $500,000 & listed sub-consultant DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CITY OF OXNARD Attn: Insurance Compliance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Reference No._ _ No._A-8261 AUTHORIZED REPRESENTATIVE P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 Exhibit INS-X Rev. 10/20 INS-G.doc GENERAL LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the ACity@) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATIONTelephone: Insurance Company: Policy No.: NAMED INSURED Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ❒ Included in Limits ❒ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSUREDTYPE OF INSURANCE GENERAL LIABILITY ❒ COMMERCIAL GENERAL LIABILITY ❒ Claims Made APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here ❒ in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS OTHER PROVISIONS ❒ COMPREHENSIVE GENERAL LIABILITY ❒ OWNERS & CONTRACTORS PROTECTIVE COVERAGES ❒ GENERAL ❒ PRODUCTS/COMPLETED OPERATIONS ❒ PERSONAL & ADVERTISING INJURY ❒ FIRE DAMAGE ❒ ❒ Retroactive Date ❒ Occurrence LIABILITY LIMITS IN THOUSANDS $ EACH OCCURRENCE AGGREGATE CLAIMS: Underwriter=s representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, insurance company agrees as follows:

Appears in 1 contract

Samples: civicclerk.blob.core.windows.net

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