CERTIFICATE OF LIABILITY INSURANCE · contributory. certholder is endorsed as additional insured on...

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SIGNATURE REQUIRED The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE The CGL, XS Policies shown above have been endorsed to include the Certificate Holder as Additional Insured using CG 2010 (11/85) or equivalent forms including, Premises and Completed Operations. Policies are endorsed to show coverage as PRIMARY, NON- CONTRIBUTORY. Certholder is endorsed as Additional Insured on Auto Policy. A WAIVER OF SUBROGATION ENDORSEMENT APPLIES TO CGL, THE FOLLOWING - FORM EXCESS, AUTO LIABILITY, AND WORKERS COMPENSATION. 30 DAY NOTICE OF CANCELLATION APPLIES TO ALL POLICIES LISTED ABOVE. CERTIFICATE HOLDER CANCELLATION DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE LOC JECT PRO- POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCUR CLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ RETENTION DED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Agency Name Address City, State, Zip Code Subcontractor Name Address City, State, Zip Code Policy # Policy # Policy # Policy # Effective Date Effective Date Effective Date Effective Date Expiration Date Expiration Date Expiration Date Expiration Date 1,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 2,000,000 2,000,000 1,000,000 50,000 X X X X X X X Project Name: ALLIANCE RESIDENTIAL BUILDERS, LP (GC Entity) 820 Gessner, Suite 1000 Houston, Texas 77024 Y Y Y Y Y Y Y Insurance Carrier (Full Name) Insurance Carrier (Full Name) Insurance Carrier (Full Name) Insurance Carrier (Full Name) #0000 #0000 #0000 #0000

Transcript of CERTIFICATE OF LIABILITY INSURANCE · contributory. certholder is endorsed as additional insured on...

Page 1: CERTIFICATE OF LIABILITY INSURANCE · contributory. certholder is endorsed as additional insured on auto policy. a waiver of subrogation endorsement applies to cgl, the following

SIGNATURE REQUIRED

The ACORD name and logo are registered marks of ACORD© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

The CGL, XS Policies shown above have been endorsed to include the Certificate Holder as Additional Insured using CG 2010 (11/85) or equivalent forms including, Premises and Completed Operations. Policies are endorsed to show coverage as PRIMARY, NON-CONTRIBUTORY. Certholder is endorsed as Additional Insured on Auto Policy. A WAIVER OF SUBROGATION ENDORSEMENT APPLIES TO CGL, THE FOLLOWING - FORM EXCESS, AUTO LIABILITY, AND WORKERS COMPENSATION. 30 DAY NOTICE OF CANCELLATION APPLIES TO ALL POLICIES LISTED ABOVE.CERTIFICATE HOLDER CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECTPRO-POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $DAMAGE TO RENTEDEACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

$

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSRLTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF(MM/DD/YYYY)

POLICY EXP(MM/DD/YYYY) LIMITS

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

$

$

$

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe underDESCRIPTION OF OPERATIONS below

(Mandatory in NH)OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTOALL OWNED SCHEDULED

HIRED AUTOSNON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)PROPERTY DAMAGE $

$

$

$

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSDADDL

WVDSUBR

N / A

$

$

(Ea accident)

(Per accident)

OTHER:

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSURED

PHONE(A/C, No, Ext):

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.

Agency NameAddressCity, State, Zip Code

Subcontractor NameAddressCity, State, Zip Code

Policy #

Policy #

Policy #

Policy #

EffectiveDate

EffectiveDate

EffectiveDate

EffectiveDate

ExpirationDate

ExpirationDate

ExpirationDate

ExpirationDate

1,000,000

1,000,0002,000,0002,000,000

1,000,0001,000,0001,000,000

2,000,0002,000,000

1,000,000

50,000

X

XX

X

XX

X

Project Name:

ALLIANCE RESIDENTIAL BUILDERS, LP (GC Entity)

820 Gessner, Suite 1000Houston, Texas 77024

Y Y

Y Y

Y

Y Y

Insurance Carrier (Full Name)Insurance Carrier (Full Name)Insurance Carrier (Full Name)Insurance Carrier (Full Name)

#0000#0000

#0000#0000

Page 2: CERTIFICATE OF LIABILITY INSURANCE · contributory. certholder is endorsed as additional insured on auto policy. a waiver of subrogation endorsement applies to cgl, the following

INSURANCE VERBIAGE FROM SUBCONTRACT AGREEMENT:

4.1 INSURANCE: Prior to starting Work, Subcontractor shall procure and maintain in force, Worker's Compensation Insurance ,Employer's liability Insurance in full compliance with the laws

of the State in which work under this Contract is performed, Commercial General Liability Insurance on an occurrence basis with contractual coverage and Commercial Automobile Liability Insurance,

including owned, non-owned and hired automobile coverage and such other insurance, to the extent required by the Contract Documents, for Subcontractor's Work. All insurance will be written by companies

lawfully authorized to do business in the state in which the Project is located, and having an AM Best Rating of A-, or a rating which will be reasonably acceptable to Owner. Such approvals shall be based

on standard coverage available within the industry, except as may be otherwise required by this Contract. Such approval shall not be unreasonably withheld.

4.2 Subcontractor's Comprehensive General and Automobile Liability Insurance, as required by Paragraph 4.1 shall be written for not less than limits of Liability as follows:

a. Workers Compensation and Employers Liability

1. Coverage to apply to all those prosecuting the Work by, through or under Subcontractor.

2. Coverage “B” – Employers Liability, limit - $1,000,000.00

b. Commercial General Liability

1. Bodily Injury $1,000,000 Each Occurrence $2,000,000 Aggregate

2. Property $1,000,000 Each Occurrence $2,000,000 Aggregate

(Aggregate limit applies per project, please check per project box on certificate indicating coverage)

c. Commercial Automobile Liability (Including Owned, Non-Owned, and Hired Automobiles) (Please check boxes on certificates indicating coverage)

1. Bodily Injury $1,000,000 Each Person $1,000,000 Each Occurrence

2. Property Damage $1,000,000 Each Occurrence

d. Umbrella Excess Liability

1. Such insurance to provide coverage with limits of not less than $2,000,000.00 per occurrence / $2,000,000.00 aggregate all in excess of coverage listed in (a), (b)

and (c) above.

4.2.1 Coverage shall be written on a Commercial General and Commercial Automobile Liability form and shall include contractual liability insurance as applicable to Subcontractor's obligations

under Paragraph 4.6. Coverage shall also include the perils of explosion, collapse, and underground liability (XCU); Independent Contractor's Coverage; Personal Injury (Agreements A, B & C) including

coverage for suits brought by employees of Subcontractor; Broad Form Property Damage including Completed Operations; and Completed Operations insurance. Completed Operations insurance shall

remain in effect for One (1) year after substantial completion of the Project. Contractor and Owner shall be added as an additional named insured under Subcontractor's Commercial General Liability

Policy and coverage under such Policy shall be primary with Contractor's insurance being excess over the Subcontractor's coverage. Subcontractor’s insurance must name Indemnitees, as such term

is defined in section 18.1.1 herein, to the full extent of the Subcontractor’s indemnity obligations set forth herein. It is the intent of the parties to this Subcontract that this Additional Insured

status shall include coverage for completed operations and for the Indemnitee’s concurrent and sole negligence to the extent indemnification is required by Section 18 hereof, but only to

the extent not prohibited by Chapter151 of the Texas Insurance Code. Subcontractor must furnish such Additional Insured coverage by endorsement or express policy language in a form

approved by Contractor and consistent with Subcontractor’s indemnity obligations hereunder. Notwithstanding any other requirements for proof of insurance hereunder Subcontractor shall

furnish the form of Additional Insured endorsement or applicable policy language to Contractor, for approval by Contractor, prior to commencement of the Work. Such insurance is to include

the Contractor and Owner as additional insured as respects premises and completed operations using form CG 2010 (11 85) or equivalent wording subject to the approval of the Contractor.

4.3 Commercial General and Auto Liability Insurance may be arranged under a single policy for the full limits required or by a combination of underlying policies with the balance provided by

an Excess or Umbrella Liability policy.

4.4 The foregoing policies shall contain a provision that coverage afforded under the policies will not be cancelled, modified or not renewed until at least thirty (30) days' prior written notice has

been given to Contractor. Certificates of Insurance and Evidence of Insurance acceptable to Contractor and naming Contractor as an additional named insured as provided above shall be filed with

Contractor prior to the commencement of Work.

4.5 Contractor and Subcontractor waive all rights against each other and against the Owner, the Architect any Project engineer, separate contractors, and all other subcontractors for damages

caused by fire or other perils to the extent reimbursed by Builder's Risk or any other property insurance, except such rights as they may have to the proceeds of such insurance.

4.6 To the fullest extent permitted by law, including, but not limited to Chapter 151 of the Texas Insurance Code, Subcontractor agrees to indemnify, protect, defend (with counsel acceptable

to Contractor) and hold harmless Contractor, Owner, and all of their affiliated companies, partners, successors, assigns, legal representatives, agents, officers, directors and employees of, from and against

all liabilities, claims, damages, losses, costs, causes of action, suits, judgments and expenses, including but not limited to attorneys' fees and court costs, arising out of or resulting from the performance, or

failure in performance, of Subcontractor's Work and obligations as provided in the Contract Documents, including any extra Work, and from any claim, damage, loss or expense which (1) is attributable to

bodily injury, sickness, disease, death, injury to or destruction of tangible property (other than the Work itself) including the loss of use resulting there from, and (2) is caused in whole or in part by any acts,

omissions or negligence of Subcontractor or anyone directly or indirectly employed by Subcontractor or Subcontractor or anyone directly or indirectly employed by Subcontractor or anyone for whose acts

Subcontractor may be liable REGARDLESS OF WHETHER IT IS CAUSED IN PART BY THE ACTS, OMISSIONS OR NEGLIGENCE OF A PARTY INDEMNIFIED HEREUNDER. Such obligations shall

not be construed to negate, abridge, or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or person described in this Paragraph 4.6.

4.6.1 In any and all claims against Contractor or any of its agents or employees by any employee of Subcontractor, anyone directly or indirectly employed by Subcontractor or anyone for which

acts Subcontractor may be liable, the indemnification obligation under this Paragraph 4.6 shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits

payable by or for Subcontractor under Worker's Compensation acts, disability benefits acts or other employee benefit acts.

4.7 Subcontractor shall be responsible for providing insurance for all property, tools and equipment used on the site or away from the site.

4.8 Subcontractor shall require the same minimum insurance requirements, as listed above, of all their subcontractors, and these subcontractors shall also comply with the additional

requirements listed below.

4.9 Subcontractor shall deliver simultaneous with the execution of this Agreement, submit, in a form satisfactory to Contractor, certificates evidencing that all of the said required insurance

coverage has been obtained and that Subcontractor is covered thereby. If such evidence is not so furnished, Contractor shall have the immediate right to procure, at Subcontractor's expense, the required

insurance on behalf of Subcontractor.

4.10 Should Subcontractor or any of its subcontractors fail to maintain the coverage required or otherwise fail to comply with the obligations set forth in this Section 4, Contractor shall, in

addition to all other rights and remedies provided herein, be entitled to withhold progress payments for the Work until Subcontractor or its subcontractors have satisfied their obligations hereunder?

4.11 Failure of Subcontractor to fulfill any of its obligations contained in this Section 4 shall constitute a breach of this Agreement. 4.12 Subcontractor waives all rights of recovery or subrogation against the Contractor, Owner, and Management Company for claims covered by its various insurance policies and shall

cause all of its insurance policies to be written or endorsed to reflect this waiver.