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