Laserfiche WebLink
CERTIFICATE OF INSURANCE <br />CHECKLIST <br />City of Newport Beach <br />This checklist Is comprised of requirements as outlined by the City of Newport Beach, * <br />Data Received: 1/29/15 Dept. /Contact Received From: Terresa <br />Date Completed: 1/29/15 Sent to: Terresa By: Chris <br />Company /Person required to have certificate: GRC Associates Inc <br />Type of contract: All Others <br />L GENERAL LIABILITY <br />EFFECTIVE /EXPIRATION DATE: 12/1/14- 12/1/15 <br />A. <br />INSURANCE COMPANY: Travelers Property & Casualty Insurance Compan <br />B. <br />AM BEST RATING (A-: VII or greater): A +:XV <br />AM BEST RATING (A -: VII or greater) A++:Xy <br />C. <br />ADMITTED Company (Must be California Admitted): <br />ADMITTED COMPANY (Must be California Admitted): <br />Is Company admitted in California? <br />N Yes ❑ No <br />D. <br />LIMITS (Must be $1M or greater): What is limit provided? <br />1,000,000/2,000,000 <br />E. <br />ADDITIONAL INSURED ENDORSEMENT — please attach <br />® Yes ❑ No <br />F. <br />PRODUCTS AND COMPLETED OPERATIONS (Must <br />LIMITS Waiver of Auto Insurance / Proof of coverage (if individual) <br />include): Is it included? (completed Operations status does <br />N/A <br />F. <br />not apply to Waste Haulers or Recreation) <br />® Yes ❑ No <br />G. <br />ADDITIONAL INSURED FOR PRODUCTS AND <br />N N/A ❑ Yes ❑ No <br />G. <br />COMPLETED OPERATIONS ENDORSEMENT (completed <br />❑ N/A N Yes ❑ No <br />H. <br />Operations status does not apply to Waste Haulers) <br />N Yes ❑ No <br />H. <br />ADDITIONAL INSURED WORDING TO INCLUDE (The City <br />its officers, officials, employees and volunteers): Is it <br />included? <br />N Yes ❑ No <br />I, <br />PRIMARY & NON - CONTRIBUTORY WORDING (Must be <br />included): Is it Included? <br />N Yes ❑ No <br />J. <br />CAUTIONI (Confirm that loss or liability of the named insured <br />is not limited solely by their negligence) Does endorsement <br />include "solely by negligence" wording? <br />❑ Yes N No <br />K. <br />ELECTED SCMAF COVERAGE (RECREATION ONLY): <br />® N/A ❑ Yes ❑ No <br />L. <br />NOTICE OF CANCELLATION: <br />❑ N/A N Yes ❑ No <br />H. AUTOMOBILE LIABILITY <br />EFFECTIVE /EXPIRATION DATE: 12/1/14- 12/1/15 <br />A. <br />INSURANCE COMPANY: RLIlnsuranceCompany <br />B. <br />AM BEST RATING (A -: VII or greater) A++:Xy <br />C. <br />ADMITTED COMPANY (Must be California Admitted): <br />Is Company admitted in California? <br />N Yes ❑ No <br />D. <br />LIMITS - If Employees (Must be $1M min. BI & PD and $500,000 <br />UM, $210 min for Waste Haulers): What is limits provided? <br />1,000,000 <br />E. <br />LIMITS Waiver of Auto Insurance / Proof of coverage (if individual) <br />(What is limits provided ?) <br />N/A <br />F. <br />PRIMARY & NON - CONTRIBUTORY WORDING (For Waste <br />Haulers only): <br />N N/A ❑ Yes ❑ No <br />G. <br />HIRED AND NON -OWNED AUTO ONLY: <br />❑ N/A N Yes ❑ No <br />H. <br />NOTICE OF CANCELLATION: <br />❑ N/A N Yes ❑ No <br />