CC - Agendas - City Council - REGULAR - 8/14/2018

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9.F.a ACORO® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 6/12/2018 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 IIeu of such endorsement(s). PRODUCER Heitel & Associates, Inc 6122 N. 7th Street Phoenix AZ 85014 CONTACT 11y Antrim A/GNNo EaU: (602)230-7726 ( No): (602)230-7836 ADDEMAILRESS: kantrim®hesterheitel.com INSURER(S) AFFORDING COVERAGE NAIC A INsuRERA:Valley Forge Insurance Company 20508 INSURED Dibble & Associates Consulting Engineers, Inc DBA: Dibble Engineering Inc. 7878 N 16th Street Ste 300 Phoenix AZ 85020-4669 INSURER B :Nati Fire Co. of Hartford 20478 INSURERC: INSURER D :SAMPLE ONLY INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:SAMPLE ONLY REVISION NUMBER: SAN PLE ONLY 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. INSR LTR TYPE OF INSURANCE IADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDOIYYYY) LIMITS X COMMERCIAL GENERAL LABILITY X Y 6021713775 11/1/2017 11/1/2018 EACH OCCURRENCE $ 2, 000, 000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 A . CLAIMS -MADE . X k OCCUR MED EXP (Any one person) 1$ 10,00E PERSONAL &ADV INJURY S 2,000,000 GENERAL AGGREGATE S 9,000,000 GN'L X `~ AGGREGATE LIMIT APPLIES PER: PRO POLICY X JECT I X 1 LOC OTHER: PRODUCTS - COMP/OP AGG S 9,000,00E S B AUTOMOBILE X 1 LIABIUTY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED AUTOS x y 6045348049 11/1/2017 11/1/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S S A X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE 6045348097 11/1/2017 11/1/2016 EACH OCCURRENCE 3 5,000,000 AGGREGATE I S 5,000,000 S DED X RETENTIONS 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUrVE OFFICERM(EMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) **SAMPLE CERTIFICATE. THE FOLLOWING COVERAGES WILL BE AFFORDED IF THE JOB IS REWARDED TO THE INSURED. The City of Prescott and Prescott Municipal Airport are an Additional Insured on both the General Liability and Auto Liability (CG20330704, CG203070704 & CAE_0131_0810) on a primary and non-contributory basis per attached form BPE 2265 9912. 30 day notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION The City of Prescott and Prescott Municipal Airport 6546 Crystal Lane Prescott, AZ 86301 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sample Only © 1988-2014 ACORD CORPORATION. / Packet Pg. 176