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

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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 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 lieu of such endorsement(s). PRODUCER Hester, Heitel & Associates, Inc 6122 N. 7th Street Phoenix AZ 85014 INSURED Dibble & Associates Consulting Engineers, Inc DBA: Dibble Engineering Inc. 7878 N 16th Street Ste 300 Phoenix AZ 85020-4669 CONTACT Kell Antrim NAME: Y PHONE (602)230-7726 E-MAIL ADDRESS: kantrim@hesterheitel.com FAX (602)230-7836 (NC No): -._ INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Valley Forge Insurance Company 20508 INSURERB:Natl Fire Co. of Hartford 20478 INSURER C : INSURER D :SAMPLE ONLY INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:SAMPLE 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 ADDL.SUBR -- - --- LTR TYPE OF INSURANCE POLICY EFF POLICY EXP ----_ - INSD WVD POLICY NUMBER ' (MM/DD/YYYYI (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RENTED 500,000 - PREMISES (Ea occurrence) $ X Y 6021713775 11/1/2017 11/1/2018 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: �.. GENERAL AGGREGATE $ 4,000,000 X POLICY'. X JECOT- X LOC PRODUCTS - COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 — . (Ea accident) B X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED -- -—_--- - --- AUTOS AUTOS X y 6045348049 11/1/2017 11/1/2018 BODILY INJURY (Per accident) $ —II NON -OWNED 1 PROPERTY DAMAGE _ -- HIRED AUTOS AUTOS. $ - - (Per accident) X UMBRELLALIAB X OCCUR EACH OCCURRENCE '. $ 5,000,000 A EXCESSLIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DEU I X RETENTION$ 10,000 6045348097 11/1/2017 111/1/2018 ', $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER _ _ Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory in NH) -- --- E.L. DISEASE - EA EMPLOYEE $ If yes, describe under - - ---- - -- -- --- - - -- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 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 '0 O ©1988-2014 ACORD CORPORATION. All rights resery ORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD f025 (201401) Attachment: SOQ for Airport Design & Engineering Services (2126 : Dibble Engineering Contract