CERTIFICATE HOLDER CANCELLATION. AUTHORIZED REPRESENTATIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Xxxxxxx XX Xxx 000 Xxxx Xxxxxxx XX 80522-0580 DocuSign Envelope ID: 7378762B-3CAB-4F36-81DD-4A11D6A3D9E7 AYREASS-01 RSAUER CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/20/2015 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 Xxxxxxx Insurance Madison 000 Xxxxxxxx Xxxx Xxxxxxx, XX 00000 CONTACT Xxxx Xx Xxxxx, AU, CIC, ARM, RPLU NAME: PHONE (000) 000-0000 (A/C, No, Ext): FAX (000) 000-0000 (A/C, No): E-MAIL xxxxxx@xxxxxxxxxx.xxx ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : RLI Insurance Group 13056 INSURED Xxxxx Associates Inc 0000 Xxxxxxx Xxxxx Xxxx Xxx Xxxxxx, XX 00000 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC JECT OTHER: PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accide...
CERTIFICATE HOLDER CANCELLATION. Should any of the above described policies be cancelled before the California Department of Corrections and Rehabilitation Office of Business Services 0000 Xxx Xxxxxxxxxxx Xx, Xxxxx X-0 Xxxxxxxxxx, XX 00000 FAX (000) 000-0000 expiration date thereof, notice will be delivered in accordance with the policy provisions: Contractor Certification Clause CCC 04/2017 CERTIFICATION I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed below. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federal ID Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County of CONTRACTOR CERTIFICATION CLAUSES STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (GC 12990 (a-f) and CCR, Title 2, Section 8103) (Not applicable to public entities.) DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions:
CERTIFICATE HOLDER CANCELLATION. Allied Residential; King County Housing Authority; Woodland North LLLP; BCP/Woodland North, LLC; Boston Capital Affordable Housing Fund V, LLC; and BCCC, LLC. ISAOA 000 Xxxxxxx Xxxx Xxxx Xxxxxxx, XX 00000-3326 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Signature of Insured’s Agent XXXXX 25-S (3/93) XXXXX CORPORATION 1993 PROVIDE GENERAL LIABILITY ENDORSEMENT and
CERTIFICATE HOLDER CANCELLATION. MSCAA OCIP c/o Xxxxxx Xxxxxx Xxxxxx National Project Insurance Practice. Attn: Xxxxxxx Xxxxx 00000 Xxxxx Xxxxxx Xxxxxxx, Xxxxx 0000 Xxxxxxx, XX 00000 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 EXHIBIT D TO LUMP SUM CONSTRUCTION CONTRACT FOR AIRFIELD MAINTENANCE FUEL FACILITY DEMOLITION - CONSTRUCTION BY AND BETWEEN THE MEMPHIS-SHELBY COUNTY AIRPORT AUTHORITY AND (CONTRACTOR NAME) CONSTRUCTION SAFETY AND HEALTH GUIDELINES Memphis-Shelby County Airport Authority Construction Safety and Health Guidelines Revision Revision Summary Date 1 Updated Safety Manual for OCIP III 11/30/2012 2 Accommodate change in policy end dates to 10/25/2018. Update Team Members 05/02/2016 3 Amendments for clothing to include “reflective safety vests” 02/06/2017 Confirmation of these Project Safety & Health Guidelines It is the responsibility of the Contractor to maintain total control of safety to ensure that employees and the general public are provided with an environment free of hazards during construction and renovation activities. This program does not relieve the Contractor of their responsibilities regarding the safety of their employees, the employees of their Subcontractors and sub-subcontractors, protection of the general public and the preservation of property. Contractors shall develop their own written site-specific safety and health plans for the Memphis-Shelby County Airport Authority. At minimum, the safety and health plan shall meet the requirements of 29CFR1926 – Federal OSHA Construction regulations and the requirements established in the Memphis-Shelby County Airport Authority Construction Safety Guidelines. In short, as required by law, each Contractor is responsible for protecting the health and safety of its employees and the employees of each subcontractor and sub-subcontractor while ensuring they have a safe and healthful place to work. The site-specific safety and health program shall be submitted for approval within fifteen (15) days after the Notice to Proceed for approval to the Project Safety Manager, Xxx Xxxxxx, 0000 Xxxxxxx Xxxx., Xxxxxxx, XX. The Safety Requirements of these safety guidelines are a supplementary document to all Government rules, codes and regulations. It does not negate, abrogate, alter or otherwise change any provisions of these rules, codes and/or regulations, and is intended to supplement ...
CERTIFICATE HOLDER CANCELLATION. Union Pacific Railroad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER. TO AGENTS OR, REPRESENTATIVES. — AUTHORIZED REPRESENTATIVE — Exhibit C
