Standard Consultant Certificate of Insurance by iqe17089


									                                                                Certificate of Insurance
                                                      City Road and Right-of-Way Use Permit Form

This certifies that policies of insurance as described below have been issued to the Insured named below and are in full force and effect at this time. It is
understood and agreed that thirty (30) days' written notice of cancellation or reduction in applicable limit of insurance of any of the policies listed below, with
the exception of ICBC, will be given to the holder of this certificate.


This Certificate is issued to:        The City of Surrey, 14245 - 56 Avenue, Surrey, B.C. V3X 3A2

Insured:        Name:

Broker:         Name:                                                                      Agent’s Name:
                Address:                                                                         Phone:

Location, Project No. and nature of contract, permit, lease, license or operation to which this Certificate applies:

                                                                                                      Policy Term
Type of Insurance                                     Company and Policy Number                       yyyy/mm/dd               Limits of Liability/Amount
Section 1                                                                                                            Bodily Injury, Death & Property Damage
                                                                                                From:                $                     Per Occurrence
Commercial General Liability                                                                    To:                  $                     General Aggregate
                                                                                                                     $                     Products & Completed
__________ ___________                            ____________________                          ___________                                Operations Aggregate
   Umbrella Liability                                                                           To:
_____________________                             _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _        ___________          $                     Umbrella Limit

      Excess Liability                                                                          From:
                                                                                                To:                  $                     Excess Limit
                                                                                                                     $                     Deductible
                                                                                                                             MINIMUM $3,000,000
Section 2                                                                                       From:                Bodily Injury & Property Damage
Automobile Liability (owned or leased                                                                                $                    Limit
vehicles)                                                                                       To:                          MINIMUM $2,000,000
Section 3                                                                                       From:
Other:                                                                                                               $                      Limit
                                                                                                To:                  $                      Deductible

                                 Particulars of General Liability Insurance (Sections 1): X indicates that the coverage is included.
   City of Surrey as Additional Insured                             Broad Form Property Damage                      Broad Form Tenants Legal Liability
   Premises & Operations                                            Incidental Medical Malpractice                  Advertising Liability
   Broad Form Products & Completed Operations                    Broad Form Loss of Use                            Host Liquor Liability
   Owners & Contractors Protective                               Personal Injury                                   Intentional Injury
                                                                     Use of explosives for blasting                  Volunteers as Additional Insureds
   Blanket Contractual
                                                                                                                     Members as Additional Insureds
                                                                     Vibration from pile driving or caisson work
   Cross Liability/Severability of Interests
                                                                     Removal or weakening of support of              Injury to Participants (sporting events)
   Employees Additional Insureds
                                                                     property, building or land whether the          Aviation Liability
   Non-Owned Automobile                                             support is natural or otherwise                 Non-owned aircraft liability
   Attached Machinery                                               Work below ground level over 3 meters           Watercraft liability
   Occurrence Property Damage                                       (XCU extension)                                 Non-owned watercraft liability
   Contingent Employer’s
   Broad Form Loss of Use

It is understood and agreed any deductible or reimbursement clause contained in the policy shall be the sole responsibility of the Named Insured.

                   (Authorized to Sign on Behalf of Insured)                                                              Date Signed

      (Authorized to Sign on Behalf of Insurers) and Brokers Stamp                                                        Date Signed

Jan 1, 2008
                                                            Certificate of Insurance
                                                  City Road and Right-of-Way Use Permit Form

Jan 1, 2008

To top