CERTIFICATE OF INSURANCE
This is to Certify to:
San Francisco Bay Area Rapid Transit District (BART) Insured:___________________________
Insurance Department
___________________________
300 Lakeside Drive, LKS-22
________________________
Oakland, CA 94612
The following described policy(ies) has been issued to the Insured stated above. BART’s Agreement No.: _____________________________
Description and Location of Project: ___________________________________________________________________________
A. COMMERCIAL GENERAL LIABILITY
D. WORKERS COMPENSATION AND EMPLOYERS
Required: Yes _________ No ____________
LIABILITY INSURANCE
______ Occurrence Form ______ Claims Made
Required: Yes _________ No ____________
________________ Retroactive Date (if applicable)
$ ______________ Per Accident/Disease (Empl. Liability)
$ ______________ Each Occurrence Limit
$ ______________ Statutory Limits (Worker’s Compensation)
$ ______________ General Aggregate Limit
Insurance Co: ______________________________________________
Insurance Co: ______________________________________________
Policy Number _____________________
Policy Number _____________________
AM Best Rating: __________
AM Best Rating: __________
Policy Term: _____________________ to ______________________
Policy Term: _____________________ to ______________________
1.
The policy shall include broad form all states/other states coverage.
The Commercial General Liability Policy includes the following
2.
Coverage will be endorsed to include the insurer’s waiver of
coverage/endorsements:
subrogation in favor of the San Francisco Bay Area Rapid Transit
1.
Personal injury, bodily injury, and property damage liability
District, and any other entity as required by contract, and their
coverages;
respective directors, officers, trustees, representatives, agents and
2.
Products and completed operations coverage as well as
employees.
premises/operations;
E. HAZMAT TRANSPORT/AUTO LIABILITY POLLUTION
3.
Explosion, collapse and underground hazards coverage
Required: Yes _________ No ____________
(construction contracts)
______ Occurrence Form ______ Claims Made
4.
Cross Liability and Severability of Interests;
$ ______________ Each Occurrence Limit
5.
Broad form property damage;
Insurance Co: _______________________________
6.
Independent contractors coverage;
Policy Number ______________________________
7.
Blanket contractual liability coverage;
AM Best Rating: ____________________________
8.
Inclusion of San Francisco Bay Area Rapid Transit District, and any
Policy Term: ______________ to ______________
other entity as required by Agreement and their respective directors,
This Automobile Liability Policy includes the following
officers, trustees, representatives, agents and employees as
coverages/endorsements:
additional insureds as respects work or operations performed in
1.
Bodily injury and property damage liability coverages;
connection with this Agreement.
2.
Coverage for all owned, non-owned and hired automobiles of the
9.
Stipulation that this insurance is primary and that no other insurance
named insured.
or self-insurance of the District will be called upon to contribute to
3.
The accidental release of hazardous waste defined in California
a loss.
Heath and Safety Code (H & S) Section 25117 and listed in Title 22
10.
For construction or excavation within 50 feet, vertically or
California Code of Regulations Section 66260.10 and
horizontally, of the BART trackway, the General Liability coverage
consequential containment, cleanup, disposal and penalties
must affirmatively delete any exclusion denying coverage for any
associated therewith.
claim occurring with the 50 foot trackway envelope. If the
4.
Pollution Liability which includes “covered pollution costs or
exclusion remains in the General Liability coverage, a Railroad
expenses”, which mean any cost or expense arising out of:
Protective Policy is required [See Section J. Railroad Protective
(a)
Any request, demand or order;
Insurance for recording policy information in lieu of coverage
(b)
Any claim or suit by or behalf of a governmental authority
under GL].
demanding that the insured or others test for, monitor, clean-
B. AUTOMOBILE LIABILITY
up, remove, contain, treat, detoxify or neutralize, or in any
Required: Yes _________ No ____________
way respond to, or assess the effects of pollutants.
$ ______________ Each Occurrence Limit
____________________________________________________
Insurance Co: _______________________________
F. POLLUTION LEGAL LIABILITY INSURANCE
Policy Number ______________________________
Required: Yes _________ No ____________
AM Best Rating: ____________________________
______ Occurrence Form ______ Claims Made
Policy Term: ______________ to ______________
________________ Retroactive Date (if applicable)
This Automobile Liability Policy includes the following
$ ______________ Each Occurrence Limit
coverage/endorsements:
Retro Exclusion Date: ________________________
1.
Bodily injury and property damage liability coverages;
Extended Reporting: ________________________
2.
Coverage for all owned, non-owned and hired automobiles of the
Insurance Co: _______________________________
named insured;
Policy Number: _____________________________
__________________________________________________________
AM Best Rating: ____________________________
Policy Term: ______________ to ______________
C. EXCESS/UMBRELLA LIABILITY INSURANCE
Required: Yes _________ No ____________
1.
Bodily injury (including death) and property damage, including
$ ______________ Each Occurrence Limit
natural resource damage and third party diminution in value claims
$ ______________ Annual Aggregate Limit
2.
Policy shall cover accidental release of hazardous materials as
Insurance Co: _______________________________
defined in California Health and Safety Code (H&S) Section 25117
Policy Number: _____________________________
and listed in the Title 22 California Code of Regulations Section
AM Best Rating: ____________________________
66260.10 and consequential containment, clean-up, disposal and
Policy Term: ______________ to ______________
penalties associated therewith.
Form No. 03-0001-R1 (Rev.12/21/10 – Insurance)