OYSTER POINT MARINA PLAZA
395 & 400 Oyster Point Boulevard, South San Francisco, CA 94080 T. (650) 873-1054 / F. (650) 873-3677
TENANT -VENDOR LIABILITY INSURANCE REQUIREMENTS-2014 PAGE 1 OF 2
TENANT‐VENDOR LIABILITY INSURANCE DOCUMENTATION REQUIREMENTS
KASHIWA FUDOSAN AMERICA, INC. (herein referred to as “Owner”) requires, in addition to and in conjunction with,
any current Lease Agreement, its subsequent Amendments or Addendums, that all contractors, vendors, service providers, service/repair technicians, equipment maintenance personnel and all other related providers (herein referred to as “Vendor”), be approved by “Owner” prior to the commencement of service(s) for Tenant(s). Vendor as part of its contract with Tenant, regardless of the form or type of: contract; purchase order; work letter; service or maintenance agreement; email acceptance; verbal; or; any other form(s) of arrangement for the purchase of goods or services rendered (herein referred to as “Service”), is required to provide to “Owner”,
for review and approval, prior to the commencement of any “Service”: (I) CERTIFICATE OF LIABILITY INSURANCE;
(II) ADDITIONAL INSURED ENDORSEMENT; and; (III) WAIVER OF SUBROGATION FOR WORKER’S COMPENSATION. These
documents will need to comply and meet all items listed and/or outlined as they pertain to “Vendor’s” current insurance policy(s) with the minimum: (i) aggregate; (ii) coverage(s); (iii) limits, and (iv) insured(s); as where explicitly stated below and in the accompanying “Owner” samples: I. CERTIFICATE OF LIABILITY INSURANCE – “Vendor” shall furnish to the “Owner” a Certificate of Liability Insurance (using an ACORD® 25 (2010/05) or a current substitute providing equivalent coverage) with the following provided below (Must be specifically listed as shown): GENERAL LIABILITY Commercial General Liability Per: OCCURRENCE General Aggregate Limit Applies Per: PROJECT LOCATION Combined Single Liability Limit: $2,000,000 Policy Liability Limits: Each Occurrence: $1,000,000 Damage To Rented Premises (per occurrence): $ 50,000 Med Exp (Any one person): $ 5,000 Personal & Adv Injury: $1,000,000 General Aggregate: $2,000,000 Products Comp/Op Agg: $2,000,000 AUTOMOBILE LIABILITY As part of the Commercial General Liability policy ANY AUTO; HIRED AUTOS; and; NON‐OWNED AUTOS
Combined Single Liability Limit (Each accident): $2,000,000
UMBRELLA LIABILITY OR EXCESS LIABILITY (if provided)
Umbrella Liability Per: OCCURRENCE Excess Liability Per: OCCURRENCE A combination of primary and excess policies may be utilized in concurrence with the requirements listed as a means to augment or supplement the required coverage and aggregate limits
WORKER'S COMPENSATION AND EMPLOYER’S LIABILITY
OYSTER POINT MARINA PLAZA
395 & 400 Oyster Point Boulevard, South San Francisco, CA 94080 T. (650) 873-1054 / F. (650) 873-3677
TENANT -VENDOR LIABILITY INSURANCE REQUIREMENTS-2014 PAGE 2 OF 2
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Must be specifically listed as shown): Additional Insured: Kashiwa Fudosan America, Inc., Cushman & Wakefield of California, Inc., and their subsidiaries are included as additional insureds with respects to General Liability coverage. If Excess Liability or Umbrella Policy(ies) have been provided in the Certificate of insurance, the following must be specifically listed as shown: Excess Liability or Umbrella policy follows form with respect to the Commercial General Liability Insurance policy listed in this Certificate of Insurance.
CERTIFICATE HOLDER (Must be specifically listed as shown):
Kashiwa Fudosan America, Inc. c/o Cushman & Wakefield of California, Inc. 400 Oyster Point Boulevard, Suite #117 South San Francisco, CA 94080 Attn: General Manager II. ADDITIONAL INSURED ENDORSEMENT – “Vendor” shall furnish to the “Owner” an Additional Insured Endorsement, which shall endorse and modify “Vendor’s” Commercial General Liability Insurance Policy, (using an ISO® 20 10 10 01 (Additional Insured – Owners, Lessees OR Contractors – Scheduled Person or Organization), ACORD® CG2037 (Completed Operations), or a current substitute providing equivalent coverage) with the following provided below (Must be specifically listed as shown): SCHEDULE
NAME OF PERSON OR ORGANIZATION (Please note that the spelling of these parties be must be specifically listed as shown or the “Service” will not be permitted to commence):
Kashiwa Fudosan America, Inc.,
Cushman & Wakefield of California, Inc. ;
and their subsidiaries are included as Additional Insureds as respects to General Liability coverage
JOB DESCRIPTION (Please note that the specific address, city, state and zip code for the
Contract Duties be must be specifically listed as shown or the “Service” will not be permitted to commence):
395 and 400 Oyster Point Boulevard, South San Francisco, CA 94080
III. WAIVER OF SUBROGATION (WORKERS COMPENSATION) – “Vendor” shall furnish to the “Owner” a
Waiver of Subrogation for Workers Compensation Insurance, which shall waive “Vendor’s” right to recover from others workers compensation and employers liability insurance policy(s), (using a WC 04 03 06 (Wavier of our Right to Recover From Others Endorsement – California), WC 00 03 13 or a current substitute providing equivalent coverage) with the following provided below (Must be specifically listed as shown): SCHEDULE
NAME OF PERSON OR ORGANIZATION (Please note that the spelling of these parties be must
be specifically listed as shown or the “Service” will not be permitted to commence): Kashiwa Fudosan America, Inc.
Cushman & Wakefield of California, Inc. ;
and their subsidiaries
JOB DESCRIPTION (Please note that the specific address, city, state and zip code for the
Contract Duties be must be specifically listed as shown or the “Service” will not be permitted to commence):
395 and 400 Oyster Point Boulevard, South San Francisco, CA 94080
*Original: (I) CERTIFICATE OF LIABILITY INSURANCE; (II) ADDITIONAL INSURED ENDORSEMENT; and; (III) WAIVER OF
SUBROGATION FOR WORKER’S COMPENSATION must be submitted, reviewed, and approved by “Owner” in
CERTIFICATE OF LIABILITY INSURANCE
INSURED
Name of the party insured
COVERAGES CERTIFICATE N REVISION NUMBER:
INSR ADDL SUB POLICY EFF POLICY EXP
LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY)
GENERAL LIABILITY
× COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE × OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT × LOC AUTOMOBILE LIABILITY
× ANY AUTOS
× ×
UMBRELLA LIAB ×
EXCESS LIAB CLAIMS-MADE DED
Y/N × OTH-ER
A.
CERTIFICATE HOLDER CANCELLATION
AUTHORIZED REPRESENTATIVE
® 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) $ - $ 1,000,000 $ - INSURER C: INSURER D: INSURER E: CONTACT NAME: PHONE (A/C, No, Ext):
FAX (A/C, No): ADDRESS:
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Kashiwa Fudosan America, Inc. c/o Cushman & Wakefield of California, Inc. 400 Oyster Point Boulevard, Suite #117 South San Francisco, CA 94080 Attn: General Manager
B.
Kashiwa Fudosan America, Inc., Cushman & Wakefield of California, Inc., and their subsidiaries are included as additional insureds as respects General Liability coverage.
C.
$ 1,000,000 $ 1,000,000
Name of the insurance company
$ - $ - $ 2,000,000 $ 50,000
INSURER F:
INSURER(S) AFFORDING COVERAGE
INSURER B: INSURER A: DATE (MM/DD/YYYY) $ 5,000 $ 1,000,000 $ 2,000,000 NAIC # EMAIL
Address of the party insured
THIS IS TO CERTIFY THAT THE POLICIES 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.
LIMITS
TYPE OF INSURANCE POLICY NUMBER
$ 1,000,000
EACH OCCURRENCE DAMAGE TO RENTED PREMISES (ea. occurrence) MED EXP (Any one person)
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 statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
Address of the insurance company
PRODUCER
ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTIONS OF OPERATIONS below
WORKERS COMPENSATION AND EMPLOYER'S LIABILITY
OCCUR
E.L. DISEASE - POLICY LIMIT COMBINED SINGLE LIMIT (ea. accident)
BODILY INJURY (per person) BODILY INJURY (per accident) ALL OWNED
AUTOS
PROPERTY DAMAGE (per accident)
The ACORD name and logo are registered marks of ACORD
RETENTION $
E.L. DISEASE - EA. EMPLOYEE PERSONAL & ADV INJURY
HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS PRODUCTS-COM/OP AGG GENERAL AGGREGATE EACH OCCURRENCE AGGREGATE
E.L. EACH ACCIDENT WC
STATU-TORY
(i.) "Excess or Umbrella policy follows form with respect to the Commercial General Liability Insurance policy listed on this Certificate of Insurance."
The COMMERCIAL GENERAL LIABILITY POLICY must be properly amended and endorsed as evidenced by an ADDITIONAL INSURED ENDORSEMENT (ISO CG 20 10 01, CG 2037 or a substitute providing equivalent coverage), specifically stating the following (Per attached Endorsement SAMPLE):
(i.) KASHIWA FUDOSAN AMERICA, INC.; and; (ii.) CUSHMAN & WAKEFIELD OF CALIFORNIA, INC., and their subsidiaries are additional insureds as respects General Liability
coverage.
2. LOCATION(S) OF COVERED OPERATIONS: 395 & 400 OYSTER POINT BOULEVARD, SOUTH SAN FRANCISCO, CA 94080
If Excess or Umbrella Policy(ies) have been listed or provided in this Certificate of insurance, the following sentance must be specifically stated :
$ 2,000,000
$ - $ - $ -
$ -
1. NAME OF ADDITIONAL INSURED PERSON(S) OR ORGANIZATION(S):
Oyster Point Marina Plaza ‐ Vendor Additional Insured Endorsement ‐ SAMPLE ‐ 2014
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s): Location(s) Of Covered Operations:
Kashiwa Fudosan America, Inc.; Cushman & Wakefield of California, Inc., and their subsidiaries are additional insureds as respects General Liability coverage. Oyster Point Marina Plaza 395 & 400 Oyster Point Boulevard South San Francisco, CA 94080
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 4-84)
Oyster Point Marina Plaza ‐ Vendor Waiver of Subrogation WC ‐ SAMPLE ‐ 2014
Name of Person or Organization:
Kashiwa Fudosan America, Inc.,
Cushman & Wakefield of California, Inc., and their subsidiaries
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be _________% of the California workers’ compensation premium otherwise due on such remuneration.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. Endorsement No.
Insured Premium
Insurance Company Countersigned by
WC 00 03 13 (Ed. 4-84)
