insurance requirements - oltmans construction co. · or e-mail [email protected]. thank you for...

Subcontractor Prequalification CA Contractor's License #86393 AB

www.Oltmans.com

COMPANY INFORMATION

Company Name License # Year Established

Address City State ZIP

Office Phone Fax Website

PRIMARY CONTACT INFORMATION

Name Title

E-mail Address Cell #

ADDITIONAL INFORMATION PAST THREE YEARS’ ACTIVITY

Total Sales Volume

Current Year Previous Year 1 Previous Year 2

Largest Job(s) Completed Amt

INSURANCE COVERAGE

Bonding Capacity Current EMR (%)

TRADE AND/OR CSI CODES

Subcontractor Trade(s)

Types of Work Performed Areas of Work Performed State Licenses

Commercial/Industrial Kern County Arizona

Infrastructure Los Angeles County California

Federal Government Orange C o u n ty Nevada

Hospital/Medical Facilities Riverside County Other

Institutional Sacramento County

Public Works San Bernardino County Union/Non-Union

Residential (multi-unit and/or multi-family) San Diego County Union

Retail San Francisco Bay Area – 9 Counties Open Shop

Schools San Joaquin Valley Prevailing Wage

Tenant Improvements Santa Barbara County

Tilt-Up Ventura County

Disadvantaged Affiliation Qualifying Agency DBE Disadvantaged Business Enterprise CA DOT

DVBE Disabled Veteran Business Enterprise Cal Trans

H HUB Zone City of Los Angeles

IOB Indian Owned Business Department of Minority Business Resources

MBE Minority Business Enterprise Federal/Military Enterprise

SB Small Business HUB Zone Enterprise

SBE Small Business Enterprise LACMTA

SD Small Disadvantaged Business Minority Business Development

SSB Service Disabled Veteran Owned Small Business Port of Long Beach

VSB Veteran Owned Small Business State of California

VSBE Very Small Business Enterprise US Small Business

WSB Woman Owned Small Business

INSURANCE

I have read and understand Oltmans Construction’s insurance requirements as posted on www.oltmans.com.

REFERENCES: Please attach a current list of references and past/present projects. When submitting a reference list include: contact name, title, company, business address, and phone number.

SUBMISSION: Please e-mail your completed subcontractor prequalification form to [email protected]. Note: It is the responsibility of the subcontractor to track projects currently bidding. The subcontractor shall follow-up with the Project Manager and/or Estimator assigned to the project. For a list of current bid opportunities, please visit www.oltmans.com or e-mail [email protected].

Thank you for considering Oltmans Construction Co. On behalf of our entire team, we look forward to working with you soon!

Corporate Office

10005 Mission Mill Road

Whittier, CA 90601

Northern California

780 Montague Expressway, Suite 106

San Jose, CA 95131

Thousand Oaks

270 Conejo Ridge Avenue, Suite 210

Thousand Oaks, CA 91361-4957

http://www.oltmans.com/

mailto:[email protected]

http://www.oltmans.com/


INSURANCE REQUIREMENTS

All insurance must be written by a U.S. Insurance company, show the complete insurance company name including any state or subsidiary designation, and be rated in the current edition of the A.M. Best Property & Casualty Guide as A, X or better. Oltmans requires complete submission of your insurance certificate prior to starting work onsite. Failure to submit within five (5) working days will force us to void your contract.

1. WORKERS COMPENSATION (binders are not accepted)Employers Liability limits:$1,000,000 Bodily Injury by Accident $1,000,000 Bodily Injury by Disease - Each Employee $1,000,000 Bodily Injury by Disease - Policy Limit

Required Waivers with policy numbers listed: Waiver of Subrogation in favor of Oltmans Construction and all owners.

2. GENERAL LIABILITY (binders are not accepted)General Liability limits:$2,000,000 General Aggregate $2,000,000 Products and Completed Operations Aggregate $2,000,000 Personal and Advertising Injury $2,000,000 Each Occurrence

Trade Specific (binders are not accepted) $3,000,000 Excess Liability for Fire Sprinklers $5,000,000 Asbestos/Pollution Liability $5,000,000 Crane Operators

Required Waivers and Endorsements with policy numbers listed: Per “Project” Aggregate, Additional InsuredEndorsement, Primary and Non-Contributory Wording Endorsement including Ongoing and Completed Operations, andWaiver of Subrogation in favor of Oltmans Construction and all owners.

3. AUTO LIABILITY (binders are not accepted)Automobile liability including owned, hired and non-owned autos. If any autos are not covered within your policy, pleaseprovide a company letter stating that these autos are not covered and will not be present at any job sites for OltmansConstruction Company.

Auto Liability limits:$2,000,000 Combined Single Limit

Required Waivers and Endorsement with policy numbers listed: Additional Insured Endorsement, Waiver ofSubrogation in favor of Oltmans Construction and all owners.

4. ADDITIONAL INSUREDOltmans Construction Co. and the Owner(s) must be named as the Additional Insured on the General Liability and AutoCertificates and on the Additional Insured Endorsements (see examples).

Required Endorsements with policy numbers listed: Additional Insured Endorsements

5. CANCELLATION PARAGRAPHYour certificate must state that Oltmans Construction Co. will be given at least a 30-day written notice of cancellation.

Submit certificates of insurance via email or fax, only

Email: [email protected]

Fax: (562) 695-9750

Questions or concerns may be addressed by e-mailing the above address, or by calling

(562) 948-4242 ext. 3451

SAMPLE


POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 oo

ADDITIONAL INSURED – OWNERS, LESSEES ORCONTRACTORS – (FORM B)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART.

SCHEDULEName of Person or Organization:

(If no entry appears above, information required to complete this endorsement will be shown in the Declarationsas applicable to this endorsement.)

WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in theSchedule, but only with respect to liability arising out of "your work" for that insured by or for you.

Oltmans Construction Co.10005 Mission Mill RoadWhittier, CA 90601

Oltmans Construction Co. & Owner(s) or "Blanket as required by written contract"

SAMPLE

(If no entry appears above, information required to complete this endorsement will be shown in the Declarationsas applicable to this endorsement.)

WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in theSchedule, but only with respect to liability arising out of "your work" for that insured by or for you.

Owner:

Oltmans Construction Co.


SAMPLE

CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1

Policy Number: COMMERCIAL GENERAL LIABILITYCG 20 01 04 13


PRIMARY AND NONCONTRIBUTORY –OTHER INSURANCE CONDITION


COMMERCIAL GENERAL LIABILITY COVERAGE PARTPRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

The following is added to the Other InsuranceCondition and supersedes any provision to the contrary:

Primary And Noncontributory Insurance

This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:

(1) The additional insured is a Named Insuredunder such other insurance; and

(2) You have agreed in writing in a contract oragreement that this insurance would beprimary and would not seek contributionfrom any other insurance available to theadditional insured.

LHA138599

Oltmans Construction Co along with Vineyard Industrial II, LLC Sares Regis Group Operating Inc., Commingled Pension Trust Fund,

JP Morgan Chase Bank, N.A., SRG Development LP


SAMPLE

SAMPLE

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US


COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization:

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above.

SAMPLE



SAMPLE

Policy Number:Effective: UGCA 35 99 01 07

COMMERCIAL AUTO


ADDITIONAL INSURED ENDORSEMENT

BUSINESS AUTO COVERAGE FORM


SCHEDULE

Name Of Person Or Organization:

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person

An additional premium of $ is fully earned at the time of issue.

or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the CoverageForm. The inclusion of additional interest or interests will not operate to increase the limit of our liability.

Page 1 of 1UGCA 35 99 01 07 ISO Copyrighted Material Included

SAMPLE



SAMPLE

POLICY NUMBER: COMMERCIAL AUTO CA 04 44 10 13


CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION)


AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured:

Endorsement Effective Date:

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.

SAMPLE



SAMPLE

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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.) 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)

© 1983 National Council on Compensation Insurance.

SAMPLE



SAMPLE

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