FIRE STATION NO. 91 ADA PARKING LOT AND PATH OF TRAVEL IMPROVEMENTS PROJECT

CITY OF DALY CITY
DEPARTMENT OF PUBLIC WORKS
INSURANCE REQUIREMENTS
IMPORTANT NOTE
Contractors and/or Homeowners shall not perform any work, or allow any work to be performed, on
behalf of the City or in the City right of way, until all required insurance documents described below
have been approved by the City. All Contractors and/or Homeowners must either sign an agreement
with the City or receive a permit from the City, and that agreement/permit includes the requirement
to provide additional insured coverage, primary coverage and cancellation endorsements for the
work to be performed. Please note that the review and approval process for insurance
documentation may take several days, so plan accordingly.
Certificates and endorsements may be initially submitted via email; however, original documents
must be mailed to the following address:
Department of Public Works, Engineering Division
333 90th Street
Daly City, CA 94015
Prior to performing work for the City of Daly City or receiving an encroachment permit to perform work
in the City right-of-way, the Contractor and/or Homeowner, including all subcontractors working for
the Contractor and/or Homeowner, shall furnish the following documents to the Engineering Division
for prior approval. Coverage shall be effective throughout the term of the City contract or permit.
HOMEOWNERS:
1. A copy of the Homeowners Insurance Policy declarations page, showing coverage is currently
in effect, and will remain in effect throughout the project period.
2. An additional insured endorsement which includes the following language: "The City of Daly
City, including its officers, officials, employees, and volunteers, are insureds"
CONTRACTORS:
Certificates of Insurance with original, authorized signatures, providing the following minimum
insurance coverage(s):
1. General Liability: Contractor shall maintain general liability coverage on an occurrence form
with limits not less than $2,000,000 per occurrence and $4,000,000 aggregate for bodily
injury and property damage liability.
2. Automobile Liability: "Any Auto" $1,000,000 Combined Single Limit per accident for bodily
injury and property damage.

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3. Workers' Compensation: Workers' Compensation Insurance as required by the State of
California and Employer's Liability Insurance of $1,000,000 per accident for bodily injury or
disease.
4. All insurance carriers shall be AM Best rated A:VII or better and certificates SHALL be
accompanied by the following endorsements:
A. LIABILITY INSURANCE ENDORSEMENT containing the following specific components:
1. The insurance policy number.
2. An additional insured endorsement which includes the following language: "The City
of Daly City, including its officers, officials, employees, and volunteers, are insureds"
3. A statement that includes the following language: "The insurance shall be primary as
respects the insured shown in the schedule above, or if excess, shall stand in an
unbroken chain of coverage excess of the Named Insured's scheduled underlying
primary coverage. In either event, any other insurance maintained by the Insured
scheduled above shall be in excess of this insurance and shall not be called upon to
contribute with it."
4. A statement that includes the following language: "The insurance afforded by this
policy shall not be canceled except after thirty days prior written notice by certified
mail return receipt requested has been given to the City."
NOTE:
a. A CG 20 10 11 85 Form is preferred for the General Liability additional insured
Endorsement, but alternative endorsements may, for good cause, be substituted with
prior approval by the City. The City can consider accepting either a CG 20 10 10 01 or a
CG 20 33 10 01 (or some form specific that has identical wording) as long as the form is
accompanied by a CG 20 37 10 01.
b. Policies that include endorsement numbers CG 22 94 10 01 and/or CG 22 95
10 01, or have the endorsement wording written into the policy DO NOT satisfy the City's
insurance requirements, and WILL NOT be accepted.
c. The City will accept strike out of the words "endeavor to" and everything after,
"...certificate holder named to the left," on the Certificate of Insurance in lieu of
cancellation language on an endorsement.
B. AUTOMOBILE INSURANCE ENDORSEMENT containing the following specific
components:
1. The insurance policy number.

CITY OF DALY CITY DEPARTMENT OF PUBLIC WORKS
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2. An additional insured endorsement which includes the following language: "The City
of Daly City, including its officers, officials, employees, and volunteers, are insureds"
3. A statement that includes the following language: "The insurance shall be primary as
respects the insured shown in the schedule above, or if excess, shall stand in an
unbroken chain of coverage excess of the Named Insured's scheduled underlying
primary coverage. In either event, any other insurance maintained by the Insured
scheduled above shall be in excess of this insurance and shall not be called upon to
contribute with it."
4. A statement that includes the following language: "The insurance afforded by this
policy shall not be canceled except after thirty days prior written notice by certified
mail return receipt requested has been given to the City."
NOTE: Within having "Any Auto" coverage, the City will alternatively accept a Certificate
stating "Scheduled Autos, Hired Autos, and Non-Owned Autos".
C. WORKERS' COMPENSATION INSURANCE ENDORSEMENT containing the
following specific components:
1. A waiver of subrogation clause which states the following: "This insurance company
agrees to waive all rights of subrogation against the City of Daly City, its officers,
officials, employees, and volunteers for losses paid under the terms of this policy
which arise from the work performed by the named insured for the City."
2. The insurance policy number.
3. An additional insured endorsement which includes the following language: "The City
of Daly City, including its officers, officials, employees, and volunteers, are insureds"
4. A statement that includes the following language: "The insurance afforded by this
policy shall not be canceled except after thirty days prior written notice by certified
mail return receipt requested has been given to the City."
NOTE:
a. Certificates issued by State Compensation Insurance Fund must have State
Fund endorsement numbers 0015, 2065, and 2570 on them. Subcontractors performing
work within the City Right-of-Way, or for Contractor's working on behalf of the City, shall
either be included upon the Contractor's policies as insured, or shall furnish separate
certificates and endorsements to the Engineering Division. All coverage for
subcontractors shall be subject to all of the insurance requirements stated previously
herein for the Contractor, and shall be effective throughout the term of the permit.
The City of Daly City reserves the right to require more or less coverage than indicated above,
and to reject any language or forms that do not meet the City's requirements.

CITY OF DALY CITY DEPARTMENT OF PUBLIC WORKS
INSURANCE REQUIREMENTS DCPWINS V1
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