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Revised 5/30/2025 Insurance Requirements for Encroachment Permits Working in the public right-of-way requires specific insurance to protect the City of Campbell. The attached checklist is used by City staff to verify the insurance provided meets all of the requirements. Please review that checklist and the attached sample insurance certificate to ensure your insurance certificate can be approved in a timely manner. The encroachment permit cannot be issued without an approved insurance certificate. Top 6 Issues with Submitted Insurance Certificates These are the common issues we see again and again with submitted insurance certificates that fail review and must be revised and resubmitted: • Certificate Holder is incorrect (should always be the City of Campbell) • Missing Language – see language in description of operations on attached sample certificate • Project Address and Encroachment Permit Number are missing from Certificate • Missing Waiver of Subrogation for Workmans Comp • NAIC for insurers are missing • Insurer does not meet A.M. Best Rating of A:VII Bonus Item that has become more common lately: • Cannot verify that Insurer(s) are eligible to conduct business in California Staff uses the California Department of Insurance website and the Surplus Line Insurer (LASLI) Lookup website to verify that insurers are authorized to transact business in California. If we cannot verify using either of those websites, then the insurance agent will need to provide an e-mail that the insurer is authorized to transact business in California. For more information contact the Public Works Department at (408) 866-2150 or [EMAIL REDACTED] ---PAGE BREAK--- INSURANCE REQUIREMENTS CHECKLIST Permit # CIP Project # Consultant/Contractor: The following insurance is required of all consultants/contractors working in the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: ❑ $1,000,000 per occurrence, and ❑ $1,000,000 general aggregate limit applying separately to the project, or ❑ $2,000,000 general aggregate limit. ❑ Policy expiration date Automotive Liability: ❑ “Any Auto” checked on certificate ❑ $1,000,000 per accident for bodily injury and property damage ❑ Policy expiration date Workers’ Compensation and Employer’s Liability ❑ Waiver of Subrogation clause ❑ $1,000,000 per accident for bodily injury or disease ❑ Policy expiration date Course of Construction (if required in Special Provisions) ❑ Completed value of the project ❑ Policy expiration date Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement: ❑ The City, its officers, employees and volunteers are named as additional insured. (Reference Project Location/Permit Number) ❑ The insurance coverage afforded to the Additional Insured is primary insurance. Cancellation area should say: Should any of the above-described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. Workers’ Compensation Insurance Sheet Submitted ❑ For General Contractor ❑ For Developer or Owner ---PAGE BREAK--- Acceptability of Insurer(s) ❑ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. Name: NAIC # _______Rating:____________Authorized in CA: Name: NAIC # _______Rating:____________Authorized in CA: Name: NAIC # _______Rating:____________Authorized in CA: Name: NAIC # _______Rating:____________Authorized in CA: ❑ Campbell Business License Expiration: ❑ Contractors License Class: Expiration: Insurance Certificate Reviewed Initials Date ❑ Copy of Insurance Certificate placed in tickler file one month prior to expiration. ---PAGE BREAK--- 1,000,000 x X 2,000,000 X 1,000,000 x WAIVER OF X SUBROGATION REQUIRED 1,000,000 1,000,000 1,000,000 City of Campbell, its officers, employees and volunteers are named as additional insured. The insurance coverage afforded to the Additional Insured is primary insurance. All work in the public right-of-way. Reference Project Location and Permit Number. City of Campbell 70 N. First St. Campbell, CA 95008 ---PAGE BREAK--- WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be - - - - - % of the California workers' compensation pre mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. CITY OF CAMPBELL 70 N. FIRST ST. CAMPBELL, CA 95008 Job Description 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 Insured Policy No. Endorsement No.