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HomeMy WebLinkAboutEBCO COI for RentonThe ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTEDEACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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. INSDADDL WVDSUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. 8/24/2017 MHBT, a Marsh & McLennan Agency, LLC company8144 Walnut Hill Lane, 16th FloorDallas TX 75231 EBCO General Contractor, Ltd.804 East 1st StreetCameron TX 76520 Valley Forge Insurance Company Transportation Insurance Company Continental Casualty Company Hanover Insurance Company XL Insurance America, Inc. 20508 20494 20443 22292 24554 Laurie Carter 972-770-7138 972-404-5580 Laurie_Carter@mhbt.com EBCOGEN 1273767935 A 6018320116 6/10/2017 6/10/2018 See Below 1,000,000 500,000 15,000 1,000,000 2,000,000 2,000,000 * X X X X 25,000 Res Ded $1,000 Dam Ded X B X 6018320102 6/10/2017 6/10/2018 1,000,000 CE X X X X 10,000 6018320133US00071548LI17A 6/10/20176/10/2017 6/10/20186/10/2018 2,000,000 2,000,000 See Below For Coverage E A 6018320147 6/10/2017 6/10/2018 X 1,000,000 1,000,000 1,000,000 D Builders Risk - Risks ofDirect Physical Loss IHD549176508 6/10/2017 6/10/2018 See BelowTransitTemp. Locs. **$500,000$500,000 Additional Insured form #G-18652-J edition 07/12 applies to the General Liability policy.Waiver of subrogation form #G-18652-J edition 07/12 applies to the General Liability policy.Primary & Non-Contributory General Liability form #G-18652-J edition 07/12. Additional Insured form #CNA63359XX edition 04/12 applies to the Automobile Liability policy.Waiver of subrogation form #CNA63359XX edition 04/12 applies to the Automobile Liability policy.See Attached... City of Renton1055 S. Grady WayRenton WA 98057 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Waiver of subrogation form #WC420304A edition 01/00 applies to the Workers Compensation policy. The General Liability policy includes a blanket additional insured endorsement to the certificate holder only when there is a written contractbetween the named insured and the certificate holder that requires such status. The General Liability policy contains an endorsement with “Primary and NonContributory” wording that may apply only when there is a writtencontract between the named insured and the certificate holder that requires such wording. The General Liability policy contains a blanket waiver of subrogation endorsement that may apply only when there is a written contractbetween the named insured and the certificate holder that requires such wording. The Automobile Liability policy contains language that provides additional insured status to the certificate holder only when there is a writtencontract between the named insured and the certificate holder that requires such status. The Automobile liability policy includes waiver of subrogation wording that may apply only when there is a written contract between the namedinsured and the certificate holder that requires such wording. The Worker’s Compensation policy includes a waiver of subrogation endorsement that may apply only when there is a written contractbetween the named insured and the certificate holder that requires such wording. ** Builders Risk - If required by written contractProject Limit: $15,000,000 exceptJoisted Masonry & Frame: $6,500,000Catastrophe Limit: $30,000,000Deductible: $2,500 All Perils except Wind/Hail; Flood and EarthquakeDeductible: Wind/Hail - $10,000 for jobs $5,000,000 and underDeductible: Wind/Hail - $25,000 for jobs over $5,000,000Flood Sublimit: $2,500,000 (within Zone C or unshaded X or outside of the 500 year flood plain)Earthquake Sublimit: $2,500,000 (outside 200 miles of city of New Madrid, MO or the States of CA,OR,UT & WA)Flood/EQ Deductible: $25,000 Named Insured includes: Contractor, All Levels of Subcontractors, Owners, and Lenders Blanket Permission to Occupy, if required by written contract.Excludes all work in Florida and wind in all coastal counties.Replacement Cost Coverage Premises & Operations - Damages Only Property Damage Deductible - Per Occurrence Deductible: $1,000Premises & Operations - Residential - Property Damage Only - Per Occurrence Deductible: $25,000 ------- COVERAGE E CONTINUED FROM ABOVE ------- Insurer: XL Insurance America, Inc.Policy #: US00071548LI17APolicy Term: 6/10/2017 thru 6/10/2018 Limits: $8,000,000 excess of the Primary $2,000,000 (Coverage C Above)The Aggregate for both the Umbrella and Excess Policies Listed Above are Applied Per Project 11 EBCO General Contractor, Ltd.804 East 1st StreetCameron TX 76520 EBCOGEN MHBT, a Marsh & McLennan Agency, LLC company 25 CERTIFICATE OF LIABILITY INSURANCE