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HomeMy WebLinkAboutCity of Renton - 24-25 Certificate of InsuranceSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE 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 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 12/4/2024 Parker Smith &Feek Insurance LLC2233112thAveNEBellevueWA98004 425-709-3600 License#:PC-1719201 United Specialty Insurance Company 12537 CONNHOM-01 Mutual of Enumclaw Insurance Company 14761ConnerHomesatMapleHighlands,LLC12600SE38thSt,Suite #250Bellevue,WA 98006 Houston Specialty Insurance Company 12936 2133764673 A X 1,000,000 X 50,000 5,000 1,000,000 2,000,000 X Y ATN2429252 8/31/2024 8/31/2025 2,000,000 WA Stop Gap 1,000,000 B 1,000,000 X X Y CPP0028526001 8/31/2024 8/31/2025 A ATN2429252 8/31/2024 8/31/2025 X WA Stop Gap 1,000,000 1,000,000 1,000,000 C ProfessionalLiability MEOHS000342902 8/31/2024 8/31/2025 full limit $1,000,000 Project Name:Maple Highlands C23004636;Project Location:13818 152nd Ave SE and 13929 154th Ave SE,Renton. City of Renton is included as Additional Insured on the General Liability Policy,if required by written contract or agreement,subject to the policy terms andconditions.This Insurance is Primary &Non-Contributory on the General Liability policy,if required by written contract or agreement,subject to the policy termsandconditions.General Liability Coverage include 30 day notice of cancellation,subject to the policy terms and conditions.Auto Liability -Additional InsuredandPrimary&Non-Contributory Endorsements to Follow from Carrier. City of RentonATTN:Huy Huynh,Development Engineering1055SouthGradyWayRenton,WA 98057 THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE ,/   ,/&RS\ULJKW,QVXUDQFH6HUYLFHV2IILFH,QF 3DJH RI†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his endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non-Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a.(1)The Additional Insured is a Named Insured under such other insurance; and (2)A fully written contract fully executed prior to the Named lnsured's commencement of work for such Additional Insured for the specific project that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i)apply on a primary and non-contributory basis; and (ii)would not seek contribution from any other insurance available to the additional insured. or b.Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Person(s) Or Organization(s) All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 United Specialty Insurance Company As Required By Written Contract, Fully Executed Prior To The Named Insured’s Work POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 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. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 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 intended 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. ATN2429252 As Required By Written Contract With The Named Insured, Fully Executed Prior To The Named Insured's Work As Required By Written Contract With The Named Insured, Fully Executed Prior To The Named Insured's Work Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 C.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ATN2429252 As Required By Written Contract With The Named Insured, Fully Executed Prior To The Named Insured's Work As Required By Written Contract With The Named Insured, Fully Executed Prior To The Named Insured's Work