Loading...
HomeMy WebLinkAboutCertificate of Insurance_C21006052INSR ADDLSUBRLTRINSRWVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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 THIS CERTIFICATE 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. 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. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Cincinnati Specialty Underwriters Ins 1/15/2025 USI Insurance Services LLC 601 Union Street, Suite 1000 Seattle, WA 98101 206 441-6300 Alisa Allen 877 678-5842 610-362-8530 alisa.allen@usi.com GASTON BROS. EXCAVATING, INC. 10936 Rainier Ave S Seattle, WA 98178 13037 A X X X BI/PD Ded:2,500 X CSU0225720 02/23/2024 02/23/2025 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 A Y CSU0225720 WA Stop Gap 02/23/2024 02/23/2025 X 1,000,000 1,000,000 1,000,000 The referenced General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder, but only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the named insured. City of Renton 1055 South Grady Way Renton, WA 98057 1 of 1 #S47842291/M43785135 GASTOBROClient#: 2034193 SAJZP This page has been left blank intentionally. Includes copyrighted material of ISO CSGA 437 12 13 Properties, Inc., with its permission.Page 1 of 2 COMMERCIAL GENERAL LIABILITY CSGA 437 12 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS,LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU - OPERATIONS AND COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.SECTION II -WHO IS AN INSURED is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy,but only with respect to "bodily injury", "property damage" or "personal and advertising injury"caused,in whole or in part, by: 1.Your acts or omissions in the perform- ance of your ongoing operations for the additional insured; 2.The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional in- sured; or 3."Your work" performed for the additional insured and included in the "products- completed operations hazard". If not specified otherwise in the written con- tract or agreement, a person's or organiza- tion's status as an additional insured under this endorsement ends one year after your opera- tions for that additional insured are completed. The written contract or agreement must be currently in effect or become effective during the term of this Coverage Part. The contract or agreement must be executed prior to the "bod- ily injury", "property damage"or "personal and advertising injury" to which this endorsement pertains. However: 1.The insurance afforded to such additional insured only applies to the extent permit- ted by law; and 2.If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such ad- ditional insured will not be broader than that which you are required by the con- tract or agreement to provide for such ad- ditional linsured. B.With respect to the insurance afforded to these additional insureds, the following addi- tional exclusions apply: This insurance does not apply to: 1."Bodily injury", "property damage"or "per- sonal and advertising injury"arising out of the rendering of,or the failure to render, any professional architectural, engineer- ing or surveying services, including: a.The preparing, approving, or failing to prepare or approve,maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw- ings and specifications; or b.Supervisory, inspection, architectural or engineering activities. 2."Bodily injury"or "property damage" aris- ing out of "your work" for which a consoli- dated (wrap-up)insurance program has been provided by the prime contrac- tor/project manager or owner of the con- struction project in which you are involved. 3."Bodily injury", "property damage"or "per- sonal and advertising injury" to any em- ployee of you or to any obligation of the additional insured to indemnity another because of damages arising out of such injury. Includes copyrighted material of ISO CSGA 437 12 13 Properties, Inc., with its permission.Page 2 of 2 4."Bodily injury", "property damage"or "per- sonal and advertising injury" for which the Named Insured is afforded no coverage under this policy of insurance. C.With respect to the insurance afforded to these additional insureds, SECTION III -LIM- ITS OF INSURANCE is amended to include: The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Cov- erage Part, whichever is less. If no limits are specified in the written contract or agreement, the limits applicable to the additional insured are those specified in the Declarations of this Coverage Part.The limits of insurance are in- clusive of and not in addition to the limits of in- surance shown in the Declarations. D.With respect to the insurance afforded to these additional insureds, SECTION IV - COMMERCIAL GENERAL LIABILITY CON- DITIONS,4. Other Insurance is amended to include: Any coverage provided herein will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless you have agreed in a written con- tract or written agreement executed prior to any loss that this insurance will be primary. This insurance will be noncontributory only if you have so agreed in a written contract or written agreement executed prior to any loss and this coverage is determined to be primary.