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HomeMy WebLinkAboutSkanska USA Building Inc._City of Renton_25012432429297@HXWHolder Identifier : 7777777707070700077763616065553330772617446304557707443126663407310072640477147231020772405557067455207522411376634556075626335324763300710423355603677207104013172270130077727252025773110777777707000707007 6666666606060600062606466204446200620002426204002006222024240042000060002040422620200600200406226002006222024040042002060022242402622200622000424224000206200226242022622066646062240664440666666606000606006Certificate No :570110594338CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/24/2025 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. PRODUCER Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 5163964000 INSURED 40142American Zurich Ins CoINSURER A: 16535Zurich American Ins CoINSURER B: 24554XL Insurance America IncINSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: Skanska USA Building Inc. 400 Fairview Avenue North, Suite 1000Seattle WA 98109 USA COVERAGES CERTIFICATE NUMBER:570110594338 REVISION NUMBER: 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X X X X GEN'L AGGREGATE LIMIT APPLIES PER: $5,000,000 $5,000,000 $5,000 $5,000,000 $10,000,000 $10,000,000 XCU 50" RR Exclusion Deleted B 08/31/2024 08/31/2025GLO489601817 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X X X X BODILY INJURY (Per accident) $2,000,000B08/31/2024 08/31/2025 COMBINED SINGLE LIMIT (Ea accident) BAP 6480660 02 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 08/31/2024UMBRELLA LIABC 08/31/2025US00076358LI24A RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $5,000,000 X OTH-ERPER STATUTEA08/31/2024 08/31/2025 $5,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $5,000,000 WC489601720 AggregateEOC50871241308/31/2024 08/31/2025 SIR applies per policy terms & conditions $25,000,000Per Claim Contractors Protective Professional Indemnity Liability B $50,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Name: 4-88 Relocate Medical Center and Project Number: 4222001-554. Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability, Automobile Liability and Excess Liability policies. General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. Workers' Compensation Coverage Not Included in Monopolistic States - OH, ND, WA, WY and Puerto Rico. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Renton1055 South Grady WayRenton WA 98057 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570110594338 570110594338 Aon Risk Services Northeast, Inc. 570000027144 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # Skanska USA Building Inc. TYPE OF INSURANCE POLICY NUMBER LIMITS OTHER B Contractors Pollution Liability CPL981713804 08/31/2024 08/31/2025 Aggregate $50,000,000 Per Claim $25,000,000 ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Excess Liab. cont. 08/31/24-08/31/25 AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: Aon Risk Services Northeast, Inc. 570000027144 570110594338 570110594338 Page _ of _ Skanska USA Building Inc. Carrier: Berkshire Hathaway Specialty Insurance CompanyNAIC: 22276Policy No.: 47XSF30284409Occ/Agg: $12,500,000 po $25,000,000 xs $5,000,000 Carrier: Starr Indemnity & Liability Company NAIC: 38318 Policy No.: 1000587300241 Occ/Agg: $12,500,000 po $25,000,000 xs $5,000,000 Carrier: Indemnity Insurance Company of North America NAIC: 43575 Policy No.: XANG47418999002 Occ/Agg: $15,000,000 xs $30,000,000 Carrier: Everest National Insurance Co NAIC: 10120Policy No.: XC5EX02073241Occ/Agg: $10,000,000 xs $45,000,000 ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance U-CA-811-A CW (05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A.If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B.If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C.If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D.If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Organization(s):Number of Days Notice: IF WE CANCEL THIS POLICY, NOTICE SHALL BE PROVIDED TO THOSE 30 PERSONS, ORGANIZATIONS OR POLITICAL ENTITIES WITH WHOM YOU HAVE CONTRACTUALLY AGREED TO GIVE NOTICE AND FOR WHICH YOU HAVE PROVIDED MAILING INFORMATION TO US. All other terms and conditions of this policy remain unchanged. Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem. BAP 6480660-02 08/31/2024 08/31/2025 08/31/2024 10463000 $ INCL $ Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l.Prem Return Prem. GLO 4896018-17 08/31/2024 08/31/205 69993000 INCL U-GL-1447-A CW (05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A.If we cancel or non-renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B.If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C.If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D.If notice as described in Paragraphs A.,B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Organization(s):Number of Days Notice: IF WE CANCEL THIS POLICY, NOTICE SHALL BE PROVIDED TO THOSE 90 PERSONS, ORGANIZATIONS OR POLITICAL ENTITIES WITH WHOM YOU HAVE CONTRACTUALLY AGREED TO GIVE NOTICE AND FOR WHICH YOU HAVE PROVIDED MAILING INFORMATION TO US. All other terms and conditions of this policy remain unchanged. 08/31/2024 ENDORSEMENT # This endorsement, effective 12:01 a.m., August 31, 2024 forms a part of Policy No. US00076358LI24A issued to Skanska Inc. by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity(ies) according to the notification schedule shown below: Name of Person(s) or Entity(ies) As on file with Company Mailing Address: As on file with Company Number of Days Advanced Notice of Cancellation: 30 All other terms and conditions of the Policy remain unchanged. IXI 405 0910 © 2010 X.L. America, Inc. All Rights Reserved. May not be copied without permission. U-WC-332-A (07-94) ENDORSEMENT Insurance for this coverage part provided by: This endorsement changes the insurance as is afforded by the policy relating to the following: Policy Number WC 4896017-20 AMERICAN ZURICH INSURANCE COMPANY Named Insured SKANSKA USA BUILDING, INC. CANCELLATION AND NON-RENEWAL NOTICE OR CANCELLATION AND NON-RENEWAL NOTICE OR MATERIAL CHANGE NOTICE ENDORSEMENT PARAGRAPH D.2. IS DELETED AND REPLACED BY: 2. WE MAY CANCEL THIS POLICY. WE MUST MAIL OR DELIVER TO YOU NOT LESS THAN 90 DAYS ADVANCE WRITTEN NOTICE STATING WHEN THE CANCELLATION IS TO TAKE EFFECT EXCEPT FOR CANCELLATION FOR NONPAYMENT OF PREMIUM. IF WE CANCEL THIS POLICY FOR NON-PAYMENT OF PREMIUM WE MUST MAIL OR DELIVER TO YOU NOT LESS THAN TEN DAYS ADVANCE WRITTEN NOTICE. MAILING THAT NOTICE TO YOU AT YOUR MAILING ADDRESS SHOWN IN ITEM 1 OF THE INFORMATION PAGE WILL BE SUFFICIENT TO PROVE NOTICE. IF WE CANCEL THIS POLICY, NOTICE SHALL BE PROVIDED TO THOSE PERSONS, ORGANIZATION OR POLITICAL ENTITIES WITH WHOM YOU HAVE CONTRACTUALLY AGREED TO GIVE NOTICE AND FOR WHICH YOU HAVE PROVIDED MAILING INFORMATION TO US. PART SIX – CONDITIONS, PARAGRAPH F. IS ADDED: F. NON-RENEWAL OR MATERIAL CHANGE NOTICE WE WILL MAIL OR DELIVER TO YOU NOT LESS THAN 90 DAYS ADVANCE WRITTEN NOTICE OF OUR INTENTION TO NON-RENEW OR MAKE ANY MATERIAL CHANGE TO THE CURRENT COVERAGES OR THE RENEWAL COVERAGES ON THIS POLICY. MAILING THAT NOTICE TO YOU AT YOUR MAILING ADDRESS SHOWN IN ITEM 1 OF THE INFORMATION PAGE WILL BE SUFFICIENT TO PROVE NOTICE. Page 1 Last page