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HomeMy WebLinkAboutKing County (SWI) COI - Exp. 2026.11.30SHOULD 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 2/25/2026 Woodruff-Sawyer &Co.50 California Street,Floor 12SanFranciscoCA94111 Chris Kelley 415-402-6521 415-989-9923 ckelley@woodruffsawyer.com Hartford Fire Insurance Company 19682 STACWIT-01 Hartford Casualty Insurance Company 29424StacyandWitbeck,Inc.2800 Harbor Bay ParkwayAlameda,CA 94502 Berkley Assurance Company 39462 Allied World Assurance Company (U.S.)Inc.19489 Hartford Underwriters Insurance Company 30104 1846887928 A X 2,000,000 X 1,000,000 25,000 2,000,000 4,000,000 X Y Y 57CSEQU2711 11/30/2025 11/30/2026 4,000,000 A 2,000,000 X X X Y Y 57CSEQU2712 11/30/2025 11/30/2026 B X X 10,000,000Y57XSBF697711/30/2025Y 11/30/2026 10,000,000 E X N Y 57WNQU2710 11/30/2025 11/30/2026 1,000,000 1,000,000 1,000,000 CD Pollution/Professional LiabilityExcessLiability(2nd Layer)Y PCADB5029737112503110506 11/30/202511/30/2025 11/30/202611/30/2026 Each Incident /Agg.Each Occ./Agg.$2,000,000$10,000,000 Excess Limits apply to the General Liability,Auto and Employers Liability Coverages.Re:Contract:KC001396;RapidRide I Line Bus Rapid Transit Improvements;Location:22135 68th Ave S,Kent WA 98032.The County,its officials,employees,agents,and representatives,City of Kent,City of Auburn,City of Renton,MW Holdings Auburn SW Block LLC are additional insured per theattachedforms,wherein coverage is primary and Non Contributory.Waivers of Subrogation apply per the attached forms.General Liability Policy includesXCU(explosion,collapse and underground).General Liability Policy has no boom or overload exclusion.Pollution Policy Includes coverage for a Non-OwnedLocationandAsbestos/Lead/PCB Abatement.Policies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium. King CountyMetroTransit Project Controls Office201S.Jackson St.,M/S:KSC-TR-0435,Seattle WA 98104 57CSEQU2712 Policy #57CSEQU2712