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M_WeatherlyInn_Certificate of Insurance (expired)
IACOROCERTIFICATEOFLIABILITYINSURANCETHISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER.IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicyQes)musthaveADDITIONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferriqhtstothecertificateholderinlieuofsuchendorsement(s).CONTACTPRODUCERNAME:HubInternationalNorthwestLLCPHONEP.O.Box3018(NC,No,Esq:(425)4894500——IWc,No):(425)485-848P._.,Bothell,WA98041.S1hss:now.info@hubinternational.com--- -—INSURER(S)AFFORDINGCOVERAGE—-NAIC#——.-—----INSURERA:TheContinentalInsuranceCompany-—35289INSUREDINSURERB:AmericanCasualtyCoofReadingPA20427PAMFCONSTRUCTIONLLCDBARINOCONSTRUCTIONINSURERc:-P0Box667INSURER0:MapleValley,WA96038INSUREREINSURERF:COVERAGESCERTIFICATENUMBER:REVISIONNUMBER:AXCOMMERcIALGENERALUABILErYEACHOCCURRENCE$1,000,000PDAMAGETORENTED100,000•CLAJMS4IADE-XOCCURXx60458144792124/2016I61112019PREkUSES(Eqoccwrence)S-—ELAGGREGAmUM:pLEspER:MEDEXP(yonepen)—150001,000,000PERSONAL&ADVINJURY$GENERALAGGREGATES2,000,000‘IPOLICYLOCPRODUCTS-COMPIOPAGG$2,000,000hiOTHERStopGap1,000,000AUTOMOBILELIABILITY—COMBINEDSINGLELIMIT1,000,000lEaaiderl)ANYAUTOxx60458144822/24/2018811/2019BODILYINJURY(PerDenon)$IIOWNEDF1SCHEDULEDIIAUTOSONLYAUTOSBODILYINJURY(Perac&enl)$X-HIRE%ONLYL1c.AUTOSONLY.IPaacodentI$NON-OWNEDPROPERTYDAMAGEhiAUTIAXUMBRELLALIAB[XOCCURLEACHOCCURRENCE$5,000,000EXCESSLIABjCLA!MS-MADE60458144962124I201881112019AGGREGATE$5,000,000ThDEDIXRETENTIONS10,0005AWORKERSCOMPENSATiONIIPERII0Th..HSTATUTEIIERIANDEMPLOYERS’UABILITYYIN160458144792124/2016Sf112019EL.EACHACCIDENTIS1,000,000ANYPRQFRIETOjPARThEREXECUTIVE1OFFICERq’EMBEREXCLU3EONIALJ.I(MaMatoryInNHIE.L.DISEASE.EAEMPLOYE1,000,000DESCRIPTiONOFOPERATIONSIIIErDE-POLICYLIMITS11000,000I(yes,destnbeunderiIDESCRIPTiONOFOPERATIONS?LOCATIONSIVEHIcLE5(ACORDiel,AddItionalRemark,Schedule,maybeattachedIfmorespaceIsrequIred)Re:ProjectAgreementCityofRentonisaddedasadditionalinsuredpertheattachedendorsements/forms.Primaryandnon-contributoryandwaiverofsubrogationapply.CERTIFICATEHOLDERCANCELLATIONSHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATETHEREOF.NOTICEWILLBEDELIVEREDINCityofRentonACCORDANCEWITHTHEPOLICYPROVISIONS.1055SouthGradyWayRenton,WA98057AUTHORIZEDREPRESENTATIVEPAMFCON-01ROCHODATE(MMIDDfYYYY)61412019TYPEOFINSURANCEADOLSUBRINSDWVOTHISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED.NOTWIThSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHThISCERTIFICATEMAYBEISSUEDORMAYPERTAIN.THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS.EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS.___ __ __ __ __ __POLICYNUMBERPOLICYEFFPOLICYEXPIMMIDDWVYYIIMMJDOIVYV’fl’LIMITSACORD25(2016/03)©1988-2015ACORDCORPORATION.Allrightsreserved.TheACORDnameandlogoareregisteredmarksofACORD CNAT4IDbXPClOtPlo.laity“U,,’,NimaPAMPina 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__J,ContractorsGeneralL(abH(tyExtens(onEndorsementPOsyNo-te4ij4y—Enoam.w0NtEO.chnfl.i.01000011yoioyNotd4Stl447iErhinm.ytNoEn.dy.out01241201NPolicyNo:iO4TSlNVPEn0000mtIlNo’boos..CO.2flhb2dt0000.0‘4001PAbrPhonvotlon.I.LC[IRAtinyCtflt40_0manoun.ruoo..o,00nnao*aoKn-.0*0*ccm•0,y100010N.m.PAMPbsoo,oiuo.LLCIOtARio,Oin.cyoclhmocort0**0040..0000ouunnou-isaiowVl.Ir100001100.t.rc..000.00.n.,,mtw CNAJCNAPARAMOÜ+]__ ___ _ ___-Contractor,GeneralUablHtyExtensionEndorsementC.DUINmONS4.rnend.dI.icdlot.1000*109aon:IeottrIC00eoIId*sd(wrw,mlbancc*p00WS*I0000tracicon.ensiotw0.o,oi:l:ci0,00.01Icc,h:ch00.porn.000100tarcOsei.drniflflllClC*Ocimaonthococtptol.dhi...oj,.d9001011Iebdtyion,.cuLlcihaeenl,.etaia,iotao,ncool,i.nccnsdcob.paj.tl.seth..icOn,CoohosacIiin,inc•ProwoonDCIP.)OtCOuI,.cto&C,rfrciWdln.w.nc.PTo.rnICC.0)Rn1...01M.inxtn.tidalii)bombs*0...30%conic’m..qcc,.aol‘inaenda.athlino.dIihiondI..boon.,..d.ee,IccicanybetnotIc,o1.d00:I.ecyl.ccm000l.n:thtu.n..o.rhn.cbaonninlon..Own10t..op.n.tNa.erDunnedcoild,c.Iocrn.pt..cod2.mcccrnmencoin•edshonsoceppomaciolloin..D000’nmp.,,c.phI.(:ndethnypooh,ha)0010,d.l.thsd910,0*1.çao.lhoc,..eric,‘cod.,.thlcMnl.Hernia.,,wh.nins,,nouodnd..i0*05.7,001.001,r..b.01I&‘Iron..0.einayneled.c.l:u’yhewn),wISoicleccinlIlyhoc.:n)Dldoroccoc..,booboocane1.011:11..,Oct01.a001.1.5..1..,dI.I1100i0011110cannellobed.inpLbboOp.500..The.WR*P.UPEXTINSIOW:OCIP,000*.05CONSOUDAIIDflOPAP4JP)SO5URAMCEP5005*115Plan,,do.,ret.ppiyto.cyp.tw.000.o.nlp.tocwhoethic.,..c,oh10...rsibohanIlcao.dmame.C..npPut50010.1l.t.,nwednodlIbca,ofthePaula)c.e.o00011.00*01.ma.cdo,nln.,ItwhomIn.pincii00.1cc.a.01a,.oebOaPoloyaicedbyIhaa.Iwe.l.d(wait’s.Ohs.s)NcIin0n.sicocacalecin.ePolicyIIin.hoer.101.01innedPolicy.om...coats.5.ch..0.1.whaonccc...sod•Xpln.s0000oo.ntpwhO‘.4PaI.oy.aa=CNAP4POSXX(1151PolayNt’cOi1l44P.e.lPaltlEMtn.rn.olNatc..r.dN.,,.:PAM?Fetcacillan.EEC[ISARI,oG’c,ineah’,EPin,nDi).3fl411011atD*MF0.laenc.,v.dro.inwasinoefl CIABlanketAdditionalInsured-Owners,LesseesorContractors-withProducts-CompletedOperationsCoverage-LimitedLiabilityEndorsementThisendorsementmodifiesinsuranceprovidedunderthefollowing:COMMERCIALGENERALLIABILITYCOVERAGEPARTItisunderstoodandagreedasfollows:TheWHOISANINSUREDsectionisamendedtoaddasanInsuredanypersonororganizationwhomtheNamedInsuredisrequiredbywrittencontracttoaddasanadditionalinsuredonthisCoveragePart;includinganysuchpersonororganization,ifany,specificallysetforthontheScheduleattachmenttothisendorsement.HoweversuchpersonororganizationisanInsuredonlywithrespecttosuchpersonororganizationsliabilityfor:A.bodilyinjury,propertydamage,orpersonalandadvertisinginjurytotheextentcausedby:1.theNamedInsured’sactsoromissions;or2.theactsoromissionsofthoseactingontheNamedInsured’sbehalf,intheperformanceoftheNamedInsured’songoingoperationsspecifiedinthewrittencontractorB.bodilyinjuryorpropertydamagetotheextentcausedbyyourworkspecifiedinthewrittencontractandincludedintheproducts-completedoperationshazard,andonlyif1.thewrittencontractrequirestheNamedInsuredtoprovidetheadditionalinsuredsuchcoverage;and2.thiscoveragepartprovidessuchcoverage.II.Subjectalwaystothetermsandconditionsofthispolicy,includingthelimitsofinsurance,theInsurerwillnotprovidesuchadditionalinsuredwith:A.coveragebroaderthanrequiredbythewrittencontract;orB.ahigherlimitofinsurancethanrequiredbythewrittencontract.III.Theinsurancegrantedbythisendorsementtotheadditionalinsureddoesnotapplytobodilyinjury,propertydamage,orpersonalandadvertisinginjuryarisingoutof:A.actsoromissionsoftheadditionalinsured,orofanyoneactingontheadditionalinsured’sbehalf:orB.therenderingof,orthefailuretorender,anyprofessionalarchitectural,engineering,orsurveyingservices,including:1.thepreparing,approving,orfailingtoprepareorapprovemaps,shopdrawings,opinions,reports,surveys,fieldorders,changeordersordrawingsandspecifications;and2.supervisory,inspection,architecturalorengineeringactivities;orC.anypremisesorworkforwhichtheadditionalinsuredisspecificallylistedasanadditionalinsuredonanotherendorsementattachedtothiscoveragepart.IV.NotwithstandinganythingtothecontraryinthesectionentitledCOMMERCIALGENERALLIABILITYCONDITIONS,theConditionentitledOtherInsurance,thisinsuranceisexcessofallotherinsuranceavailabletotheadditionalinsuredwhetheronaprimary,excess,contingentoranyotherbasis.However,ifthisinsuranceisrequiredbywrittencontracttobeprimaryandnon-contributory,thisinsurancewinbeprimaryandnon-contributoryrelativesolelytoinsuranceonwhichtheadditionalinsuredisanamedinsured.V.Solelywithrespecttotheinsurancegrantedbythisendorsement,thesectionentitledCOMMERCIALGENERALLIABILITYCONDITIONSisamendedasfollows:CNA75O81XX(1-15)PolicyNo:6045814479Page1of2EndorsementNo:InsuredName:PAMPExcavation,LLCDBARinoConstructionEffectiveDate:2/24/2018copyrightCNAAllRightsReserved.IncludescopyrightedmaterialofInsuranceServicesOlfice,Inc.,vMhitspermission. CIABlanketAdditionalInsured-Owners,LesseesorContractors-withProducts-CompletedOperationsCoverage-LimitedLiabilityEndorsementTheConditionentitledDutiesInTheEventofOccurrence,Offense,ClaimorSuitisamendedwiththeadditionofthefollowing:Anyadditionalinsuredpursuanttothisendorsementwillassoonaspracticable:1.givetheInsurerwrittennoticeofanyclaim,oranyoccurrenceoroffensewhichmayresultinaclaim;2.exceptasprovidedinParagraphIV.ofthisendorsement,agreetomakeavailableanyotherinsurancetheadditionalinsuredhasforanylosscoveredunderthiscoveragepart:3.sendtheInsurercopiesofalllegalpapersreceived,andotherwisecooperatewiththeInsurerintheinvestigation,defense,orsettlementoftheclaim:and4.tenderthedefenseandindemnityofanyclaimtoanyotherinsurerorselfinsurerwhosepolicyorprogramappliestoalossthattheInsurercoversunderthiscoveragepart.However,ifthewrittencontractrequiresthisinsurancetobeprimaryandnon-contributory,thisparagraph4doesnotapplytoinsuranceonwhichtheadditionalinsuredisanamedinsured.TheInsurerhasnodutytodefendorindemnifyanadditionalinsuredunderthisendorsementuntiltheInsurerreceiveswrittennoticeofaclaimfromtheadditionalinsured.VI.Solelywithrespecttotheinsurancegrantedbythisendorsement,thesectionentitledDEFINITIONSisamendedtoaddthefollowingdefinition:WrittencontractmeansawrittencontractorwrittenagreementthatrequirestheNamedInsuredtomakeapersonororganizationanadditionalinsuredonthiscoveragepart,providedthecontractoragreement:A.iscurrentlyineffectorbecomeseffectiveduringthetermofthispolicy;andB.wasexecutedpriorto:1.Thebodilyinjuryorpropertydamage:or2.Theoffensethatcausedthepersonalandadvertisinginjuryforwhichtheadditionalinsuredseekscoverage.Anycoveragegrantedbythisendorsementshallapplysolelytotheextentpermissiblebylaw.AllothertermsandconditionsofthePolicyremainunchanged.Thisendorsement,whichformsapartofandisforattachmenttothePolicyissuedbythedesignatedInsurers,takeseffectontheeffectivedateofsaidPolicyatthehourstatedinsaidPolicy,unlessanothereffectivedateisshownbelow,andexpiresconcurrentlywithsaidPolicy.CNA75O81XX(1-15)PolicyNo:6045814479Page2of2EndorsementNo:EffectiveDate:InsuredName:PAMEExcavation,LLCDBARinoConstructioncopyrighicNAAllRighisReservedIncludescopyrightedmaterialofInsuranceservicesOffice,Inc,withitspermission CNACNi715ADDITIONALINSUREDENDORSEMENT—CONTRACTUALOBLIGATIONItisunderstoodandagreedthatthisendorsementamendstheBUSINESSAUTOCOVERAGEFORMasfollows:SCHEDULENameofAdditionalInsuredPersonOrOrganizationASPERWRITTENCONTRACT1.ParagraphA.1.WhoIsAnInsuredofSectionII—LIABILITYCOVERAGEisamendedtoincludeasanadditionalinsuredthepersonororganizationscheduledabove,butonlyifyouarerequiredby“writtencontract”tomakethatpersonororganizationanadditionalinsuredunderthispolicy.2.Theinsuranceprovidedtotheadditionalinsuredislimitedasfollows:a,Thepersonororganizationisanadditionalinsuredonlywithrespectto“bodilyinjury”or“propertydamage”arisingoutofacovered“auto”andcausedbyyournegligentactsoromissionsorthenegligentactsoromissionsofsomeone,otherthantheadditionalinsured,forwhomyouarelegallyliable.b.Thepersonororganizationisnotanadditionalinsuredforthepersonororganization’sownactsoromissions,northoseofanyone,otherthanyou,forwhomthepersonororganizationislegallyliable.c.Wewillnotprovidetheadditionalinsuredanybroadercoverageoranyhigherlimitofliabilitythantheleastthatis:(1)Requiredbythe“writtencontract”;or(2)Affordedtoyouunderthispolicy.3.Condition2.DutiesIntheEventofAccident,Claim,SuitorLossofSectionIV—BUSINESSAUTOCONDITIONSisamendedtoaddthefollowingconditionsapplicabletotheadditionalinsured:Anadditionalinsuredunderthisendorsementwillassoonaspracticable:a.Giveuswrittennoticeofan“accident”whichmayresultinaclaimor“suit”underthisinsurance,andofanyclaimor“suit”thatdoesresult;b.Agreetomakeavailableanyotherinsurancetheadditionalinsuredhasforalosswecoverunderthispolicy;c.Senduscopiesofalllegalpapersreceived,andotherwisecooperatewithusintheinvestigation,defense,orsettlementoftheclaimor“suit”;andd.Tenderthedefenseandindemnityofanyclaimor“suit”toanyotherinsurerorselfinsurerwhosepolicyorprogramappliestoalosswecoverunderthispolicy.Butifthe“writtencontract”requiresthisinsurancetobeprimaryandnon-contributory,thisprovisiond.doesnotapplytoinsuranceonwhichtheadditionalinsuredisaNamedInsured.Wehavenodutytodefendorindemnifyanadditionalinsuredunderthisendorsementuntilwereceivefromtheadditionalinsuredwrittennoticeofa“suit.”4.Onlyforthepurposeoftheinsuranceprovidedbythisendorsement,SECTIONV—DEFINITIONSisamendedtoaddthefollowingdefinition:“Writtencontract”meansawrittencontractorwrittenagreementthatrequiresyoutomakeapersonororganizationanadditionalinsuredunderthispolicy,providedthecontractoragreement:1.Iscurrentlyineffectorbecomeseffectiveduringthetermofthispolicy;and2.Wasexecutedpriortotheaccidentforwhichtheadditionalinsuredseekscoverageunderthispolicy.CNA71526XX(10/12)PolicyNo:6045814482Page1of2EndorsementNo:EffectiveDate:2/24/2018InsuredName:PAMFExcavation,LLCDBARinoConstructioncoovriQhtCNAAllRichtsReserved. CNA71526XX(Ed.10/12)AUothertermsandconditionsofthePolicyremainunchanged.MaterialusedwithpermissionofISOProperties,IncCNA71526XX(10/12)PolicyNo:604581448Page2of2EndorsementNo:EffectiveDate:22/24/2018InsuredName:copyrightCNAAllRightsReserved. CNA(Ed.10/12)ADDITIONALINSURED—PRIMARYANDNON-CONTRIBUTORYItisunderstoodandagreedthatthisendorsementamendstheBUSINESSAUTOCOVERAGEFORMasfollows:SCHEDULENameofAdditionalInsuredPersonsOrOrganizationsANYPERSONORORGANIZATIONTHATYOUAREREQUIREDBYWRITTENCONTRACTORWRITTENAGREEMENTTONAI4EASANADDITIONALINSURED1.InconformancewithparagraphA.1.c.ofWhoIsAnInsuredofSectionII—LIABILITYCOVERAGE,thepersonororganizationscheduledaboveisaninsuredunderthispolicy.2.Theinsuranceaffordedtotheadditionalinsuredunderthispolicywillapplyonaprimaryandnon-contributorybasisifyouhavecommittedittobesoinawrittencontractorwrittenagreementexecutedpriortothedateofthe‘accidentforwhichtheadditionalinsuredseekscoverageunderthispolicy.AllothertermsandconditionsofthePolicyremainunchanged.§SCNA71527XX(10/12)PolicyNo:6045814482Page1of1EndorsementNo:EffectiveDate:02/24/2018InsuredName:PANFEXCAVATIONLLCCopyrightCNAAllRightsReserved. POLICYNUMBER:6045814482COMMERCIALAUTOCA04441013THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY.WAIVEROFTRANSFEROFRIGHTSOFRECOVERYAGAINSTOTHERSTOUS(WAIVEROFSUBROGATION)Thisendorsementmodifiesinsuranceprovidedunderthefollowing:AUTODEALERSCOVERAGEFORMBUSINESSAUTOCOVERAGEFORMMOTORCARRIERCOVERAGEFORMWithrespecttocoverageprovidedbythisendorsement,theprovisionsoftheCoverageFormapplyunlessmodifiedbytheendorsement.Thisendorsementchangesthepolicyeffectiveontheinceptiondateofthepolicyunlessanotherdateisindicatedbelow.NamedInsured:PAMPExcavation,LLCDBARinoConstructionEndorsementEffectiveDate:2/24/2018SCHEDULEName(s)OfPerson(s)OrOrganization(s):PERWRITTENCONTRACTInformationrequiredtocompletethisSchedule,ifnotshownabove,willbeshownintheDeclarations.TheTransferOfRightsOfRecoveryAgainstOthersToUsconditiondoesnotapplytotheperson(s)ororganization(s)shownintheSchedule,butonlytotheextentthatsubrogationiswaivedpriortothe“accident’orthe“loss”underacontractwiththatpersonororganization.CA04441013Copyright,InsuranceServicesOffice,Inc.,2011Page1ofI