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HomeMy WebLinkAboutCertificate of InsuranceDATE (MM/DDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 1 1/15/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY NSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CO REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificN ate holder is an ADDITIOAL INSURED, the policy(ies) must 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). Rebecca Christian PRODUCER MADDRESS: FAX (253)939-9356 NE (253)833-5140 A/C No:Leavitt Group Northwest o xt, IL rebecca-Christian@leavitt.COm201 Auburn Way N Suite C -- - , r rnvccel:P NAIC Auburn WA 98002 INSURED Palensky Dozing Inc 25230 SE 359th St A: First Auburn WA 98092 1 INSURER F COVERAGES CERTIFICATE NUMBER:CL1941926196 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 POLICY EFF POLICY EXP WK TR TYPE OF INSURANCE MD`'"`"' ,•�„""•. ...---- - EACH OCCURRENCE $ X COMMERCIAL GENERAL LIABILITY DAMA E TO RENTE PREMISES Ea occurrence $ A CLAIMS -MADE ❑X OCCUR X WA -CGL -0000009384-08 4/16/2019 4/18/2020 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE It GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECOT F7 LOC PRODUCTS. $ $ OTHER: COMBINED SINGLE LIMIT $ Ea AUTOMOBILE LIABILITY accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 13 X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X AAA54436801 5/30/2019 5/30/2020 PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE $ $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ PER X OTH- STATUTE ER WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER.ECUTIVE OFFICER(MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under N / A WA Stop Gap WA -CGL -0000009384-08 4/18/2019 4/18/2020 E.L. EACH ACCIDENT 5 E.L. DISEASE -EA EMPLOYEE a E.L. DISEASE - POLICY LIMIT 106 240 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Pre con meeting, Tuesday, January 21st, 6th Floor Conference room #620. City of Renton is named as additional insured per terms and conditions of forms CG2033 0413, FM IC-GL-l0U2 (10/2015), AC8501 0618, FMIC-GL-2686 (19/2018) per attached. 1,000,000 50,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000 0,000 0,000 0.000 CERTIFICATE HOLDER CANCELLATION (425)430-7665 glamb@rentonwa.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Renton ACCORDANCE WITH THE POLICY PROVISIONS. 1055 South Grady Way Renton, WA 98057 AUTHORIZED REPRESENTATIVE Emily Hursh/RECHRI s� © 1988-2014 ACORD CORPORATION. All rights reser ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)