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Home My WebLink AboutM_COI_20210416_v1INSR 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 Zurich American Insurance Company - ZUR Allied World Assurance Co Berkley Insurance Company 04/16/2021 Turner Surety & Ins. Brokerage 250 Pehle Avenue, Suite 311 Saddle Brook, NJ 07663 TSIB INC. 201 267-7500 201-267-7532 flatironcerts@tsibinc.com Flatiron West, Inc. 1400 Talbot Road South Suite 500 Renton, WA 98055 16535 10690 32603 A X X AI: UGL 1175 X X Y Y GLO0593970712 06/15/2020 06/01/2021 3,000,000 300,000 10,000 3,000,000 6,000,000 6,000,000 A X X X Y Y BAP593970812 06/15/2020 06/01/2021 3,000,000 B X X X 10000 Y Y 03084113 06/15/2020 06/01/2021 5,000,000 5,000,000 C B Professional Liab Pollution Liab Y Y Y PCAB50117820720 03101590 07/01/2020 06/01/2020 06/01/2021 06/01/2021 $1,000,000 EA CLAIM/AGG $1,000,000 OCC/AGG SEPERATE LIMITS APPLY Re: Evidence of Insurance for Permit C21000235 Project Description: I-405 Renton to Bellevue Widening & Express Tolls Project Area: NE 44th Street Field Offices and Laydown/Staging Area Owner: State of Washington Department of Transportation Contract No. XL5467 (See Attached Descriptions) The City of Renton ATTN: Kelsey R. Ternes Risk Manager 1055 South Grady Way Renton, WA 98057 1 of 2 #S212452/M212451 FLATRENTONClient#: 552 KM 1 of 2 #S212452/M212451 SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) Flatiron Job Number: 2129 The following is included as an Additional Insured with respect to Commercial General Liability but only as required for obtaining a Permit by the Named Insured for the performance on work on the above project. The following is an Additional Insured on the Automobile Liability Policy but only to the extent they meet the definition of an insured in the policy, which provides in pertinent part that an insured includes anyone liable for the conduct of an insured but only to the extent of that liability. Additional Insureds: City of Renton All coverages, terms, conditions and exclusions of the policies apply. The General Liability coverage applies on a Primary and Non-Contributory basis per the policy terms and conditions but only if required by written contract and/or written agreement. No Exclusion for Explosion, Collapse and Underground Hazard (XCU Coverage). This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract and/or written agreement. * The following cancellation conditions always apply: - Ten (10) Days for Non-Payment of Premium If Policy shown, Ten (10) days for Workers' Compensation for fraud; material misrepresentation; Non-Payment of Premium; other reasons approved by the Commissioner of Insurance. All other Notices of Cancellations Thirty (30) Days apply. 2 of 2 #S212452/M212451