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HomeMy WebLinkAboutSkanska City of Renton_11.15.22Holder Identifier :DH7777777707070700077761616045571110767735336137444307760135572414021073751655047311210737153012241102107477726162176664076073337460376740774473537677453607526722423073331076727242035772000777777707000707007 7777777707070700073525677115456000776015516022543107422377706432014071233373430620010702333624216211007133336342073010070333273421730000712222725217311007023337352073101077756163351765540777777707000707007Certificate No :CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/15/2022 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 # (516) 396-4000 16535Zurich American Ins CoINSURER A: 40142American Zurich Ins CoINSURER B: 24554XL Insurance America IncINSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: INSURED Skanska USA Building Inc. 221 Yale Avenue North, Suite 400 Seattle WA 98109 USA COVERAGES CERTIFICATE NUMBER: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 $10,000 $5,000,000 $10,000,000 $10,000,000 50' RR Exclusion Deleted XCU A 08/31/2022 08/31/2023GLO489601815 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) $2,000,000A08/31/2022 08/31/2023 COMBINED SINGLE LIMIT (Ea accident) BAP 6480660-00 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 08/31/2022UMBRELLA LIABC 08/31/2023US00076358LI22A RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $5,000,000 X OTH-ERPER STATUTEB08/31/2022 08/31/2023 $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 WC489601718 Per ClaimEOC50871241108/31/2022 08/31/2023 SIR applies per policy terms & conditions $50,000,000Aggregate Contractors Protective Professional Indemnity Liability A $25,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Evidence of Insurance. City of Renton is included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability and Excess Liability Policies evidenced herein are Primary and Non-Contributory to other insurance available to an 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. Stop Gap Coverage included. 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: 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 A Environmental Contractors Pollution Liability CPL981713802 08/31/2022 08/31/2023 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 Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l.Prem Return Prem. GLO 4896018-15 08/31/2022 08/31/203 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. POLICY NUMBER: GLO 4896018-15 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ADDITIONAL INSURED – STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION – PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1.This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a.The insurance afforded to such additional insured only applies to the extent permitted by law; and b.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2.This insurance does not apply to: a."Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b."Bodily injury" or "property damage" included within the "products-completed operations hazard". B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Any Person, Organization, State or Political Entity you have agreed through Contract, Agreement or permit to provide Additional Insured Coverage. Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l.Prem Return Prem. GLO 4896018-15 08/31/2022 08/31/203 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.