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HomeMy WebLinkAboutCOI.PDFSHOULD 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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY Willis Towers Watson Midwest, Inc.c/o 26 Century BlvdP.O. Box 305191Nashville, TN 372305191 USA Alston Construction Company, Inc.8775 Folsom Blvd, Suite 201Sacramento, CA 95826 City of RentonAttention: Development Engineering Division1055 S Grady WayRenton, WA 98057 03/14/2023 1-877-945-7378 1-888-467-2378 certificates@willis.com Hartford Accident and Indemnity Company 22357 Hartford Casualty Insurance Company Twin City Fire Insurance Company 29424 29459 W28312653 A 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 Y 83 UEA QT2505 09/01/2022 09/01/2023 B 1,000,000 09/01/202309/01/202283 UEA QT2506 83 WEA QT2504C 1,000,000No09/01/2022 09/01/2023 1,000,000 1,000,000 City of Renton is included as an Additional Insured as respects to General Liability as required by written contract. 289079123863018SR ID:BATCH: Willis Towers Watson Certificate Center Page 1 of 1 POLICY NUMBER: ABCDEFGHIJ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION II This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Designated Project(s) Or Location(s) Or Organization(s):Of Covered Operations: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.With respect to those person(s) or organization(s)in the Schedule; or shown in the Schedule above when you have (c)In connection with "your work" for the agreed in a written contract or written agreement additional insured at the project(s) or to provide insurance such as is afforded under this location(s) designated in the Schedule f. Any Otherpolicy to them, Subparagraph ,and included within the "products- Party Additional Insureds When, under the completed operations hazard", but Required By Written Contract, Written only if: Agreement Or Permit Section II –Paragraph of (i)The written contract or agreementWho Is An Insured is replaced with the following:requires you to provide such f. Any Other Party coverage to such additional Any other person or organization who is not insured at the project(s) or a. e.an insured under Paragraphs through ,location(s) designated in the but only with respect to liability for "bodily Schedule; and injury", "property damage" or "personal and (ii)This Coverage Part provides advertising injury" caused by:coverage for "bodily injury" or (1)Your acts or omissions or the acts or "property damage" included within omissions of those acting on your behalf:the "products-completed operations hazard"; or(a)In the performance of your ongoing (2)operations for such additional insured The acts or omissions of the additional at the project(s) or location(s)insured in connection with their general designated in the Schedule;supervision of your operations at the project(s) or location(s) designated in the(b)In connection with your premises Schedule.owned by or rented to you and shown Form HS 24 81 07 13 Page 1 of 2 © 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) 83 UEA QT2505 ALL,EXCEPT ADDITIONAL INSUREDS THAT ARE INSURED UNDER A SEPARATE ADDITIONAL INSURED ENDORSEMENT ON THIS POLICY When You Add Others As An AdditionalThe insurance afforded to the additional insured Insured To This Insuranceshown in the Schedule applies: (1)(a) Primary Insurance When Required ByOnly if the "bodily injury" or "property damage" Contractoccurs, or the "personal and advertising injury" offense is committed:This insurance is primary if you have agreed (a)During the policy period; and in a written contract or written agreement that this insurance be primary. If other insurance(b)Subsequent to the execution of such is also primary, we will share with all thatwritten contract or written agreement; and other insurance by the method described in(c)Prior to the expiration of the period of time (c)Paragraph below. This insurance does notthat the written contract or written apply to other insurance to which theagreement requires such insurance be additional insured in the Schedule has beenprovided to the additional insured.added as an additional insured.(2)Only to the extent permitted by law; and (b) Primary And Non-Contributory To Other(3)Will not be broader than that which you are Insurance When Required By Contractrequired by the written contract or agreement This insurance is primary to and will not seekto provide for such additional insured.contribution from any other insuranceWith respect to the insurance afforded to the available to an additional insured under yourperson(s) or organization(s) that are additional policy provided that:insureds under this endorsement, the following (i)The additional insured in the Schedule isadditional exclusion applies:a Named Insured under such otherThis insurance does not apply to "bodily injury", insurance; and"property damage" or "personal and advertising (ii)You have agreed in a written contract orinjury" arising out of the rendering of, or the failure agreement that this insurance would beto render, any professional architectural,primary and would not seek contributionengineering or surveying services, including:from any other insurance available to the(1)The preparing, approving, or failing to prepare additional insured in the Schedule.or approve maps, shop drawings, opinions,(c) Method Of Sharingreports, surveys, field orders, change orders, If all of the other insurance permitsdesigns or specifications; or contribution by equal shares, we will follow(2)Supervisory, inspection, architectural or this method also. Under this approach, eachengineering activities.insurer contributes equal amounts until it hasThe limits of insurance that apply to the additional paid its applicable limit of insurance or none ofinsured shown in the schedule are described in the the loss remains, whichever comes first.Limits Of Insurance section.If any of the other insurance does not permitHow this insurance applies when other insurance is contribution by equal shares, we willavailable to the additional insured is described in the contribute by limits. Under this method, eachSection IV –Other Insurance Condition in insurer's share is based on the ratio of itsCommercial General Liability Conditions, except as applicable limit of insurance to the totalotherwise amended below.applicable limits of insurance of all insurers. B.With respect to insurance provided to the All other terms and conditions in the policy remainperson(s) or organization(s) that are additional unchanged.When Youinsureds under this endorsement, the Add Others As An Additional Insured To This Insurance Othersubparagraph, under the Insurance Section IV – Commercial Condition of General Liability Conditions is replaced with the following: Page 2 of 2 Form HS 24 81 07 13