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HomeMy WebLinkAbout24-25 MASTER COI - City of RentonANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD 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) 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 EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY 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 LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) 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 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 6/14/2024 (425) 489-4500 (425) 485-8489 23434 Pacific Earth Works WBE LLC 12411 Wagner Road Monroe, WA 98272 37974 A 1,000,000 X X A0176158004 6/18/2024 6/18/2025 1,000,000 Stop Gap Liability 15,000 1,000,000 3,000,000 2,000,000 EMPLOYEE BENFIT 1,000,000 1,000,000A X X A0176158001 6/18/2024 6/18/2025 1,000,000A X A0176158005 6/18/2024 6/18/2025 1,000,000 10,000 A A0176158004 6/18/2024 6/18/2025 1,000,000 1,000,000 1,000,000 B Pollution / Environm EGL0011921 6/18/2024 Limit:3,000,000 Re: Cascade ES. City of Renton is included as an additional insured, Coverage is Primary and non-contributory and Waiver of Subrogation applies per the attached forms/endorsements. Per Project Aggregate applies to General Liability policy, per attached forms/endorsements. City of Renton 1055 South Grady Way Renton, WA 98057 PACIEAR-01 GSARASWATHI Hub International Northwest LLC PO Box 3018 Bothell, WA 98041 now.info@hubinternational.com Middlesex Insurance Company Mt. Hawley Insurance Company X 6/18/2025 X X X X X X X X Page 1 of 2CG 20 10 12 19 04/06/2023A0194158Middlesex Insurance Company © Insurance Services Office, Inc., 2018 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE CG 20 10 12 19 Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations 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 the person(s)or organization(s)shown in the Schedule,but only with respect to liability for "bodily injury", "property damage"or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations fortheadditionalinsured(s)at the location(s)designated above. However: 1.The insurance afforded to such additionalinsuredonlyappliestotheextentpermittedbylaw; and 2.If coverage provided to the additional insuredisrequiredbyacontractoragreement,theinsuranceaffordedtosuchadditionalinsuredwillnotbebroaderthanthatwhichyouarerequiredbythecontractoragreementtoprovide for such additional insured. B.With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to "bodily injury"or "property damage" occurring after: 1.All work,including materials,parts or equipment furnished in connection with such work,on the project (other than service, maintenance or repairs)to be performed by oronbehalfoftheadditionalinsured(s)at thelocationofthecoveredoperationshasbeencompleted; or 2.That portion of "your work"out of which theinjuryordamageariseshasbeenputtoitsintendedusebyanypersonororganizationotherthananothercontractororsubcontractorengaged in performingoperationsforaprincipalasapartofthesameproject. 00001 0000000000 23096 0 N1 1c7501d3-1ffc-4969-a093-dd57f3206a6d1c7501d3-1ffc-4969-a093-dd57f3206a6d Any person or organization you are required to addas an additional insured under a written contract orwritten agreement in effect prior to any loss ordamage. Any and all projects © Insurance Services Office, Inc., 2018 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.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. 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. Page 1 of 1CG 20 37 12 19 Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage. Any and all projects COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named Insured under such other insurance; and (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2018 Page 1 of 1CG 20 01 12 19 © Insurance Services Office, Inc., 2018 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. Page 1 of 1CG 24 04 12 19 Any person or organization to whom you are required to waive your right to recover by a written contract or agreement executed prior to loss CG 71 18 06 20 Page 1 of 2 COMMERCIAL GENERAL LIABILITY CG 71 18 06 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EACH CONSTRUCTION PROJECTGENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Maximum Each Construction Project General Aggregate Limit: Not Applicable Designated Construction Project(s):All construction projects away from premises owned by or rented to theInsured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences"under Section I -Coverage A, and for all medical expenses caused by accidents under Section I -Coverage C,which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1.Subject to Paragraph 2.below,a separate Each Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2.If shown in the Schedule,the Policy Maximum Each Construction Project General Aggregate Limit is the most we will pay for the sum of all damages paid under all Each Construction Project General Aggregate Limits included in this policy. 3.Subject to Paragraph 2.above,the Each Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A,except damages because of "bodily injury"or "property damage"included in the "products-completed operations hazard",and for medical expenses under Coverage C regardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits". 4.Subject to Paragraph 2.above,any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Each Construction ProjectGeneralAggregateLimitforthatdesignated construction project.Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Each Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 5.Subject to Paragraph 2.above,the limits shown in the Declarations for Each Occurrence,Damage To Premises Rented To You and Medical Expense continue to apply.However,instead of being subject to the General Aggregate Limit shown in the Declarations,suchlimits will be subject to the applicable Each Construction Project General Aggregate Limit. Includes copyrighted material of Insurance Services Office, Inc., with its permission.04/06/2023A0194158Middlesex Insurance Company 00001 0000000000 23096 0 N1 a3e5ff1f-dec0-40ed-b131-e001c06c0ab5a3e5ff1f-dec0-40ed-b131-e001c06c0ab5 Page 2 of 2 CG 71 18 06 20 B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences"under Section I -Coverage A, and for all medical expenses caused by accidents under Section I -Coverage C,which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2.Such payments shall not reduce any Each Construction Project General Aggregate Limit provided under this policy. C.When coverage for liability arising out of the "products-completed operations hazard"is provided,any payments for damages because of "bodily injury"or "property damage"included in the "products-completed operations hazard"will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor any Each Construction Project General Aggregate Limit provided under this policy. D.If the applicable designated construction project has been abandoned,delayed,or abandoned and then restarted,or if the authorized contracting parties deviate from plans,blueprints, designs,specifications or timetables,the project will still be deemed to be the same constructionproject. E.The provisions of Section III -Limits Of Insurance not otherwise modified by this endorsement shall continue to apply asstipulated. Includes copyrighted material of Insurance Services Office, Inc., with its permission.04/06/2023A0194158Middlesex Insurance Company POLICY NUMBER: SCHEDULE COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date isindicated. Named Insured: Endorsement Effective Date: Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage,but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1)Paragraph A.1.of Section II -Covered AutosLiabilityCoverageintheBusinessAuto and Motor Carrier Coverage Forms; or (2)Paragraph D.2.of Section I -Covered AutosCoverages of the Auto Dealers Coverage Form. B.Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1)The person or organization is a Named Insured under such other insurance; and (2)Prior to the “accident”you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1CA 76 01 06 15 06/18/2023A0176158Middlesex 00001 0000000000 21169 0 N1 ddb82d45-a3d0-49b2-be07-19aa566896e9ddb82d45-a3d0-49b2-be07-19aa566896e9 Any person or organization you are required to add as anadditional insured under a written contract or writtenagreement in effect prior to any loss or damage. Pacific Earth Works WBE, LLC 06/18/2023 Named Insured: Endorsement Effective Date: Name(s) Of Person(s) Or Organization(s): POLICY NUMBER: COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery AgainstOthersToUsconditiondoesnotapplytothe person(s)or organization(s)shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident"or the "loss"under a contract with that person or organization. © Insurance Services Office, Inc., 2011 Page 1 of 1CA 04 44 10 13 06/18/2023A0176158Middlesex 00001 0000000000 21169 0 N1 8349b29e-429f-410e-9520-c6e84f0cfd9d8349b29e-429f-410e-9520-c6e84f0cfd9d Any person or organization you are required to add as anadditional insured under a written contract or writtenagreement in effect prior to any loss or damage. 06/18/2024 Pacific Earth Works WBE LLC