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HomeMy WebLinkAbout20-21 Master COI - Renton School District; Sierra Heights Elementary School Playfield RenovationANY 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 7/2/2021 (425) 489-4500 (425) 485-8489 20095 Premier Field Development, Inc Julie Geddes 207 Cedar Avenue Snohomish, WA 98290 A 1,000,000 X X CLP3700884 12/16/2020 12/16/2021 300,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000A X X CAP3700883 12/16/2020 12/16/2021 A CLP3700884 12/16/2020 12/16/2021 1,000,000 1,000,000 1,000,000 Sierra Heights Elementary School Playfield Renovation Renton School District is added as additional insured per the attached endorsements & forms; coverage is primary and non-contributory and waiver of subrogation applies. Renton School District 300 SW 7th Street Renton, WA 98057 PREMFIE-01 ROCHOA Hub International Northwest LLC PO Box 3018 Bothell, WA 98041 now.info@hubinternational.com BITCO General Insurance Corporation X X X X X X X                                                                            Policy # CLP3700884                                                                                                                                                                                                   BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY AP-0401 (10/17) -1- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE - AUTOMOBILES The following modifies insurance provided under: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. 1 - Broad Form Named Insured 11 - Bodily Injury Extension 2 - Automatic Waiver of Subrogation 12 - Hired Auto Physical Damage 3 - Automatic Additional Insured 13 - Enhanced Supplementary Payments 4 - Primary and Noncontributory - Other Insurance Condition 14 - Fellow Employee Coverage for Designated Positions 5 - Unintentional Failure to Disclose Hazards 15 - Physical Damage – Transportation Expenses 6 - Extended Notice of Cancellation, Non-Renewal 16 - Rental Reimbursement Coverage 7 - When We Do Not Renew 17 - Loan/Lease Gap Coverage 8 - Notice of Knowledge of Accident or Loss 18 - Accidental Air Bag Discharge Coverage 9 - Employees as Insured 19 - Glass Repair – Waiver of Deductible 10 - Employee Hired Autos 1.BROAD FORM NAMED INSURED SECTION II. A. 1. - WHO IS AN INSURED - Paragraph d. is added: d.Any organization you newly acquire or form, except for a partnership, joint venture or limited liability company, and over which you maintain majority ownership or interest (51% or more) or for which you have assumed the active management, will qualify as a Named Insured if there is no other similar insurance available to that organization. However, coverage under this provision is only afforded until the end of the policy period or the 12-month anniversary of the policy inception date, whichever is earlier. 2.AUTOMATIC WAIVER OF SUBROGATION Section IV – Business Auto Conditions, Paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is deleted and replaced with the following: a.If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b.If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for damages under this coverage form. Policy # CAP3700883 AP-0401 (10/17) -2- 3.AUTOMATIC ADDITIONAL INSURED SECTION II – WHO IS AN INSURED, Paragraph A.1, is amended to include as an "insured" any person or organization who is required by written contract or agreement to be an additional insured on your policy, but only with respect to liability arising out of operations performed by you or on your behalf for the additional insured. 4.PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1.Such "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 such "insured". 5. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. 6. EXTENDED NOTICE OF CANCELLATION, NON-RENEWAL The COMMON POLICY CONDITIONS, Item A.2.b. is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. 7. WHEN WE DO NOT RENEW SECTION IV – BUSINESS AUTO CONDITIONS, is amended to add Item B.9.: a.If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b.If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty (60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one-time sixty-day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a. above. 8. NOTICE OF KNOWLEDGE OF ACCIDENT OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, Item A.2.a. is deleted and replaced with the following: 2.Duties in the Event of Accident, Claim Suit or Loss: a.You must see to it that we are notified of an "accident", "claim", "suit" or "loss" which may result in a claim as soon as practicable after the "occurrence" has been reported to you, a partner, a member, an officer, or an employee designated to give notice to us. Notice should include: AP-0401 (10/17) -3- (1)How, when and where the "accident" or "loss" occurred; (2)The "insured's" name and address; and (3)To the extent possible, the names and addresses of any injured persons and witnesses. 9. EMPLOYEES AS INSURED The following is added to the Section II - Covered Autos Liability Coverage, Paragraph A.1. Who Is An Insured provision: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. 10. EMPLOYEE HIRED AUTOS A.Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. B.Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph 5.f. of the Other Insurance - Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: 1.Any covered "auto" you lease, hire, rent or borrow; and 2.Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". 11. BODILY INJURY EXTENSION SECTION V - DEFINITIONS, Paragraph C. is deleted and replaced by the following: C."Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from any of these, at any time. Mental anguish means any type of mental or emotional illness or disease. 12. HIRED AUTO PHYSICAL DAMAGE SECTION III.A.4. - Coverage Extensions - Paragraph c. is added: c.Hired Auto Physical Damage If Comprehensive, Specified Causes of Loss or Collision coverage is provided under this policy, then Hired Auto Physical Damage is provided for that coverage part subject to the following: AP-0401 (10/17) -4- (1) The most we will pay for any one "accident" or "loss" under this Hired Auto Physical Damage Coverage is the lesser of: (a) The any one "Accident" or "Loss" amount of $100,000; (b) The actual cash value; or (c) Cost of repair. Our obligation to pay for a loss in c.(1) above will be reduced by a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. The deductible will be waived for "loss" caused by fire or lightning. (2) Subject to paragraph c.(1). above, we will provide coverage equal to the broadest physical damage coverage applicable to any covered "auto" shown in the declarations. (3) When you are required by written contract to indemnify a lessor for actual financial loss because of loss of use of a hired "auto" resulting from a covered "accident" or "loss", we will cover that financial loss subject to the limit specified in paragraph c.(1). 13. ENHANCED SUPPLEMENTARY PAYMENTS SECTION II.A.2.a. COVERAGE EXTENSIONS, Supplementary Payments (2) and (4) are replaced by the following: (2) Up to $2,500 for the cost of bail bonds (including bonds for related traffic laws violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $350 a day because of time off from work. 14. FELLOW EMPLOYEE COVERAGE FOR DESIGNATED POSITIONS The Fellow Employee Exclusion contained in Section II.B.5. does not apply to the following positions or job titles: foreman, supervisor, manager, officer, partner or other senior level "employee". Coverage is excess over all other collectible insurance. 15. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES SECTION III.A.4.a. Transportation Expenses, is replaced by the following: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto". We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Cause of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expirations, when the covered "auto" is returned to use or we pay for its "loss". For autos provided with temporary transportation expense, the following physical damage coverage will apply: (1) The most we will pay for any one "accident" or "loss" under the temporary transportation expense physical damage coverage is the lessor of: (a) The any one "Accident" or "Loss" amount of $100,000; (b) The actual cash value; or AP-0401 (10/17) -5- (c) Cost of repair. Our obligation to pay for a loss in a.(1) above will be reduced by a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. The deductible will be waived for "loss" caused by fire or lightning. (2) Subject to paragraph a.(1). above, we will provide coverage equal to the broadest physical damage coverage applicable to any covered "auto" shown in the declarations. (3) When you are required by written contract to indemnify a lessor for actual financial loss because of loss of use of a hired "auto" resulting from a covered "accident" or "loss", we will cover that financial loss subject to the limit specified in paragraph a.(1). 16. RENTAL REIMBURSEMENT COVERAGE SECTION III.A.4. - Coverage Extensions - Paragraph d. is added. d. If you carry Comprehensive, Specified Causes of Loss or Collision coverage for the damaged covered "auto" as provided under this policy, then Rental Reimbursement Coverage is provided for that coverage part subject to the following: 1. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" other than theft, to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. 2. We will only pay for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: (a) The number of days reasonably required to repair or replace the covered "auto"; or, (b) 30 days. (c) Our payment is limited to the lesser of the following amounts: (1) Necessary and actual expenses incurred; or (2) $50 per day. 17. LOAN/LEASE GAP COVERAGE Physical Damage Coverage is amended by the addition of the following: In the event of a total "loss" to a covered "auto", we will pay your additional legal obligation for any difference between the actual cash value of the "auto" at the time of the loss and the "outstanding balance" of the loan/lease, not to exceed $2,500 for any one vehicle or $25,000 annually in aggregate. For the purposes of this endorsement, "outstanding balance" means the amount you owe on the loan/lease at the time of loss less any amounts representing taxes, overdue payments, penalties, interest or charges resulting from overdue payments, additional mileage charges, excess wear and tear charges or lease termination fees, costs for extended warranties, credit Life Insurance; Health, Accident or Disability Insurance purchased with the loan or lease; and carry-over balances from previous loans or leases. AP-0401 (10/17) -6- 18. ACCIDENTAL AIR BAG DISCHARGE COVERAGE SECTION III.B.3.a - Exclusions. This exclusion does not apply to the accidental discharge of an air bag. 19. GLASS REPAIR - WAIVER OF DEDUCTIBLE SECTION III.D - Deductible is replaced with the following: For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. The deductible does not apply to glass damage if the glass is repaired rather than replaced.