HomeMy WebLinkAboutACORD Fprm for Colvico for CAG-16-160COLVELE-01 KGEH
A!'OI�Q DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE
12/1/2016
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).
PRODUCER
Spokane Office
PayneWest Insurance, Inc.
501 N. Riverpoint Blvd., Ste 403
Spokane, WA 99202
INSURED
Colvico Electrical , Inc.
PO Box 2682
Spokane, WA 99220
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rMMY1C1rA'r= r.niaacMc• RFVISION NUMBER:
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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.
INSR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM1DD1YYYYI
POLICY EXP
JM
LIMITS
LTR
A
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
DAMAGE TO eEONTEDn eg&Wrrec$ 500,000
CLAIMS MADE OCCUR
X
X
EPP0166589
11/01/2016
11/01/2017
MED EXP (Any oneperson) $ 10,000
PERSONAL & ADV INJURY $ 1'000'000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY [ JECT F-1LOCPRODUCTS
GENERAL AGGREGATE 2'000'000
2,000,000
- COMP/OP AGG
WA STOP GAP 1,000,000
A
OTHER:
AUTOMOBILE LIABILITY
SINGLE LIMIT $ 1,000,000
Ea BINEDaccident)
BODILY INJURY Perperson) $
X ANY AUTO
X
X
EBA0166589
11/01/2016
11/01/2017
BODILY INJURY Per accident $
OWNED SCHEDULED
AUTOSONLY AUUTOSyyN D
X AUTOS ONLY X AUTO OO
R
PPeOr a.de t AMAGE $
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
EPP0166589
11101/2016
11/01/2017
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ S,000,OOO
DED X I RETENTION$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
KE.L.
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
EREMBER EXCLUDE[
FICMI
andatory In NH)
NIA
PER OTH-
T
EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE
E.L. DISEASE - POLICY LIMIT
Limit 840,000
A
Ifyes, describe under
DESCRIPTION OF OPERATIONS below
Equipment Floater
EPP0166589
11/01/2016
11/01/2017
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
project WTR-27-03759: Highlands Generator Replacement and Radio Equipment Relocation
Coverage applies on a primary non-contributory basis, waiver of subrogation applies per form attached.
City of Renton
5th Floor City Hall
1055 S Grady St
Renton, WA 98057
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) v . aoo-cV . v r+ �....
The ACORD name and logo are registered marks of ACORD