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HomeMy WebLinkAbout19-20 SPECIAL - City of Renton; Re Brown Bear Project.pdfANY 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 7/21/2020 (425) 489-4500 (425) 485-8489 10851 Evergreen Environmental Services, Inc. 17108 - 9th Ave SE Bothell, WA 98012-6312 21849 A 1,000,000 X EF4ML06368191 12/15/2019 12/15/2020 50,000 5,000 1,000,000 2,000,000 2,000,000 WA STOP GAP EL 1,000,000 1,000,000B SCV002514-19 12/15/2019 12/15/2020 A EF4ML06368191 12/15/2019 12/15/2020 1,000,000 1,000,000 1,000,000 Re: Brown Bear Project City of Renton is added as additional insured per the attached endorsements. City of Renton 1055 South Grady Way Renton, WA 98057 EVERENV-01 ROCHOA Hub International Northwest LLC PO Box 3018 Bothell, WA 98041 now.info@hubinternational.com Everest Indemnity Insurance Company American Automobile Ins Co X X X X X POLICY NUMBER: EF4ML06368-191 COMMERCIAL GENERAL LIABILITY ECG 20 558 06 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ECG 20 558 06 08 © Everest Reinsurance Company, 2008 Includes copyrighted material of ISO Properties, Inc. used with permission Page 1 of 1 †† ADDITIONAL INSURED – STATE OR POLITICAL SUBDIVISIONS – PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: CITY OF RENTON 1055 South Grady Way Renton, WA 98057 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured under the Commercial General Liability Coverage Part is amended to include as an insured any state or political subdivision shown in the Schedule, sub- ject 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 political subdivision has issued a permit. 2. This insurance does not apply to: a. "Bodily injury," "property damage" or "per- sonal and advertising injury" arising out of operations performed for the state or mu- nicipality; or b. "Bodily injury" or "property damage" in- cluded within the "products-completed op- erations hazard". B. For the purposes of this endorsement, para- graph 4. Other Insurance under SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS of the Commercial General Li- ability Coverage Part is replaced by the follow- ing: 4. Other Insurance The insurance afforded to these additional insureds is excess over any other insur- ance naming an insured whether such in- surance is primary, excess, contingent or contributing. This insurance may not be used to satisfy any deductible or self- insured retention amounts an insured may owe as a result of this loss, damage or in- jury.