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HomeMy WebLinkAbout4221027 - Apron A Stormwater - Skanska COI.pdfHHolder Identifier : 7777777707070700077763616065553330760627576226545707772315753416201070773675264333200772705101355130207635115460176560077624715120541300756241531067633207526233572076730077727252025773110777777707000707007 6666666606060600062606466204446200620202626004002206200204062240200062020042620402000620020426204200006022004062262002062002042620400200622002406206000006020026262240222066646062240664440666666606000606006Certificate No :570088117305CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/28/2021 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. PRODUCER Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (516) 396-4000 INSURED 16535Zurich American Ins CoINSURER A: 40142American Zurich Ins CoINSURER B: INSURER C: INSURER D: INSURER E: INSURER F: FAX (A/C. No.):(800) 363-0105 CONTACT NAME: Skanska USA Building Inc. 221 Yale Avenue North, Suite 400 Seattle WA 98109 USA COVERAGES CERTIFICATE NUMBER:570088117305 REVISION NUMBER: 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X X X X GEN'L AGGREGATE LIMIT APPLIES PER: $5,000,000 $5,000,000 $10,000 $5,000,000 $10,000,000 $10,000,000 XCU 50' RR Exclusion Deleted A 08/31/2020 08/31/2021 GLO600624600A 08/31/2020 08/31/2021 NY Only AOS Except NY GLO489601813 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X X X X BODILY INJURY (Per accident) $2,000,000A08/31/2020 08/31/2021 COMBINED SINGLE LIMIT (Ea accident) BAP-6004715-00 EXCESS LIAB OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED UMBRELLA LIAB RETENTION E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $5,000,000 X OTH- ER PER STATUTEB08/31/2020 08/31/2021 $5,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $5,000,000 WC489601716 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project No. 4221027, Project Name: Apron A Stormwater. Workers Compensation Coverage Not Included in Monopolistic States - OH, ND, WA, WY and Puerto Rico. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVEThe Boeing Company Attn: Jon L Larscheid-III 737 Logan Ave N Renton WA 98103 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l.Prem Return Prem. GLO 4896018-13 08/31/2020 08/31/201 69993000 INCL Notification to Others of Cancellation U-GL-1446-A CW (05/10) Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A.If we cancel this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B.If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C.If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Organization(s):Number of Days Notice: IF WE CANCEL THIS POLICY, NOTICE SHALL BE PROVIDED TO 90 THOSE PERSONS OR ORGANIZATIONS OR POLITICAL ENTITIES WITH THOSE PERSONS, ORGANIZATIONS OR POLITICAL ENTITIES WITH WHOM YOU HAVE CONTRACTUALLY AGREED TO GIVE NOTICE AND FOR WHICH YOU HAVE PROVIDED MAILING INFORMATION TO US. All other terms and conditions of this policy remain unchanged. Policy No.Eff. Date of Pol.Exp. Date of Pol.Eff. Date of End.Producer No.Add’l.Prem Return Prem. GLO 6006246-00 08/31/2020 08/31/201 69993000 INCL U-GL-1447-A CW (05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A.If we cancel or non-renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B.If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C.If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1.To the name and address corresponding to each person or organization shown in the Schedule below; and 2.At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D.If notice as described in Paragraphs A.,B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Organization(s):Number of Days Notice: IF WE CANCEL THIS POLICY, NOTICE SHALL BE PROVIDED TO THOSE 90 PERSONS, ORGANIZATIONS OR POLITICAL ENTITIES WITH WHOM YOU HAVE CONTRACTUALLY AGREED TO GIVE NOTICE AND FOR WHICH YOU HAVE PROVIDED MAILING INFORMATION TO US. All other terms and conditions of this policy remain unchanged.