Loading...
HomeMy WebLinkAboutM_COI_20211108_v1SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/21/21X 15,000 1-206-343-2323 10/21/21 A 1,000,000 1,000,000 Pacific Civil & Infrastructure, Inc. 6050544795 2,000,000 1055 South Grady Way Matt Benoit X X City of Renton B 2,000,000X X A 10/21/22 63557883 63557883 10/21/226050544781 X X matt.benoit@assuredpartners.com 2,000,000 X 2,000,000 X mattbenoit Seattle, WA 98101 206-508-5910 Sumner, WA 98390 10/19/2021 USA X 1,000,000 1,000,000 206-343-4174 CollComp 1214 140th Ave Ct E AssuredPartners of Wash. Ins. Agency, LLC CA Lic 0K61066 CONTINENTAL INS CO AssuredPartners of Washington, LLC VALLEY FORGE INS CO WA Stop Gap Renton, WA 98057 35289 20508 6050544778 1325 Fourth Avenue, Suite 2100 10/21/22 WA#877030 X This insurance is primary and non-contributory per the attached. XX City of Renton The following are additional insured per the attached: RE: All operations where required by the City 10/21/21 X CNA PARAMOUNT Contractors'General Liability Extension Endorsement It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows.If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision,and the changes made by this endorsement withrespecttosuchprovisiondo not apply. TABLE OF CONTENTS 1.Additional Insureds 2.Additional Insured -Primary And Non-Contributory To Additional Insured's Insurance 3.Bodily Injury –Expanded Definition 4.Broad Knowledge of Occurrence/Notice of Occurrence 5.Broad Named Insured 6.Broadened Liability Coverage For Damage To Your Product And Your Work 7.Contractual Liability -Railroads 8.Electronic Data Liability 9.Estates,Legal Representatives and Spouses 10.Expected Or Intended Injury –Exception for Reasonable Force 11.General Aggregate Limits of Insurance –Per Project 12.In Rem Actions 13.Incidental Health Care Malpractice Coverage 14.Joint Ventures/Partnership/Limited Liability Companies 15.Legal Liability –Damage To Premises /Alienated Premises /Property In The Named Insured's Care,Custody or Control 16.Liquor Liability 17.Medical Payments 18.Non-owned Aircraft Coverage 19.Non-owned Watercraft 20.Personal And Advertising Injury –Discrimination or Humiliation 21.Personal And Advertising Injury -Contractual Liability 22.Property Damage -Elevators 23.Supplementary Payments 24.Unintentional Failure To Disclose Hazards 25.Waiver of Subrogation –Blanket 26.Wrap-Up Extension:OCIP CCIP,or Consolidated (Wrap-Up)Insurance Programs CNA74705XX (1-15)Page 1 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Contractors'General Liability Extension Endorsement 1.ADDITIONAL INSUREDS a.WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphsA.through H.below whom a Named Insured is required to add as an additional insured on this Coverage Partunderawrittencontractorwrittenagreement,provided such contract or agreement: (1)is currently in effect or becomes effective during the term of this Coverage Part;and (2)was executed prior to: (a)the bodily injury or property damage;or (b)the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b.However,subject always to the terms and conditions of this policy,including the limits of insurance,the Insurerwillnotprovidesuchadditionalinsuredwith: (1)a higher limit of insurance than required by such contract or agreement;or (2)coverage broader than required by such contract or agreement,and in no event broader than that describedbytheapplicableparagraphA.through H.below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A.Controlling Interest Any person or organization with a controlling interest in a Named Insured,but only with respect to such person or organization's liability for bodily injury,property damage or personal and advertising injury arising out of: 1.such person or organization's financial control of a Named Insured;or 2.premises such person or organization owns,maintains or controls while a Named Insured leases oroccupiessuchpremises; provided that the coverage granted by this paragraph does not apply to structural alterations,new construction ordemolitionoperationsperformedby,on behalf of,or for such additional insured. B.Co-owner of Insured Premises A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner's liability for bodily injury,property damage or personal and advertising injury as co-owner of such premises. C.Lessor of Equipment Any person or organization from whom a Named Insured leases equipment,but only with respect to liability forbodilyinjury,property damage or personal and advertising injury caused,in whole or in part,by the NamedInsured's maintenance,operation or use of such equipment,provided that the occurrence giving rise to suchbodilyinjury,property damage or the offense giving rise to such personal and advertising injury takes placepriorto the termination of such lease. D.Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodilyinjury,property damage or personal and advertising injury arising out of the ownership,maintenance or use of such land,provided that the occurrence giving rise to such bodily injury,property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease.The CNA74705XX (1-15)Page 2 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Contractors'General Liability Extension Endorsement coverage granted by this paragraph does not apply to structural alterations,new construction or demolitionoperationsperformedby,on behalf of,or for such additional insured. E.Lessor of Premises An owner or lessor of premises leased to the Named Insured,or such owner or lessor's real estate manager,but only with respect to liability for bodily injury,property damage or personal and advertising injury arising out of the ownership,maintenance or use of such part of the premises leased to the Named Insured,and provided that the occurrence giving rise to such bodily injury or property damage,or the offense giving rise to such personalandadvertisinginjury,takes place prior to the termination of such lease.The coverage granted by this paragraph does not apply to structural alterations,new construction or demolition operations performed by,onbehalfof,or for such additional insured. F. Mortgagee,Assignee or Receiver A mortgagee,assignee or receiver of premises but only with respect to such mortgagee,assignee or receiver'sliabilityforbodilyinjury,property damage or personal and advertising injury arising out of the NamedInsured's ownership,maintenance,or use of a premises by a Named Insured. The coverage granted by this paragraph does not apply to structural alterations,new construction or demolitionoperationsperformedby,on behalf of,or for such additional insured. G.State or Governmental Agency or Subdivision or Political Subdivisions –Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization butonlywithrespecttosuchstateorgovernmentalagencyorsubdivisionorpoliticalsubdivision's liability for bodilyinjury,property damage or personal and advertising injury arising out of: 1.the following hazards in connection with premises a Named Insured owns,rents,or controls and to whichthisinsuranceapplies: a.the existence,maintenance,repair,construction,erection,or removal of advertising signs,awnings,canopies,cellar entrances,coal holes,driveways,manholes,marquees,hoistaway openings,sidewalkvaults,street banners,or decorations and similar exposures;or b.the construction,erection,or removal of elevators;or c.the ownership,maintenance or use of any elevators covered by this insurance;or 2.the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a.Bodily injury,property damage or personal and advertising injury arising out of operations performedforthestateorgovernmentalagencyorsubdivisionorpoliticalsubdivision;or b.Bodily injury or property damage included within the products-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a writtencontractoragreement,the Insurer will treat as a written contract any governmental permit that requires theNamedInsuredto add the governmental entity as an additional insured. H.Trade Show Event Lessor 1.With respect to a Named Insured's participation in a trade show event as an exhibitor,presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured,but onlywithrespecttosuchpersonororganization's liability for bodily injury,property damage or personal andadvertisinginjurycausedby: CNA74705XX (1-15)Page 3 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Contractors'General Liability Extension Endorsement a.the Named Insured's acts or omissions;or b.the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operations at the trade show event premises during the trade show event. 2.The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. 2.ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended toadd the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non-contributory relative to an additional insured's own insurance,then this insurance is primary,and the Insurer will notseekcontributionfromthatotherinsurance.For the purpose of this Provision 2.,the additional insured's owninsurancemeansinsuranceonwhichtheadditionalinsuredisanamedinsured.Otherwise,and notwithstandinganythingto the contrary elsewhere in this Condition,the insurance provided to such person or organization is excessofanyotherinsuranceavailabletosuchpersonororganization. 3.BODILY INJURY –EXPANDED DEFINITION Under DEFINITIONS,the definition of bodily injury is deleted and replaced by the following: Bodily injury means physical injury,sickness or disease sustained by a person,including death,humiliation,shock,mental anguish or mental injury sustained by that person at any time which results as a consequence of the physicalinjury,sickness or disease. 4.BROAD KNOWLEDGE OF OCCURRENCE/NOTICE OF OCCURRENCE Under CONDITIONS,the condition entitled Duties in The Event of Occurrence,Offense,Claim or Suit is amendedto add the following provisions: A.BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence,offense or claim only when the occurrence,offense or claim is known to a natural person Named Insured,to apartner,executive officer,manager or member of a Named Insured,or an employee designated by any of theabovetogivesuchnotice. B.NOTICE OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to givetheInsurernoticeof an occurrence,offense or claim and that failure is solely due to the Named Insured's reasonable belief that the bodily injury or property damage is not covered under this Coverage Part.However, the Named Insured shall give written notice of such occurrence,offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence,offense or claim. 5.BROAD NAMED INSURED WHO IS AN INSURED is amended to delete its Paragraph 3.in its entirety and replace it with the following: 3.Pursuant to the limitations described in Paragraph 4.below,any organization in which a Named Insured hasmanagementcontrol: a.on the effective date of this Coverage Part;or CNA74705XX (1-15)Page 4 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Contractors'General Liability Extension Endorsement claims arising solely out of their capacity or status as such and,in the case of a spouse,where such claim seeksdamagesfrommaritalcommunityproperty,jointly held property or property transferred from such natural personInsuredtosuchspouse.No coverage is provided for any act,error or omission of an estate,heir,legalrepresentative,or spouse outside the scope of such person's capacity or status as such,provided however that thespouseof a natural person Named Insured and the spouses of members or partners of joint venture or partnershipNamedInsuredsareInsuredswithrespecttosuchspouses'acts,errors or omissions in the conduct of the NamedInsured's business. 10.EXPECTED OR INTENDED INJURY –EXCEPTION FOR REASONABLE FORCE Under COVERAGES,Coverage A –Bodily Injury and Property Damage Liability,the paragraph entitledExclusionsisamendedtodeletetheexclusionentitledExpectedorIntendedInjuryandreplaceitwiththefollowing: This insurance does not apply to: Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the Insured.This exclusion does notapplytobodilyinjuryorpropertydamageresultingfromtheuseofreasonableforcetoprotectpersonsorproperty. 11.GENERAL AGGREGATE LIMITS OF INSURANCE -PER PROJECT A.For each construction project away from premises the Named Insured owns or rents,a separate ConstructionProjectGeneralAggregateLimit,equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: 1.All damages under Coverage A,except damages because of bodily injury or property damage included in the products-completed operations hazard;and 2.All medical expenses under Coverage C, that arise from occurrences or accidents which can be attributed solely to ongoing operations at that constructionproject.Such payments shall not reduce the General Aggregate Limit shown in the Declarations,nor theConstructionProjectGeneralAggregateLimitofanyotherconstructionproject. B.All: 1.Damages under Coverage B,regardless of the number of locations or construction projects involved; 2.Damages under Coverage A,caused by occurrences which cannot be attributed solely to ongoing operations at a single construction project,except damages because of bodily injury or property damage included in the products-completed operations hazard;and 3.Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoingoperationsat a single construction project, will reduce the General Aggregate Limit shown in the Declarations. C.The limits shown in the Declarations for Each Occurrence,for Damage To Premises Rented To You and forMedicalExpensecontinuetoapply,but will be subject to either the Construction Project General Aggregate LimitortheGeneralAggregateLimit shown in the Declarations,depending on whether the occurrence can beattributedsolelytoongoingoperationsat a particular construction project. D.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 operationshazardwillreducetheProducts-Completed Operations Aggregate Limit shown in the Declarations,regardless of the number of projects involved. CNA74705XX (1-15)Page 8 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Contractors'General Liability Extension Endorsement E.If a single construction project away from premises owned by or rented to the Insured has been abandoned andthenrestarted,or if the authorized contracting parties deviate from plans,blueprints,designs,specifications or timetables,the project will still be deemed to be the same construction project. F.The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12.IN REM ACTIONS A quasi in rem action against any vessel owned or operated by or for the Named Insured,or chartered by or for theNamedInsured,will be treated in the same manner as though the action were in personam against the NamedInsured. 13.INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE Solely with respect to bodily injury that arises out of a health care incident: A.Under COVERAGES,Coverage A –Bodily Injury and Property Damage Liability,the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1.b.(1)and 1.b.(2)with the following: b.This insurance applies to bodily injury provided that the professional health care services are incidental totheNamedInsured's primary business purpose,and only if: (1)such bodily injury is caused by an occurrence that takes place in the coverage territory. (2)the bodily injury first occurs during the policy period.All bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act,error,or omission that is part of the occurrence; and B.Under COVERAGES,Coverage A –Bodily Injury and Property Damage Liability,the paragraph entitled Exclusions is amended to: i.add the following to the Employers Liability exclusion: This exclusion applies only if the bodily injury arising from a health care incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits). ii.delete the exclusion entitled Contractual Liability and replace it with the following: This insurance does not apply to: Contractual Liability the Insured's actual or alleged liability under any oral or written contract or agreement,including but notlimitedtoexpresswarrantiesorguarantees. iii.add the following additional exclusions: This insurance does not apply to: Discrimination any actual or alleged discrimination,humiliation or harassment,including but not limited to claims based onanindividual's race,creed,color,age,gender,national origin,religion,disability,marital status or sexualorientation. Dishonesty or Crime Any actual or alleged dishonest,criminal or malicious act,error or omission. Medicare/Medicaid Fraud CNA74705XX (1-15)Page 9 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Contractors'General Liability Extension Endorsement B.Solely for the purpose of the coverage provided by this PROPERTY DAMAGE –ELEVATORS Provision,the Other Insurance conditions is amended to add the following paragraph: This insurance is excess over any of the other insurance,whether primary,excess,contingent or on any otherbasisthatisPropertyinsurancecoveringpropertyofothersdamagedfromtheuseofelevators. 23.SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS –COVERAGES A AND B is amended as follows: A.Paragraph 1.b.is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.limit;and B.Paragraph 1.d.is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a$1,000.limit. 24.UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the NamedInsured's Coverage Part,the Insurer will not deny coverage under this Coverage Part because of such failure. 25.WAIVER OF SUBROGATION -BLANKET Under CONDITIONS,the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended toadd the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because ofpaymentstheInsurermakesforinjuryordamagearisingoutof: 1.the Named Insured's ongoing operations;or 2.your work included in the products-completed operations hazard. However,this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery inawrittencontractorwrittenagreement,and only if such contract or agreement: 1.is in effect or becomes effective during the term of this Coverage Part;and 2.was executed prior to the bodily injury,property damage or personal and advertising injury giving rise to the claim. 26.WRAP-UP EXTENSION:OCIP,CCIP,OR CONSOLIDATED (WRAP-UP)INSURANCE PROGRAMS Note:The following provision does not apply to any public construction project in the state of Oklahoma,nor to any construction project in the state of Alaska,that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSION –CONSTRUCTION WRAP-UP is attached to this policy,or another exclusionaryendorsementpertainingtoOwnerControlledInsurancePrograms(O.C.I.P.)or Contractor Controlled InsurancePrograms(C.C.I.P.)is attached,then the following changes apply: A.The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up)insurance program project in which the Named Insured is or was involved,this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1.Bodily injury,property damage,or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project,or during such operations of anyone acting on the Named Insured'sbehalf;nor CNA74705XX (1-15)Page 16 of 17 Copyright CNA All Rights Reserved.Includes copyrightedmaterial of Insurance Services Office,Inc.,with its permission.