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HomeMy WebLinkAboutCOI 202777 Canopy 55 - City of Renton (2223)SHOULD 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 THISCERTIFICATE 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 belowIf 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 HIREDAUTOS ONLY 5/13/2022 Risk Solution Partners,LLC800BethelStreetSuite201HonoluluHI96813 Christine Kelley (808)954-7475 (808)954-7444 chkelley@woodruffsawyer.com American Contractors Insurance Co RRG 12300 GOODFELLOW Goodfellow Bros.LLCGoodfellowBros.,Inc.P.O.Box 598WenatcheeWA 98807 816371137 AAA X 10,000,000 X 100,000 10,000 10,000,000 10,000,000 X Y GL22A00015GL22B00015GL22C00015 6/1/20226/1/20226/1/2022 6/1/20236/1/20236/1/2023 10,000,000 A 5,000,000 X X X Y AL22000017 6/1/2022 6/1/2023 AAA XGL22A00015(STOP GAP)GL22B00015 (STOP GAP)GL22C00015 (STOP GAP) 6/1/20226/1/20226/1/2022 6/1/20236/1/20236/1/2023 10,000,000 10,000,000 10,000,000 JOB NO.202777 CANOPY 55AdditionalInsuredifrequiredby written contract:City of Renton.Coverage is primary and non-contributory. City of RentonAttn:Michael S.Sippo1055SouthGradyWayRentonWA98057 933 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ADDITIONAL INSURED – AUTOMATIC STATUS AS REQUIRED BY CONTRACT – BLANKET This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Any person or organization that you are required by written contract to include as an additional insured on this policy if the contract is executed prior to the loss. A.Who is an Insured (Section II) is amended to include as an insured any person or organization shown in the above SCHEDULE(called additional insured), but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury”arising out of your premises or your operations for the additional insured, and only to the extent and for the minimum limits requiredin the written contract. B.The insurance provided to the additional insured is subject to the following limitations: 1.Unless required by written contract, this insurance does not apply to “bodily injury” or “property damage” occurring after“your work” for the additional insured has been completed or after that portion of “your work” out of which the “bodily injury”or “property damage” arises has been put to its intended use by any person or organization, whichever occurs first. 2. Unless specifically required by written contract, this insurance does not apply to “bodily injury” or “property damage” arisingout of the sole negligence, act or omission of the additional insured. 3.This insurance does not apply to “bodily injury”, “property damage” or “personal and advertising injury” for which theadditional insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement except tothe extent that the additional insured would have been obligated to pay such damages in the absence of the contract oragreement. 4.This insurance does not apply to “bodily injury”, “property damage” or “personal and advertising injury” arising out of therendering or failure to render any professional services by any insured or on any insured’s behalf, including: a)The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, fieldorders, change orders, drawings or specifications; andb)Supervisory, inspection, architectural or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or the offense which caused the “personal and advertising injury”, involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 5.This endorsement shall not apply to a person or organization if any other additional insured endorsement attached to thispolicy specifically applies to that person or organization. 6.The insurance afforded herein only applies to the extent permitted by applicable state law, including statutes governingadditional insured coverage in the construction industry. 7.The insurance afforded to the additional insured shall not exceed the minimum limits required in the written contract. C.In no event shall the insurance provided to the additional insured exceed the scope of coverage, including minimum limits, requiredby the contract. If a written contract or agreement requires that additional insured status be provided by the use of specified editiondates of the ISO CG2010 and/or CG2037, then the terms of that endorsement are incorporated into this endorsement as respectssuch additional insured and shall supersede the coverage grant and limitations in Sections A. and B. of this endorsement. In theevent that CG2010 and/or CG2037 are required but no edition dates are specified, the 04/13 editions shall apply. D.This insurance is excess to any other insurance, whether primary, excess, contingent or on any other basis, available to theadditional insured unless a written contract requires that this insurance be primary or primary and non-contributing. However, thisinsurance is always excess to other insurance, whether primary, excess, contingent or on any other basis, when the additionalinsured has been added to the other insurance as an additional insured. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the mentioned Policy, other than as above stated. Endorsement Effective: Same as policy effective date unless otherwise indicated above. Policy Effective: 6/1/2022 Policy No.: GL22A00015, GL22B00015, GL22C00015 Insured: Goodfellow Bros. LLC; Goodfellow Bros., Inc.; Goodfellow Bros. California, LLC; Goodfellow Top Grade Construction, LLC. Insurance Company: American Contractors Insurance Co. RRG 596 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy No.: AL22000017 Endorsement No.: AL1 Premium $ Endorsement Effective: 06/01/2022 Policy Effective: 06/01/2022 Insured: Goodfellow Bros. LLC; Goodfellow Bros., Inc.; Goodfellow Top Grade Construction, LLC; Goodfellow Bros. California, LLC Insurance Company: American Contractors Insurance Company Risk Retention Group Countersigned By ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO LIABILITY COVERAGE PART Any person or organization you are required by contract to include as an additional insured on this policy is an "insured" but only with respect to liability arising out of the ownership, maintenance or use of an "auto" in the operations incidental to the contract and to the extent set forth below: (1) The limit of insurance will not be greater than that required by such contract. (2) The coverage provided to the additional insured will not be greater than that customarily provided by the policy forms specified in and required by the contract. (3) All insuring agreements, exclusions and conditions of this policy will apply. (4) In no event shall the coverage or limit of insurance in this coverage form be increased by such contract. This insurance is excess to any other insurance, whether primary, excess, contingent or on any other basis, available to the additional insured unless a written contract requires that this insurance be primary or primary and non-contributing. However, this insurance is always excess to other insurance, whether primary, excess, contingent or on any other basis, when the additional insured has been added to the other insurance as an additional insured. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the mentioned Policy, other than as above stated. Michael Landucci