Loading...
HomeMy WebLinkAboutPW15-233 - Insurance Certificate - KBA, Inc. - 05/10/2015-05/10/2016 Liability Coverage Client#:322877 KBAINC ACORD,P CERTIFICATE OF LIABILITY INSURANCE °ATE'M2 5 Y, 7/011015 '. 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 pollcy(ies)must 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 CONTACT Kibble&Prentice,a USI Co PR ONE 206 441.6300 FAX 610.362.8528 601 Union Street,Suite 1000 Alt° E.c; _._._ tAlc,Nal: Seattle,WA 98101 ADDRESS: pl.certrequest@kpcom.com INSURERS AFFORDING COVERAGE NA1CV INBURERA:Travelers Indemnity Company of 25682 INSURED - - - INSURER B:Catlin Insurance Company,Inc. 19518 KBA, Inc. INSURER c:Chorter Oak Fire Insurance Comp 25615 11000 Main Street ----- ---- Bellevue,WA 98004 INSURER D: INSU RER E: INSURER F. I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISPED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 EECLAIMS, IINTRR 1YPEOFINSURANCE INSRL NNO POLICYNUMBER 481L.�NYYY (MM�DO/1'YYVI LIMITS A GENERAL LIABILITY 6808564X346 5110/2015 05/10/201 EACHOCTCURRENCE $1 OOO,DOO X COMMERCIAL GENERAL LIABILITY >pM�GES RENTED RE ISE Ee nurrenc�a_ $1,000 0 00 CIAIMS-MADE n OCCUR MED EXP(Any ono person) $1 O 000 PERSONAL&ADV INJURY__s1,0001000 I GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIM IT APPLIES PER: PRODUCTS-codpiOPAGG $2,000,000 POLICYn JLCI cGayscolNE°D slcLe LIMIT AUTOMOBILE LIABILITY BA8570X17A 5/10/2015 05/10/201 1,000,000 X ANYAUTO BODILY INJURY(P.,ecreca) $ ALL OWNED - SCHEDULED AUTOS AUTOS BODILY INJURY(Par arcldenQ S AUTO NEO PROPERTY DAMAGE -- X HIRED AUI OS X AUTOS Parnccidanl $ $ I UMBRELLA LIAR OCCUR F.ACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ _. DEC RETENTION$ A WORKERS COMPENSATION 6808564X346 5110/2015 05/10/201 ,WCSTATU- X oTlo AND EMPLOYERS'LIABILITY nNV PB1IEiOR/PAkTNER/Eecunve (WA Stop Gap) eL.encHAcaDENr $1000,000 OFFICE EMBBER EXCLUDED NJ NIA (Mandatory lu NH) E.L.015EAEE-EA EMPLOYEE $1 OOD OOO styes,doscrihn andnr _DESCRIPTION OFOPERANONS b°Imv ..__ E.L.DISEASE-POLICY LIMIT 52,000,000 B Professional AED976310516 5/10/2015 0511012016 $1,000,000 per claim Liability $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Sehedulo,If mom space Is required) - RE: Project BP#14-146-01,LA#8224-Central Ave.S,Pavement Preservation and Utility Improvements. The Gonoral Liability and Automobile Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to City of Kent,WA State,Agency,their officers, employees, agents and only when there is a written contract that requires such status,and only wlth regard to work performed on behalf of the named Insured.The General Llablilty policy contains a special endorsement (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Eric Connor ACCORDANCE WITH THE POLICY PROVISIONS. 220 4th Ave. S Kent,WA 98032 AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD -- -#S15713261/M15070674 - - --- _-- - _- - - NXNZP - - -- L I DESCRIPTIONS (Continued from Page 1) with Primary and Noncontributory wording, when required by written contract.The General Liability, Automobile Liability and Professional Liability policies include a Waiver of Subrogation endorsement in favor of the Certificate Holder as referenced above. i SAGITTA 25.3(2010/05) 2 of 2 ICI #51 571 3 261/M15070674 i Policy 46808564X346 COMMERCIAL GENERAL LIABILITY i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED INSURANCE (Section III) for this Coverage (Section II): Part. Any person or organization that you agree in a B. The following is added to Paragraph a. of 4. "contract or agreement requiring insurance" to in- Other Insurance In COMMERCIAL GENERAL elude as an additional insured on this Coverage LIABILITY CONDITIONS (Section IV): Part, but only with respect to liability for"bodily in- However, if you specifically agree in a "contract or jury", "property damage" or "personal Injury" agreement requiring Insurance"that the Insurance caused, in whole or in part, by your acts or omis- provided to an additional Insured under this Cov- sions or the acts or omissions of those acting on erage Part must apply on a primary basis, or a your behalf: primary and non-contributory basis,this Insurance a. In the performance of your ongoing opera- is primary to other insurance that is available to Lions; such additional insured which covers such addi- b. In connection with premises owned by or tional insured as a named Insured,and we will not rented to you;or share with the other insurance, provided that: c. In connection with "your work" and included (1) The "bodily injury" or "property damage" for within the "products-completed operations which coverage Is sought occurs;and hazard". (2) The "personal Injury" for which coverage is Such person or organization does not qualify as sought arises out of an offense committed; an additional insured for "bodily injury" "property after you have entered into that "contract or damage" or "personal Injury" for which that per- agreement requiring insurance". But this insur- son or organization has assumed liability in a con- ante still is excess over valid and collectible other tract or agreement. insurance,whether primary,excess, contingent or The Insurance provided to such additional Insured on any other basis, that Is available to the insured is limited as follows: when the insured is an additional insured under d. This Insurance does not apply on any basis to any other Insurance. any person or organization for which cover- C. The following is added to Paragraph 8. Transfer age as an additional Insured specifically is Of Rights Of Recovery Against Others To Us added by another endorsement to this Cover- in COMMERCIAL GENERAL LIABILITY CON- age Part, DITIONS(Section IV): e. This insurance does not apply to the render- We waive any rights of recovery we may have Ing of or failure to render any "professional against any person or organization because of services". payments we make for "bodily injury", "property f. The limits of Insurance afforded to the addi- damage" or "personal Injury" arising out of"your tional Insured shall be the limits which you work" performed by you, or on your behalf, under agreed in that "contract or agreement requir- a"contract or agreement requiring Insurance"with ing insurance" to provide for that additional that person or organization, We waive these Insured, or the limits shown In the Declara- rights only where you have agreed to do so as tions for this Coverage Part, whichever are part of the "contract or agreement requiring Insur- less.This endorsement does not increase the ante" with such person or organization entered limits of Insurance stated In the LIMITS OF into by you before, and in effect when, the "bodily CG D3 81 09 07 ©2007 The Travelers Companies,Inc. Page 1 of 2 Includes the copyrighted material of Insurance Servlces Office,Inc.,with its permission i COMMERCIAL GENERAL LIABILITY injury" or "properly damage" occurs, or the "per- erage Part, provided that the "bodily injury" and sonal injury"offense is committed. "property damage" occurs, and the "personal In- D. The following definition is added to DEFINITIONS jury"is caused by an offense committed: (Section V): a. After you have entered Into that contract or "Contract or agreement requiring insurance" agreement; means that part of any contract or agreement un- b. While that part of the contract or agreement is der which you are required to include a person or in effect; and organization as an additional Insured on this Cov- c. Before the end of the policy period. I III I� Page 2 of 2 m 2007 The Travelers companies,Inc, CG D3 81 09 07 Includes the copyrighted material of Insurance Services Office,Inc.,with Its permission Policy #BAS570X17A COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may he excluded or limited by another endorsement to the Coverage Part,and these coverage broadening provisions do not apply to the extent that coverage Is excluded or limited by such an endorsement;The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties,and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. .AUDIO, ' VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C. EMPLOYEES AS INSURED 1. WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY LIMITS K. AIRBAGS E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1., Who Is your business. An Insured,of SECTION II—COVERED AUTOS 2, The following replaces Paragraph b. in B.5., LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who Is required under NESS AUTO CONDITIONS: a written contract or agreement between you and h. For Hired Auto Physical Damage Cover- that person or organization, that is signed and ago, the following are deemed to be cov- executed by you before the "bodily Injury" or Bred"autos"you own: "property damage" occurs and that Is in effect (1) Any covered "auto" you lease, hire, during the policy period, to be named as an addi- rent or borrow;and tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by this Insurance applies and only to the extent that your "employee" under a contract in person or organization qualifies as an "insured" an "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties in Section II. related to the conduct of your bust- B. EMPLOYEE HIRED AUTO ness. 1. The following Is added to Paragraph A.1., However, any"auto"that is leased, hired, Who Is An Insured, of SECTION II — COV- rented or borrowed with a driver is not a ERED AUTOS LIABILITY COVERAGE: covered"aSURED I An "employee" of yours is an "insured" while C. EMPLOYEES AS INN SURED operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is under a contract or agreement in an "am_ An Insured, of SECTION II—COVERED AUTOS ployes's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 ©2016 the Travelers Indemnity company.All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL AUTO Any"employee"of yours Is an "insured"while us- (2) An adjustment for depreciation and physical ing a covered "auto"you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs. cash value in the event of a total"loss". D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better LIMITS than like kind or quality,we will not pay for the 1. The following replaces Paragraph A.2,a.(2) of amount of betterment. SECTION 11—COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of ball bonds (in- covered "auto". eluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to: tions) required because of an "accident" (a) Any "auto" that is hired, rented or bor- we cover. We do not have to furnish rowed with a driver; or these bonds. 2. The following replaces Paragraph A.2.a.(4) of (b) Any "auto" that is hired, rented or bor- SECTION II—COVERED AUTOS LIABILITY rowed from your"employee". COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION (4) All reasonable expenses incurred by the EXPENSES—INCREASED LIMIT "Insured" at our request, including actual The following replaces the first sentence in Para- i loss of earnings up to $500 a day be- graph A,4.a., Transportation Expenses, of cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER- E. TRAILERS—INCREASED LOAD CAPACITY AGE: The following replaces Paragraph CJ. of SEC- We will pay up to $50 per day to a maximum of TION I—COVERED AUTOS: $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- 1. 'Trailers" with a load capacity of 3,000 ercd"auto"of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT—INCREASED LIMIT F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.11, of SECTION III — PHYSICAL The following is added to Paragraph A.4., Cover- DAMAGE COVERAGE is deleted. age Extensions, of SECTION III — PHYSICAL I. WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: Hired Auto Physical Damage Coverage The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than also provides Physical Damage Coverage for an replaced. owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY ago is extended to "autos" that you hire, rent or The following Is added to Paragraph AA., Cover- borrow subject to the following: age Extensions, of SECTION III — PHYSICAL (1) The most we will pay for "loss" to any one DAMAGE COVERAGE: "auto" that you hire, rent or borrow is the Personal Property Coverage lesser of: We will pay up to $400 for "loss" to wearing ap- (a) $50,000; parel and other personal property which is: (b) The actual cash value of the damaged or (1) Owned by an"insured"; and stolen property as of the time of the (2) In or on your covered "auto". "loss"; or This coverage only applies in the event of a total (c) The cost of repairing or replacing the theft of your covered"auto", damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age Page 2 of 3 ©2015 The Travelers Indemnity company.All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance services Office,Inc.with its permission, COMMERCIAL AUTO K. AIRBAGS (2) Any: The following Is added to Paragraph B.3., Exclu- (a) Overdue lease or loan payments at the sions, of SECTION III — PHYSICAL DAMAGE time of the"loss"; COVERAGE; (b) Financial penalties imposed under a Exclusion 3,a. does not apply to "loss" to one or lease for excessive use, abnormal wear more alrbags in a covered "auto"you own that in- and tear or high mileage; flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto" is a covered "auto"for Corriere- (d) Costs for extended warranties, Credit Life hensive Coverage under this policy; Insurance, Health, Accident or Disability b. The airbags are not covered under any war- Insurance purchased with the loan or rarity; and lease; and c. The airbags were not Intentionally inflated. (e) Carry-over balances from previous loans or leases. We will pay up to a maximum of$1.000 for any M. BLANKET WAIVER OF SUBROGATION one"loss". L. AUTO LOAN LEASE GAP The following replaces Paragraph A,5., Transfer Of Rights Of Recovery Against Others To Us, The following is added to Paragraph A.4., Cover. of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private 5. Transfer Of Rights Of Recovery Against Passenger Type Vehicles Others To Us In the event of a total"loss"to a covered"auto" of We waive any right of recovery we may have the private passenger type shown In the Schedule against any person or organization to the ex- or Declarations for which Physical Damage Cov- tent required of you by a written contract exe- erage is provided, we will pay any unpaid amount cuted prior to any "accident" or "loss", pro- due on the lease or loan for such covered "auto" vided that the"accident" or"loss"arises out of less the following: the operations contemplated by such con- (1) The amount paid under the Physical Damage tract.The waiver applies only to the person or Coverage Section of the policy for that"auto"; organization designated In such contract. and CA T4 20 02 15 02e15 The Travelers Indemnity Company.All rights reserved, Page.3 of 3 Includes copyrighted material of Insurance Sorvices Office,Inc.with Its permission. ii