HomeMy WebLinkAboutPW15-232 - Insurance Certificate - South 224th Street Project - Geotechnical Value Engineering Services i
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Client#: 330606 SHANNWIL11
ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM YYJ
6/02l2015
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(les)must b-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
NAME:
Kibble& Prentice,a USI Co PR PHONE 206 441.6300 FAX 610-362.8530
HIM No Exl: IA1C No):
601 Union Street,Suite 1000 E-MAIL st k - _
Seattle,WA 98101 ADDRESS: pLcertre u q _.e @ p-com.com _
INSURER(S)AFFORDING COVERAGE _ NAIC#
_ INSURER A:Lloyd's of London - 85202
INSURED Shannon &Wilson, Inc. INSURER8
P.O.Box 300303 INSURER C:
Seattle,WA 98103 INSURER D: _
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD
INDICATED. NOTWITI ISTANDING ANY REQUIREMENT, PERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WI'IICH 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.
INSR - -- ADD L SUBF FOLIGYEFF POLICY EXP _
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO BEN I ED
COMMERCIAL GENERAL LIARILrrY PREMISES Ea occurrence $ _
CLAIMS-MADE 1:1OCCUR MED EXP(Any one person) $ _
PERSONAL&ADV INJURY $
GENERALAGGREGATE $
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $
POLICY 7 PRO-
JECT E LOG - - §
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT'
Ea eco1d nD_
ANY AUTO HODILY INJURY(Per person) S
ALL OWNED SCHEDULED - - _
AUTOS AUTOS BODILY INJURY(Per awident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ -
AUTOS per accident
S
UMBRELLA LIAR rOCCUR EACH OCCURRENCE $
EXCESS LIAR -I CLAIMS-MADE
AGGREGATE $
DUD RETENTION$ _ _ $
WORKERS COMPENSATION
ILITY
IIIS
OTHF
IDENT
NFFOICEWryOM E�XCLUDEDZ ECUTIVE� NIA E.L.IDISEASECH CEA EMPLOYEE S
I(Mandator,in under _.._.
DESCRIPTION OF OPERATIONS below.._ E.L.DISEASE-
POLICY LIMIT S ".
A Professional LDUSA1504579 01/01/2015 01/011201E $2,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace is required)
South 224th Value Engineering Study
Value Engineering Study of the South 224th St Project in Kent,WA
Fife,WA
CERTIFICATE HOLDER CANCELLATION
City of Kent Washington SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Jeminl Davis ACCORDANCE WITH THE POLICY PROVISIONS.
City of Kent Engineering,400
West Grove AUTHORIZED REPRESENTATIVE
Kent,WA 98032 9RWIr� —
@ 1988.2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S152250561M14305941 EZGJU
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