HomeMy WebLinkAboutEC15-102 - Insurance Certificate - Barghausen Consulting Engineers, Inc. - Certificate of Insurance - 02/26/2016 0 DATE IMMt=YYYY)
CERTIFICATE OF LIABILITY INSURANCE
F2/29/2016
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(ies) must be endorsed. If SUBROGATION is 1 JAIVED, 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 NAME:
Gail Scott
Arthur J. Gallagher Risk Manageinent Services, Inc, PHO I N E F I A 11 X 1 -45-1-3 1 716
P.O. Box 367 (AIC No"t,,): 425-5816-11031 WC rja)� 425
E-ML
Bellevue WA 98009-0367 ADDAIRESS,Bail scott(d)ajg,cor-n
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A Mational Surety Corporation ;21881
INSURED INSURER:6:
Barghausen Consulting Engineers, Inc, INSURER C
18215 - 721r
id Avenue South INSURER D.
K N- J, WA 98032-1006
INSURER F
INSURER:F:
COVERAGES CERTIFICATE NUMBER: 1 1 89561 599 REVISION NUMBER:
THIS IS '10 CER I IFY I I IAT I HE POLICIES OF INSURANCE LISTED BELOW HAVE BF_.EN ISSUFE'D 10 IIA E INSURED NAMED ABOVE FOR THE POFICY F'Ewol)
INI)ICATED. NOTWI JrI I SIANDING ANY RE()UIRFMENr, TE_RM OR CONDHION 01' ANY CONTRACT OR 011-IER DOCUMENT WITH RESPECI ro wl-j[cFl 11-11s
:LRIIFICATE MAY BE ISSUED OR MAY PERTAIN, fl-fl` INSURANCE WrF 0RDED BY THE P0lIG'IE1.) DESCRIBED HEREIN IS SUBJECI TO ALL ]HE TFRMS,
t,",XCLUS IONS AND COND TiONS OF SUCH POLICIES,LIMITS SHOWN MAY lrrIAVE BEEN REDUCED BY PAO CLAIMS.
RhiSR 'ADDL�SUBR P I OL IC,Y''E_F,F POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLJCY NUMBER (MMfDDIYYYY) (MMIDDJYYYY) LIMITS
A x COMMEAI RCMIAL MAD GENERAL.LIAB OCCUR ILITY MIX80968781 2126/201F3 212N2017
EACH occuRRENicE s2,000,000
FIAME TO RENTF0
CLS- C X $1,000,000
x JAEOEXP(Any onelvwn) $5,000
PERSIONAL&A0V I�I URY $ '900
GEN'L AGGREC,A rE UMI F APPLIFS PEII. GENERAL AGGRE:C;AI-E $2,000,0(0
F 1�yX PRO
LOC ODUCS-CO 00O , 0,
ONIER:A AUTOMOBILE LIABILITY MZXB()968781 2126/2016 212C4201 i ,r7� S1,0 -
(,Ea c a ,�Kje III ..... 00,000
X ANY AU I RODILY INJURY(Por penAxi) S
Al-1:OWNED D SCHF17FULFl)
AU FOS AUT05 BODILY INJURY(Per accrderrt) S
N(.)N-0WNED PROPI.MTY DAMA�,F
HIRED AUTO S AIJ to,-; (I or accidew
UMBRELLA LIAB OCCUR EACH OCCURRLNCE
EXCESS LIAB CLAIMS-MADE AGGREGA7E S
DED RLlLNTIQN$
A WORKERS COMPENSATION MZX80968781 WA Stop Gap 2126/2016 2/26/201 SU I F P 0JII_
IAI I�
AND EMPL YIN
OYERS'LIAE31LITY -,1- 1
OFFICERINIEMBER EXCLUDED —. NIA F�I_�_EACH ACCII EN $1,00r),000 ANY PRO��RIE'pOrtfPA��,rNERJEWI:Ct)TIVE�. [_N
(Mandatory in N14) El.DISEASF EMM OYFF,' $1,0001,0�)()
II m,J nxdbu"TKtur I I I I'll I I ' "D SCRIIII-ION OF OPERA"TIONS bOow C L.01$EASE-POLICY LIMI I-� $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGORD 101,AddIllonal Renwrks Schadule,may bo aUachod If triore space is toc(uired)
Workers Compensation covered by ftashington State Industrial with Dept. of Labor & Industries,
Re: Operations of the Narned Insured/City of Kent Permits 'The Clity of KEHit, its clactcd and/or appointed Officials, its Officers, Employees,
Agents, Volunteers, and Representatives are Additional Insureds as respects work, obligations and activities performed by the
Owner/Developer and Authorized by the City of Kent porrTift.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Cy y wi of Kent ACCORDANCE TI-I THE POLICY PROVISIONS.
City
Kent Engineering Div
220 4th Avenue South AUTHOWZED REPRESENTATIVE
Kent WA 98032 USA
10 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD C,C VC5— 10_)_