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HomeMy WebLinkAboutPK16-348 - Insurance Certificate - Rock Solid Trucking Inc. dba Bark Time Blower Truck Service - Certification of Liability Insurance - 9/9/2016 AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD/YYYY) `� 1 09/01/2016 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 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: PHONE FAX q LAl6 Npk._..._...._ LEGACY ONE INS SERVICES INC Ab..ESS, 750 SWIFT BLVD STE 4 INSURERS AFFORDING COVERAGE NAIC# RICHLAND WA 99352-3521 INSURERA: NATIONWIDE MUTUAL INSURANCE COMPANY 23787 INSURED INSURERS: AMCO INSURANCE COMPANY 19100 BARK TIME BLOWER TRUCK SERVICE INSURERC: DBA ROCK SOLID TRUCKING INC INSURERD: 2225 CHERRY RD INSURER E: LAKE STEVENS WA 98258-9532 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TI-IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR iADDL SURR --- POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSD Me POLICY NUMBER MMDDrYYYYI (MMIDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RE TED 100,000 CLAIMS-MAD[ OCCUR PREMISES Eaoccurrence $ 'X PDDedOcc250 NED EXPAny one person) $ 5,000 B X ACP GLAD 7545770723 09/07/2016 09/07/2017 'PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY JECT J LOC PRODUCTS-COMP/CP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ee ecddant ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED �( quiooULED X ACP BA 7545770723 09/07/2016 09/07/2017 BODILY INJURY tPer.s,ddent) $ AUTOS X X AUTOSWNED PPer.edden DAMAGE $ HIRED AUTOS UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,000 _ B EXCESS LIAB CLAIMS-MADE X ACP CAA 7545770723 09/07/2016 09/07/2017 AGGREGATE $ 2,000,000 OLD- - RETENTIONS I - -- $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STAT H- YIN UTE ERR _.—_- ANYPROPRIETORIPARTNEIUEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFPICERJMEMBER EXCLUDED? ---- !Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ X DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remark.Schedule,may be ett.nh.d If more space Is req.1rod) City of Kent is added as an additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Kent AUTHORIZED REPRESENTATIVE 220 4th Ave S Jeff Pomeroy Kent WA 98032 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD