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HomeMy WebLinkAboutPW18-148 - Insurance Certificate - A T & T - Liability Coverage 06/01/2019 - 06/01/2020 • `� /YYYY) ACORN DATE(MM/DD CERTIFICATE OF LIABILITY INSURANCE 051232019 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 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). PRODUCER CONTACT US Centralized Services Marsh USA Inc. NAME., 701 Market Street,Suite 1100 PHCNN Ext: 866-966A664 (FAX, No St.Louis,Ce 63101 ADDRESS: Att.CertRequest@marsh.com Attn:ATT.CertRequest@marsh.com INSURERS AFFORDING COVERAGE NAIC S CN103150778-GAW-CRT-19-20 X X INSURER A:Old Republic Insurance Company 24147 INSURED INSURERS: New Cingular Wireless PCS,LLC 208 South Akard Street,Room 2731 INSURER C: Dallas,TX 85301 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-009263742-05 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IPOLICY EFF POLICY EXP �TRR TYPE OF INSURANCE ADDL SWyo UER POLICY NUMBER MM/DD/YYYY) 1MMIDOIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 31363619 06/012019 06/01/2020 EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE X OCCUR DAMAGET RENTED 1,000,000 —. PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY❑ PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWTB31363519 06/012019 06/01/2020 COMBINED SINGLE LIMIT $ 5,000,000 Ea accident A X ANY AUTO MWZX 31363719(MI) 06/012019 06/01/2020 BODILY INJURY(Per person) $ OWNE SD ONLY AUTOS SCHEDULED BODILY INJURY(Per accident) $ AUTO HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION MWC 31363819 / 06/01/20 00 X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBEREXCLUC F NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation I MWXS 31363919(OH,WA) 06/012019 06/01/2020 EL Each Accident/EL Disease 1,000,000 Employers'Liability See Second Page EL Disease-Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City,officers,officials&employees is/are included as Additional Insured under the General Liability policy but only with respect to the requirements of the contract between the Certificate Holder and the Insured. Waiver of Subrogation is provided for General Liability,as required by written contract and allowable by law. This insurance is primary with respect to the interest of the Additional Insured and any other insurance maintained by Additional Insured is excess and non-contributory with this insurance. CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Law Department c/o Kelly Finn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD P\0►� -r°� AGENCY CUSTOMER ID: CN103150778 LOC#: St. Louis ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. New Cingular Wireless PCS,LLC 208 South Akard Street,Room 2731 POLICY NUMBER Dallas,TX 85301 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Excess Workers Compensation-MWXS 31363919(OH-WA) Self Insured Retentions OH&WA-$500,000,000(except Terrorism) OH&WA-$600,000,000 Terrorism Excess Automobile Liability-MWZX MWZX 31363719(MI) Combined Single Limit-$1,000,000 Self Insured Retention-$1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Paragraph 2. of SECTION II -WHO IS AN INSURED is amended to include any person or organization for whom you have agreed under contract or agreement to provide insurance. However, the insurance provided shall not exceed the scope of coverage or limits of this policy. Notwithstanding the foregoing sentence, in no event shall the insurance provided exceed the scope of coverage or limits required by said contract or agreement. Where required by contract, we will consider our policy to be primary under any other insurance maintained by the additional insured for injury or damage covered by this endorsement and that their policy will be noncontributing with this insurance. GL 739 006a 0609 M11UZY 313636 19 AT&T Inc 06/01 f2019-06/01/2020