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HomeMy WebLinkAboutCAG2019-040 - Insurance Certificate - CenturyLink - Liability Coverage - 09/01/2018 A�® CERTIFICATE OF LIABILITY INSURANCE D08/24/2018DYYYY) 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 endorsen ient(s). PRODUCER CONTACT Marsh USA Inc. NAME: - CA License#0437153 A/C No E:t: nAC No 1301 5th Avenue,Suite 1900 E-MAIL Seattle,WA 98101-2682 ADDRESS: Attn:Seattle.certrequest@marsh.com/Fax:212-948-4326 INSURERS AFFORDING COVERAGE NAIC# CN102197661-STND-ALL-1 8-19 INSURER A:Greenwich Insurance Company 22322 INSURED INSURER B:XL Specialty Insurance Co. 37885 CenturyLink,Inc.and all subsidiaries, - ----— including but not limited to:Qwest Communications International Inc.;Embarq Corporation; INSURER C:Allianz Underwriters Ins Co 36420 Level 3 Parent,LLC and Level 3 Communications,LLC INSURER D: 100 CenturyLink Drive,Mailstop 5TS154 - — - Monroe,LA 71203 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-00351 0 161-1 2 REVISION NUMBER: 0 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. INSR TYPE OF INSURANCE ADDL SUBRPOLICY LTR POLICY NUMBER (MMID D/YYYY MM DDYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY RGD500033306 09/01/2018 09/01/2019 EACH OCCURRENCE $ 3,000,000 CLAIMS-MADE a OCCUR PREMISES(Ea oDAMAGE TO ccur ante) $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 15,000,000 X POLICY PRO ❑JECT LOC PRODUCTS-COMP/OP AGG $ 15,000,000 OTHER: $ A AUTOMOBILE LIABILITY RAD500033406 09/01/2018 09/01/2019 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident X ANY AUTO Auto Physical Damage-Self Insured BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident _ $ X UMBRELLA LIAB X OCCUR ART3016558 09/01/2018 09/01/2019 EACH OCCURRENCE $ 10,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 DIED I I RETENTION$ $ B WORKERS COMPENSATION RWD500032906AOS 09/01/2019 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B Y/N RWR500033006 WI 09/01/2018 09/01/2019 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A RWE500033106-WA 09/01/2018 09/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 B If yes,describe under RWE500033206-OH 09/01/2018 09/01/2019 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Technology E&O incl. ART3016558 09/01/2018 09/01/2019 Each Claim/Aggregate 10,000,000 Cyber/Privacy Liability Retention 57000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Franchise Agreement.CITY OF KENT is included as Additional Insured on the General,Automobile,and Umbrella Liability Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attm City Clerk 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. Cheri Garrison ►yZ¢tta�fft -jy Cf2Mwryt ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD O'}61Of- G116 AGENCY CUSTOMER ID: CN102197661 LOC#: Seattle ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. CenturyLink,Inc.and all subsidiaries, including but not limited to:Qwest Communications International Inc.;Embarq Corporation; POLICY NUMBER Level 3 Parent,LLC and Level 3 Communications,LLC 100 CenturyLink Drive;Mailstop 5TS154 Monroe,LA 71203 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 -------------------GENERAL LIABILITY------------------- Automatic Additional Insured's Primary Coverage Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. Coverage provided by the above General Liability policy shall be primary and is limited to liability arising out of Named Insured's ownership and/or operations.Any insurance carried by the additional insured shall not be contributory insurance.Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-Any person or organization with whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Separation of Insureds Applies.Insurance covers incidents that occur within 50'of railroad property,any railroad exclusions have been deleted per endorsement CG2417. -------------------AUTOMOBILE LIABILITY-------------------- Additional Insured as respects your interest in the operations of the Named Insured as required by written contract.Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary,excess,contingent or on any other basis unless the contract specifically requires that this policy be primary. Lessor-Additional Insured and Loss Payee-All Lessors Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-Any person or organization with whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Separation of Insureds Applies. ---------WORKERS'COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS'COMPENSATION AND EMPLOYER'S LIABILITY(OH&WA-SELF-INSURED- $1,000,000 RETENTION) --------- Waiver of Our Right to Recover from Others(Waiver of Subrogation)-Any person or organization with whom you have entered into a contract or agreement,but only to the extent required by such contractor agreement. ------------------EXCESS/UMBRELLA------------------- Coverage applies per occurrence.Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement.Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-Any person or organization with whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Separation of Insureds Applies. -------------------COMMERCIAL CRIME-FIDELITY BOND------------------- Carrier:ACE American Insurance Company Policy Number:DONG23680075 005 Effective Dates:03/01/2018-03/01/2019 Each Occurrence:$10,000,000 -----------------U.S.PROPERTY------------------ Carrier:Allianz Underwriters Insurance Company Policy Number:ART 3016558 Effective Dates:03/15/2018-03/15/2019 Limit:$25,000,000 Deductible:$25,000,000 Property Coverage:"All Risk"of Direct Physical Loss or Damage to All Real and Personal Property,including Boiler&Machinery,Earthquake,Flood and Wind-Replacement Cost Basis,and Business Interruption-Actual Loss Sustained. Loss Payee or mortgagee as required by written contract/loan agreement to the the extent of your insurable interest.Waiver of Subrogation-Any person or organization whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Other deductibles may apply as per policy terms and conditions. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD