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HomeMy WebLinkAboutCAG2019-032 - Insurance Certificate - Krazan & Associates, Inc. - 10/01/2019-10/01/2020 Liability CoverageSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/1/2019 Dealey,Renton &Associates P.O.Box 12675 Oakland CA 94604-2675 510-465-3090 510-452-2193 certificates@dealeyrenton.com Lexington Insurance Company 19437 KRAZAASSO Krazan &Associates,Inc. 215 West Dakota Avenue Clovis CA 93612 1718726708 A Professional and Pollution Liability 028174909 10/1/2019 10/1/2020 Per Claim Annual Aggregate $1,000,000 $1,000,000 KA Project #066-19017 /640 Pressure Zone Booster Pump Station,13300 SE 236th Place,Kent,WA. 30 Days Notice of Cancellation. City of Kent Attn:Phil McConnell 220 4th Avenue S. Kent WA 98032 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/4/2019 (WC) Heffernan Insurance Brokers 1350 Carlback Avenue Walnut Creek, CA 94596 Shelaine Gonsalves 925-934-8500 925-934-8278 ShelaineG@heffins.com Travelers Property Casualty Company of America 25674 KRAZ&AS-01 Krazan & Associates, Inc. 215 West Dakota Avenue Clovis, CA 93612 505836978 A X 1,000,000 X 100,000 X STOP GAP 5,000 X Deductible $0 1,000,000 2,000,000 X Y 6600F55445ATIL19 10/1/2019 10/1/2020 2,000,000 A 1,000,000 X X X Y 8100F55445ATIL19 10/1/2019 10/1/2020 A X X 1,000,000CUP9J292435194310/1/2019Y 10/1/2020 1,000,000 X 0 Re: KA Project #066-19017, Project #16-3012, 640 Pressure Zone Booster Station, 13300 SE 236th Place, Kent, WA. The City of Kent is included as an additional insured (primary and non-contributory) and includes product & completed operations on General Liability policy and additional insured (primary and non-contributory) on Automobile Liability policy per the attached endorsements, if required. The Umbrella Liability follows the General Liability policy for Additional Insured coverage as per policy forms, if required. Per project aggregate is included on General Liability policy per the attached endorsement, if required. Cancellation notice endorsements for General Liability and Automobile Liability policies are attached, if required. City of Kent Attn: Phil McConnell 220 4th Avenue S. Kent, WA 98032 POLICY NUMBER:6600F55445ATIL19 POLICY NUMBER:6600F55445ATIL19 CG D3 69 09 05 Page 1 of 2 © 2005 The St. Paul Travelers Companies, Inc. POLICY NUMBER: 6600F55445ATIL19 COMMERCIAL GENERAL LIABILITY ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): The City of Kent PROJECT/LOCATION OF COVERED OPERATIONS: KA Project #066-19017, Project #16-3012, 640 Pressure Zone Booster Station, 13300 SE 236th Place, Kent, WA. 1. WHO IS AN INSURED (Section II) is amended "written contract requiring insurance" for that to include the person or organization shown in the additional insured, the insurance provided to Schedule above, but: the additional insured shall be limited to the a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and limits of liability required by that "written con- tract requiring insurance". This endorsement shall not increase the limits of insurance de- a) If, and only to the extent that, the injury or scribed in SECTION III LIMITS OF INSUR- damage is caused by acts or omissions of ANCE. you or your subcontractor in the performance of "your work" on or for the project, or at the location, shown in the Schedule. The person or organization does not qualify as an addi- tional insured with respect to the independent acts or omissions of such person or organiza- tion. 1. The insurance provided to the additional insured b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to by this endorsement is limited as follows: prepare or approve, maps, shop draw- a) In the event that the Limits of Insurance of ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, this Coverage Part shown in the Declarations approving, or failing to prepare or ap- exceed the limits of liability required by a prove, drawings and specifications; and Page 2 of 2 CG D3 69 09 05 © 2005 The St. Paul Travelers Companies, Inc. COMMERCIAL GENERAL LIABILITY i. Supervisory, inspection, architectural or a) If a claim is made or "suit" is brought against engineering activities. the additional insured, the additional insured a) The insurance provided to the additional in- must: sured does not apply to "bodily injury" or i. Immediately record the specifics of the "property damage" caused by "your work" and included in the "products-completed opera- tions hazard". 1. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, ex - cess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if a "writ- claim or "suit" and the date received; and i. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit", cooperate with ten contract requiring insurance" for that addi- us in the investigation or settlement of the tional insured specifically requires that this insur- ance apply on a primary basis or a primary and claim or defense against the "suit", and oth- erwise comply with all policy conditions. non contributory basis, this insurance is primary c) The additional insured must tender the de- to "other insurance" available to the additional in- fense and indemnity of any claim or "suit" to sured which covers that person or organization as any provider of "other insurance" which would a named insured for such loss, and we will not cover the additional insured for a loss we share with that "other insurance". But the insur- cover under this endorsement. However, this ance provided to the additional insured by this condition does not affect whether the insur- endorsement still is excess over any valid and ance provided to the additional insured by this collectible "other insurance", whether primary, ex- endorsement is primary to "other insurance" cess, contingent or on any other basis, that is available to the additional insured which cov- available to the additional insured when that per- ers that person or organization as a named son or organization is an additional insured under insured as described in paragraph 3. above. such "other insurance". 5. The following definition is added to SECTION V. 1. As a condition of coverage provided to the addi- DEFINITIONS: tional insured by this endorsement: "Written contract requiring insurance" means a) The additional insured must give us written that part of any written contract or agreement notice as soon as practicable of an "occur- under which you are required to include a rence" or an offense which may result in a person or organization as an additional in- claim. To the extent possible, such notice sured on this Coverage Part, provided that should include: the "bodily injury" and "property damage" oc- i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; i. The nature and location of any injury or b. While that part of the contract or damage arising out of the "occurrence" or offense. agreement is in effect; and b. Before the end of the policy period. POLICY NUMBER: 6600F55445ATIL19 POLICY NUMBER:POLICY NUMBER:6600F55445ATIL19POPOLILICYCY N NUMUMBEBER:R: KA Project #066-19017, Project #16-3012, 640 Pressure Zone Booster Station, 13300 SE 236th Place, Kent, WA. POLICY NUMBER: 6600F55445ATIL19 KA Project #066-19017, Project #16-3012, 640 Pressure Zone Booster Station, 13300 SE 236th Place, Kent, WA. «A I_N ame » T16 POLICY NUMBER: 8100F55445ATIL19 The City of Kent 16 POLICY NUMBER:6600F55445ATIL19 POLICY NUMBER:6600F55445ATIL19 POLICY NUMBER:8100F55445ATIL19