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HomeMy WebLinkAboutPW18-146 - Insurance Certificate - Zayo Group, LLC - Liability Coverage - 08/01/2019 Page 1 of 1 aATE(MMDDNYY �R�`� CERTIFICATE OF LIABILITY INSURANCE FD07/25/2019Y) 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 NAME: Willis of Colorado, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd A1C No: E-MAIL certificates@willis.com P.O. Box 305191 ADDRESS: @ Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE LL NAIC# INSURERA: Great Northern Insurance Company 20303 INSURED INSURERB: Federal Insurance Company 20281 Zayo Group, LLC --- -- 1805 29th Street, Suite 2050 INSURERC: Sentry Casualty Company 28460 Boulder, CO 80301 USA INSURER D: INSURER E: INSURER F: -- COVERAGES CERTIFICATE NUMBER:W12114171 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. 1NSR TYPEOFINSURANCE pbbL$UBR -- - ----- POLICYrFF POLtCYEXP - LIMITS - -LTR POLICY NUMBER MMlDD/YYYY ! MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE15 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence)_ $,__ 1 000,000 A i MED EXP(Any one person) $ 10,000 3604-53-52 08/01/2019�08/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE :$ 2,000,000 POLICY X PRO- JECT LOC PRODUCTS-COMPIOP AGG .$ 2,000,000 OTHER:u $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 __ Ea ancid nl) X ANY AUTO BODILY INJURY(Per person) $ S OWNED SCHEDULED 7359-90-$5 08/O1/2019 08/01/2020i BODILYINJURV(Peraccident); $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ B X UMBRELLALIAB X!OCCUR EACHOCCURRENCE $ 51000,000 EXCESS LIAR CLAIMS-MADE 7989-77-47 08/01/2019 08/01/2020 AGGREGATE $ 5,000,000 DED ! X RETENTION$ 10,000 _ WORKERS COMPENSATION X PER O H AND EMPLOYERS'LIABILITY YIN .STATUTE ER C ECU7IVE 1,000,000 OFFICER/M MBEREXCLU ED? No NIA 90-20463-01 01/01/2019 i 01/01/2020 i E.L.EACH ACCIDENT L$ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE!`!$ 1,000,000 II yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ,$ C Workers Compensation 90-20463-02 01/01/2019,01/01/2020'E.L. Each Accident $1,0001000 s Employers Liability E.L.Disease-Each Emp ',:$1,000,000 Per Statute !E.L.Disease—Pol Limit$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is named as an Additional Insured as respects the ongoing operations of the Named Insured with respects to General and Auto Liability coverage as required by written and signed contract subject to policy terms, conditions, limits and exclusions. 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 Fourth Ave S A�Cjj//_ ®�.y��y//Y Kent, WA 98032 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD sR ID: 18291220 BATCH: 1297890 2 of 3 5173 Page 1 of 1 A R0� DATE(MM D ) CERTIFICATE OF LIABILITY INSURANCE 07/25l20192019 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 NAME: Willis of Colorado, Inc. c/o 26 Century Blvd PHNo,E EX • 1-877-945-7378 a ON C No: 1-888-467-2378 E-MAIL certificates@willis.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Great Northern Insurance company 20303 INSURED INSURERB: Federal Insurance Company 20281 Zayo Group, LLC -- -- - 1805 29th Street, Suite 2050 INSURERC: Sentry Casualty Company 28460 Boulder, CO 80301 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W12114170 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. ILTR TYPEOFINSURANCE ADDL5UBR- POLICY NUMBER MMILD'M MMIDDYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR 1 000,000 A MED EXP(Any one person) $ 10,000 3604-53-52 OB/O1/2019'08/O1/2020! PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY, X JE O LOC PRODUCTS COMPrOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ _LEa.accident) X ANY AUTO BODILY INJURY(Per person) ;$ 8 OWNED %: SCHEDULED 7359-90-85 08/01/20191I08/01/2020'_ BODILY INJURY(Per accident)1; $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY I $ _ LPer accident) , B X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 7989-77-47 08/OS/20191,08/01/2020' AGGREGATE $ 5,000,000 DED X' RETENTION$10,000 _ $ WORKERS COMPENSATION X PER ERH AND EMPLOYERS'LIABILITY r--- — YIN C ANYPROPRIETOR!PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDEI No !NIA 90-20463-01 01/01/2019101/01/2020' ' - (Mandatory in NH) E.L.DISEASE EA EMPLOYEE$ 1,000,000 II es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ C 'workers Compensation 90-20463-02 01/01/2019,01/01/2020:E.L. Each Accident ,$1,000,000 b Employers Liability - 'E.L.Disease-Bach Emp ;$1,000,000 Per Statute "IE.L.Disease-Pol Limit$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Additional Named Insured Includes: AboveNet Communications, Inc. The City of Kent, its officers, officials, employees, agents and assigns are recognized as an Additional Insured under General, Auto and Umbrella Liability but solely as respects liability arising from the Named Insured's operations and/or work performed by the Named Insured, ATIMA. . This coverage shall apply separately to each insured. This insurance shall be primary. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Rent AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South Attn: City Clark Kent Rent, WA 98403 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sa rD: 18291220 aATCH: 1297890 2 of 2 5176 Page 1 of 1 n,. ,acokr� CERTIFICATE OF LIABILITY INSURANCE DATE(MMD 07/25/ 4192019) ��. 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. It 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: Willis of Colorado, Inc. c/o 26 Century Blvd q ONW,Ex ; 1-877-945-7378 A/C No: 1-888-467-2378 E-MAIL certifices�willis.com _ P.O. Box 305191 ADDRESS: at__ Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE — NAIC# INSURERA: Great Northern Insurance Company 20303 INSURED INSURERB: Federal Insurance Company 20281 Zayo Group, LLC ----- ' — 1805 29th Street, Suite 2050 INSURERC: Sentry Casualty Company 28460 Boulder, CO 80301 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W12114172 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. INSR TYPE OF INSURANCE_. .____._ TAbDL SUER: _ ___ _. __-.. ___. POUCY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYY MM/DD,YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED j CLAIMS-MADE I X OCCUR PREMISES_(Ea occurrenceZ $ 1,000,000 A ! MED EXP lAny one person) $ 10,000 3604-53-52 08/01/2019l08/01/2020' PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY X JEOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ j AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 LEa accident)-___ X ANY AUTO BODILY INJURY(Per person) $ a OWNED t— SCHEDULED 7359-90-85 08/01/2019 08/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY ', (Per accident) B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS-MADE 7989-77-47 08/01/2019 08/01/2020 AGGREGATE $ 51000,000 i DED X: RETENTION$ 10,000 $ WORKERS COMPENSATION xr PER AND EMPLOYERS'LIABILITY STATUTE ER -- C ANYPROPRIETOR.'PARTNER,,EXECUTIVE t E.L.EACH ACCIDENT $ 1,000,000 OFFICERWEMBEREXCLUDED? No !NIA 90-20463-01 01/01/2019''.01/01/2020 -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE)$ 1,000,000 If yes.describe under �— 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT is C .Workers Compensation 90-211"3-02 --- 01/01/2019 01/01/20201X-X:.-Each Accident-- ,ODO,-OD-fi- 6 Employers Liability E.L.Disease-Each Emp ''.$1,000,000 Per Statute E.L.Disease-Pol Limit$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS:VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CITY OF KENT IS INCLUDED AS ADDITIONAL INSURED UNDER GENERAL LIABILITY AS REQUIRED BY WRITTEN CONTRACT, SUBJECT TO POLICY TERMS, CONDITIONS & EXCLUSIONS, WITH THE NAMED INSURED. RE: FRANCHISE/PERMITS. 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 Avenue, S Ken Kent,, WA 98032 UP 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID_ 18291220 BATcH: 1297890 3 of 3 5173 C H U B B• Liability Insurance Endorsement Policy Period August 1, 2019 to August 1, 2020 Effective Date August 1, 2019 Policy Number 3604-53-52 DEN Insured Zavo Group LLC Name of Company Great Northern Insurance Company Date Issued August 1, 2019 This Endorsement applies to the following forms: GENERAL IJABII= Under Who Is An Insured,the following provision is Who is An Insured Additional Insured- Persons or organizations shown in the Schedule are insureds;but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However,the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur,in whole or in part,before the execution of the contract or agreement;and • with),r--q=t to damages,loss,cost ur--per---for injury or damage tc wL h this iam raxce applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section(regardless of any limitation applicable thereto). • with respect to any assumption of liability(of another person or organization)by them in a contract or agreement.This limitation does not apply to the liability for damages,loss,cost or expense for injury or damage,to which this insurance applies,that the person or organization would have in the absence of such contract or agreement. Liability Insurance Addltio►al Insured-Schaduisd Person Or Organization cand-wd Form 2 (Rev.5-M Endarsarnant page I a CHUBB' Liability Endorsement (continued) Under Conditions,the following provision is added to the condition titled Other Insurance. Conditions Ofher Insurance— If you are obligated,pursuant to a contract or agreement,to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy,then in such case Insurance—Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization, Schedule Persons-or organizations that you are obligated,pursuant w a contractor agreement,w provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representatives Liability Insurance Additional Insured-Scheduied Person Or Organtzabw kw~ Form 7( 7) Embrannent __ Papa 2 Page 1 of 2 DATE(MM/DD/YYYY) ACC)IIR" CERTIFICATE OF LIABILITY INSURANCE 09/30/2019 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 NAME: Willis of Colorado, Inc. c/o 26 Century Blvd A/CN No, Ed: 1-877-945-7378 A/C,No): 1-688-467-237$ P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE ! NAIC# INSURER A: Great Northern Insurance Company 20303 INSURED INSURERB: Federal Insurance Company 20281 Zayo Group, LLC 1805 29th Street, Suite 2050 INSURER C: Sentry Casualty Company 28460 Boulder, CO 80301 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W13198732 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. INSR TYpE OF INSURANCE ADDLISUBR POLICY EFF POLICY EXP LIMITS LTR N '.WVD' POLICY NUMBER MM/DD MM/DD X I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 CLAIMS-MADE � OCCUR PREMISES Ea occurrence I$ — - A III MED EXP(Any one person) 1$ 10,0001 Y Y 3604-53-52 Ii08/01/2019'08/O1/2020�' T 1 r i PERSONAL 8 ADV INJURY $ _ ,000,00� GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I^J POLICY! x , PRO-JECT �'`_ LOC j PROD MP/OPAGG�i $ __2,000 ,OOG r" OTHER: is__ I AUTOMOBILE LIABILITY �COMBINED SINGLE LIMIT $ 1,000,000E Ea accident X ii ANY AUTO j1 BODILY INJURY(Per person) $ H ! OWNED SCHEDULED Y 7359-90-85 08/01/2019 08/01/2020; BODILY INJURY(Per accident)',S I AUTOS ONLY AUTOS HIRED NON-OWNED I PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY is accident) I $ H X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 5,000,000 EXCESS LIAB CLAIMS-MADE Y 7989-77-47 08/01/2019108/01/2020 AGGREGATE $ 5,000,000 DIEDx RETENTION$ 10,000 c WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY Y!N STATUTE ER _ 1 000 OOL C OFFICE IM E BERE EXCLUDED? E.L.EACH ACCIDENT $ __ (Mandatory EREXCLUDED7 No N/A 90-20463-01 j01/01/2019,01/01/2020. (Mandatory in Ni E.L.DISEASE-EA EMPLOYEE!$ 1,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ i.�r„crY.e_s Compensation 90-2114EL-02 '01101/2�.B��'_-JOi/2020'�E.L. Bach Accicien.. ''.$?,C00,O,u ---- 4 Employers Liability E.L.Disease-Each Emp ll$1 1 000 1 000 IPer Statute E.L.Disease-Pol Limit,,$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SEE ATTACHED 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 Rent Attn: City Clerk AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South Rent, WA 98403 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sB ID: 18606346 BATCH: 1389931 AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis of Colorado, inc. Zayo Group, LLC 1805 29th Street, Suite 2050 POLICY NUMBER Boulder, CO 80301 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The City, its officers, officials, boards, commissions, employees, and agents are included as Additional Insureds as respects to General Liability and Auto Liability. General Liability and Auto Liability policies shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability. Umbrella/Excess Follows Form. INSURER AFFORDING COVERAGE: Great Northern Insurance Company NAIC#: 20303 POLICY NUMBER: 3604-53-52 EFF DATE: 08/01/2019 EXP DATE: 08/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Stop Gap Coverage Aggregate $1,000,000 North Dakota, Ohio, Washington, Bodily Inj - Accident $1,000,000 6 Wyoming Bodily Inj - Disease $1,000,000 4 f Y ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 18606346 BATCH: 1389931 CERT: W13198732 Page 1 of 1 ,4cc�► r��' CERTIFICATE OF LIABILITY INSURANCE FD12/24ATE iD2019 ) lz/za/zo19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center _ Willis of Colorado, Inc. PHONNAME___ E c/o 26 Century Blvd NA!CNo:1-877-945-737$ FAX 1-886-467-2378 P.O. Box 305191 E-MAIL certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDINti_COVERA_GE NAIC# INSURER A: Great Northern Insurance Company ! 20303 INSURED Federal Insurance Company ! 202$1 Zayo Group, LLC INSURER B: __.__ _, _, 1805 29th street, suite 2050 INSURERC: sentry Casualty Company 28460 Boulder, CO 80301 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:W14961771 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP LTR TYPE OFtNaURANCE 1NSR - AbdL$U6Rj POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1 PR ESO MISRbN Ea occurrence $ 1,000,000 A MED EXP(Any one person) ! $ 10,000 3604-53-52 08/01/2019 08/01/2020 PERSONAL&ADV INJURY ' $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO- __. POLICY X JECT LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _jE-a accident. Is 11000,000 X ANY AUTO BODILY INJURY(Per person) Is B OWNED SCHEDULED 7359-90-85 08/01/2019I08/01/2020` BODILY INJURY(Per accident)`:$ AUTOS ONLY AUTOS PROPERTYDAMAGE HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY (Per eccldent) B X UMBRELLA UAB X OCCUR EACH OCCURRENCE is 5,000,000 -- - - EXCESS UAB CLAIMS-MADE 7989-77-47 08/01/2019 08/01/2020, AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 Is WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y N - C ANYPROPRIETOR'PARTNERIEXECUTIVE - E.L.EACH ACCIDENT $ 1,000,000 OFFICER,MEMBEREXCLUDED? No :NIA 90-20463-01 01/01/2020 01/01/2021 - -------- (Mandatory to NH) E.L.DISEASE EA EMPLOYEE $ 11000,000 II yes.describe under -----.._-_-- _-- DESCRIPTION OF OPERATIONS below E.L.DtSFA" POLICY LIMIT $ 11000,000 C Workers Compensation 90-20463-02 01/01/2020.01/01/2021 E.L. Each Accident $1,000,000 6 Employers Liability E.L.Disease—Each Emp $1,000,000 Per Statute E.L.Disease—Pol Limit$1,000,000 DESCRIPTION OF OPERATIONS%LOCATIONS,VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached it more space is required) Additional Named Insured Includes: AboveNet Communications, Inc. The City of Kent, its officers, officials, employees, agents and assigns are recognized as an Additional Insured under General, Auto and Umbrella Liability but solely as respects liability arising from the Named Insured's operations and/or work performed by the Named Insured, ATIMA. . This coverage shall apply separately to each insured. This insurance shall be primary. 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 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Attn: City Clerk Kentf G!• L+1i Kent, WA 98403 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sn ID: 19011643 BATCH: 1504589 2 d 3 27429 l Page 1 of 1 AC_C�RD11 CERTIFICATE OF LIABILITY INSURANCE FDATE(MM,'DD,YYYY) t�,.� 12/24/2019 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 IINSURER ACT Willis Towers Watson Certificate Center ______ Willis of Colorado, Inc. E 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd AIC No P.O. Box 305191 L certificates@willia.com ESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# A: Great Northern Insurance Company 20303 INSURED INSURERB: Federal Insurance Company 20281 2ayo Group, LLC - 1805 29th Street, suite 2050 INSURERC: Sentry casualty Company 28460 Boulder, CO 80301 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:W14961774 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. INSR- -. .ADOL§UBRI. POLICY EFF POLICY EXP LTR TYPEOFINSURANCEINSO i VVVDPOLICYNUMBER MMlDDIYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 I CLAIMS-MADE X OCCUR ' DAMAGE ETO RENTFO occurrencel_ $ 1,000,000 A ! MED EXP(Any one person) $ L0,000 3604-53-52 08/01/2019 08/Ol/2020 PERSONAL&ADV INJURY is 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY i x JEQ LOC I PRODUCTS COMP/OP AGG ;$ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT jEa accident) $ 11000,000 X ANY AUTO BODILY INJURY(Per person) $ B OWNED j SCHEDULED I 7359-90-85 08/01/2019 08/01/2020' BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY leer dccideng UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB 71 CLAIMS-MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION x , PER - AND Y!N ; STATUTE I ER C ANY ROPRRIETOR PAIRTBNER/EX ECUTIVE No NIA ! E L EACH ACCIDENT $ 1,000,000 'OFFI„ER.;MEMBER EXCLUDED. 90-20463-01 01/01/2020 01/01/2021r_- `"-- -'-(Mandatory inin NH) 1 E.L.DISEASE EA EMPLOYEEI$ 1,000,000 It yes,describe under -- -- -- DESCRIPTION OF OPERATIONS below EI-JXSEASE-POLICY LIMIT I$ 1,000,000 C Workers Compensation 90-20463-02 01/01/2020101/01/2021 E.L. Each Accident 1$1,000,000 s Employers Liability E.L.Disease-Each Emp?$1,000,000 Per Statute E.L.Disease-Pol Limit $1,000,000 DESCRIPTION OF OPERATIONS'LOCATIONS,VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached it more space is required) 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 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Attn: City Clerk Kent Kent, WA 9$403 Oc 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR ID: 19011643 BATCH: 1504589 3 of 3 27429 Page 1 of 2 ! �'' DATE(MM;DDNYYY) Af �' CERTIFICATE OF LIABILITY INSURANCE 12/24/2019 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 Willis Towers Watson Certificate Center NAME_-- ---- --------- —Willis of Colorado, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 A C No: c/o 26 Century Blvd E-MAIL P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Great Northern insurance Company 20303 INSURED INSURERS: Federal insurance Company 20281 Zayo Group, LLC -- - --------- 1805 29th street, suite 2050 INSUREFIC: sentry Casualty company 28460 Boulder, CO 80301 INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:W14961773 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. INSR __._...-.. . . - ADOL§UBR:-- - -.. LTR TVPE OFINSURANCE POLICY NUMBER ^MMDCDYY MM 6 YYYV LIMITS X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000 DAMAGE TO HEN It:U CLAIMS-MADE X I OCCUR PREM SES occurrence] i$ EXP(An one person) 1,000,000 A MED $ 10,000 j I Y Y 3604-53-52 �108/Ol/2019 08/01/2020 GSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 OTHER PRO- _ --- - _— POLICY X PRODUCTS-COMP%OP AGO 1$JECT LOC i I 2,000,000 $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1,000,000 LEa accident) X ANY AUTO BODILY INJURY(Per person) i$ B OWNED �— SCHEDULED Y 7359-90-85 08/01/2019'08/01/2020i BODILY INJURY(Per accident)�$ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOfi ONLY AUTOS ONLY Per agcidegt)--___,_-, X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 B ---- EXCESS LIAB CLAIMS-MADE Y 7989-77-47 08/01/2019 08/01/2020 AGGREGATE $ 5,000,000 __ _ -_ DED X' RETENTION$ 10,000 $ WORKERS COMPENSATION IX i STATUTE ER OTH- AND EMPLOYERS LIABILITY C ANYPROPRIETORPARTNERiEXECUTIVE YIN ELL ACH ACCIDENT $ 1,000,000 OFFICER'MEMBEREXCLUDED? No .NIA 90-20463-01 01/01/2020'O1/O1/2021 --- ----- ---_.- (Mandatory In NH) SEASE EA EMPLOYEE S _ 1,000,000 It Yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ C Workers Compensation 90-20463-02 01/01/2020l01/01/2021IE.L. Each Accident $1,OOD,000 I I s Employers Liability !E.L.Disease-Each Emp1$1,000,000 Per Statute I E.L.Disease-Pol Limil!$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS,VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) SEE ATTACHED 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 Attn: City Clerk AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South Kent, WA 98403 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR IV: 19011643 BATCH: 1504589 2 of 3 27430 AGENCY CUSTOMER ID: LOC#: A`COR" ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED Willis of Colorado, Inc. Zayo Group, LLC 1805 29th Street, Suite 2050 POLICY NUMBER Boulder, CO 80301 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The City, its officers, officials, boards, commissions, employees, and agents are included as Additional Insureds as respects to General Liability and Auto Liability. General Liability and Auto Liability policies shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability. Umbrella/Excess Follows Form. INSURER AFFORDING COVERAGE: Great Northern Insurance Company NAIC#: 20303 POLICY NUMBER: 3604-53-52 EFF DATE: 08/01/2019 EXP DATE: 08/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Stop Gap Coverage Aggregate $1,000,000 North Dakota, Ohio, Washington, Bodily Inj - Accident $1,000,000 6 Wyoming Bodily Inj - Disease $1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 19011643 BATCH: 1504589 CERT: W14961773 C H U B B° Liability Insurance Endorsement Policy Period August 1, 2019 to August 1, 2020 Effective Date August 1, 2019 Policy Number 3604-53-52 DEN Insured Zayo Group LLC Name of Company Great Northern Insurance Company Date Issued August 1, 2019 This Endorsement applies to the following forms: GENERAL LLkBII.rrY Under Who Is An Insured,the following provision is added. Who Is An Insured Additional Insured- Persons or organizations shown in the Schedule are insureds;but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to pmvidc them with such insurance as is afforded by Or Organization this policy. However,the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur,in whole or in part,before the execution of the contract or agreement;and Wfth-ft-Wect-to cMr es oTss,Cass expense�r tafiuy o�ardige fo wb-icc t1~tffi-s idgu--mace — — applies. No person or organisation is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section(regardless of any limitation applicable thereto). • with respect to any assumption of liability(of another person or organization)by them in a contract or agreement.This limitation does not apply to the liability for damages,loss,cost or expense for injury or damage,to which this insurance applies,that the person or organization would have in the absence of such contract or agreement. Liability Insurance AddVonelInsured-scheduled Person 0,Organ4zation contkwed Fbrrn80-W-"3s7(Rev.5-07) Endorsement � _�-,_ ._ __. _-•--_- ___ Page 1.__ 3 of 3 27430 CHUBS' Liability Endorsement (continued) Under Conditions,the following provision is added to the condition titled Other Insurance. Conditions Other Insurance— If you are obligated,pursuant to a contract or agreement,to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy,then in such case Insurance—Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated,pursuant to a contract or agreement,to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Q-Jvk ' ., Liability Insurance Additions/Insured-Scheduled Person Or Organizedon iest page Joan W4*-2W(Rev.rrO7) F.ndorsonaant Papa 2 Page 1 of 1 'T> DATE(MM DD�VYYY) CERTIFICATE OF LIABILITY INSURANCE 12/24/2019 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 Willis Towers Watson Certificate Center NAME:JC _ Willis of Colorado, Inc. "PHONE 1-877-945-7378 (FAX No): 1-888-467-2378 c/o 26 Century Blvd EMAIL P.O. Box 305191 ADDRESS: certificates@will is.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICI! INSURER A: Great Northern Insurance Company 20303 INSURED INSURERB: Federal Insurance Company 20281 zayo Group, LLc 1805 29th Street, Suite 2050 INSURERC: sentry Casualty Company 28460 Boulder, Co 80301 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W14961772 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. ILTR TYPE OF INSURANCE ADDLSU INSD D I ­�' POLICY NUMBER— MM DD�YYYY POLICY ML bIY'YV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO ENTrz CLAIMS-MADE X OCCUR PR EM SE_S Ea occurrence $ 1,000,000 A MED EXP(Any one person) $ 10,000 3604-53-52 08/01/2019 08/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- JECT -----�. POLICY x LOC PRODUCTS COMP,OPAGG $ 2,000,000 I OTHER: ! $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 �Ea agciden)� X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 7359-90-85 08/01/2019,08/01/2020'' BODILY INJURY(Per acciderft) $ AUTOS ONLY AUTOS HIRED —I NON OWNED -PROPERTY DAMAGE $ AUTOS ONLY I1 AUTOS ONLY rr 11 � $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 7989-77-47 08/01/2019 08/01/20201 AGGREGATE $ 5,000,000 DED X RETENT ION$ 10,000 $ WORKERS COMPENSATION x 'STATUTE ER AND EMPLOYERS'LIABILITY Y/N C ANYPROPRIETOR•PARTNER'EXECUTIVE !NIA EACH ACCIDENT $ 1,000,000 OFFICERMEMBEREXCLUDE] No !NIA 90-20463-01 01/01/2020'01/01/20211— -- (Mandatory In NH) E L.DISEASE EA EMPLOYEE $ 1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE,POLICY LIMIT $ 1,000,000 C Workers Compensation 90-20463-02 01/01/2020,101/01/2021;E.L- Each Accident $1,000,000 6 Employers Liability IE.L.Di6ease-Each Emp $1,000,000 Per Statute iE.L.Disease-Pol Limit$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required) CITY OF KENT IS INCLUDED AS ADDITIONAL INSURED UNDER GENERAL LIABILITY AS REQUIRED BY WRITTEN CONTRACT, SUBJECT TO POLICY TERMS, CONDITIONS & EXCLUSIONS, WITH THE NAMED INSURED. RE: FRANCHISE/PERMITS. 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 Avenue, S Kent, WA 98032Y 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR ID: 19011643 BATCH: 1504589 203 27428 Page 1 of 1 AC DATE(MM,'DDVYYY) CERTIFICATE OF LIABILITY INSURANCE 12/24/2019 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 Willis Towers Watson Certificate Center NAME:_ _ ___ _ Willis of Colorado, Inc. FAX PHONE 1-877-945-7378 AJC No: 1-888-467-2378 c/o 26 Century Blvd P.O. Box 305191 ApDDRESS: certifi_c_ates@willis.com _ Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC* INSURERA: Great Northern Insurance Company 20303 INSURED INSURERS: Federal Insurance Company 20281 Eayo Group, LLC 1805 29th Street, Suite 2050 INSURER-C: Sentry Casualty Company 28460 Boulder, CO 80301 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W14961775 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. TYPE OF INSURANCE POLICY EFF POLI'Y EXP LIMITS INSR "A6 6L'SUBR CC LTR POLICY NUMBER MMiDDNYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS MADE X OCCUR PREMISES _ rrence)_ i$ 1,000,000 A ; MED EXP(Any one person) $ 10,000 I 3604-53-52 08/01/2019 08/01/2020'. PERSONAL&ADV INJURY $ 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY X PRO JECT LOC i PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1 000,000 X ANY AUTO BODILY INJURY(Per person) $ B OWNED r—' SCHEDULED 7359-90-85 08/01/2019 08/01/20201 BODILY INJURY(Per accident)f$ AUTOS ONLY AUTOS HIRED NON-OWNED , PR PO ERTYDAMAGE i$ AUTOS ONLY AUTOS ONLY �jPer accident) __ is B X UMBRELLA ILIA X OCCUR EACH OCCURRENCE i$ 5,000,000 EXCESS LIAB CLAIMS-MADE 7989-77-47 08/01/2019109/01/2020 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 is WORKERS COMPENSATION XPER - ± AND EMPLOYERS'LIABILITY y i N / / ' ER C ANYPROPRIETOR!PARTNER.!EXECUTIVE EL EACH ACCI DENT $ 1,000,000 OFFICER�MEMSEREXCLUDEI No NIA 90-20463-01 01/01/2020 Ol Ol 2021t--`- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe unde, ! 1,000,000 DESCRIPTION OF OPERATIONS below _ DISEASE-.POLICY.LIMIT,$. C Workers Compensation 90-20463-02 01/01/20201101/01/2021 E.L. Each Accident $1,000,000 b Employers Liability E.L.Disease-Each Emp $1,000,000 Per Statute iE.L.Disease-Pol Limit$1,000,000 DESCRIPTION OF OPERATIONS-LOCATIONS+VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is named as an Additional Insured as respects the ongoing operations of the Named Insured with respects to General and Auto Liability coverage as required by written and signed contract subject to policy terms, conditions, limits and exclusions. 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 Fourth Ave S Ken Kent, WA 98032 O 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR ID: 19011643 BATCH: 1504589 3 of 3 27428