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HomeMy WebLinkAboutCAG2020-048 - Insurance Certificate - Mayes Testing Engineers, Inc. - 01/01/2020-01/01/2021 Liability Coverage AC� DATE(MMIDD/YYYY) �, CERTIFICATE OF LIABILITY INSURANCE 1/1/2021 2i6i2020 THIS .;ERTIFICATE 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). CONTACT PRODUCER LOckton COmpanics NAME.' 444 W.47th Street,Suite 900 PHONE FAX Kansas City MO 64112-1906 E-MAIL ac No (816)960-9000 ADDRESS: INSURE S)AFFORDING COVERAGE NAIC S INSURER A:Lexiri on Insurance Company Compny 19437 INSURED MAYES TESTING ENGINEERS,INC. INSURER B:Travelers Property Casualty Co of America 25674 1312893 TERRACON CONSULTANTS,INC INSURER C:The Travelers Indemnity Company 25658 20225 CEDAR VALLEY RD INSURER D: LYNNWOOD WA 98036 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 16565891 REVISION NUMBER: XXXXXXX 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 1 _ADDLTYPE OF INSURANCE INSD UBR POLICY NUMBER MMIDDIIYYYY MM LTR /DIYYYY LIMITS LT B X COMMERCIAL GENERAL LIABILITY Y N TC2J-GLSA-1118L293 1/1/2020 1/1/2021 EACH OCCURRENCE $ 1,000,000 DAMAGECLAIMS-MADE �OCCUR PREMISES E.TORE $ 1 000 000 X CONTRACTUAL LIAB MED EXP(Any one person) $ 25 OOO X XCU COVERAGE PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY F PE LOC PRODUCTS-COMP/OP AGG $ 2 000 000 OTHER: 1 $ B AUTOMOBILE LIABILITY Y N TC2J-CAP-131J3858 1/1/2020 1/1/2021 CEOaac identSINGLE LIMIT $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED OS ONLY AUTOSULED BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per.,'7It $ XXXXXXX $ XXXXXXX UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ XXXXXXX B WORKERS COMPENSATION N X PER OTH- AND E TC2J-UB-6N32541-0(AOS)) 1/1/2020 1/1/2021 STATUTE ER MPLOYERS'LIABILITY C YIN ANY TRK-UB-6N32384-6 AZ,MA,WI 1/1/2020 1/1/2021 PROPRIETOR/PARTNER/EXECUTIVE ( E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? 7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1 000 000 If yyes,describe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 A PROFESSIONAL N N 26030216 1/1/2020 1/1/2021 $1,000,000 EACH CLAIM& LIABILITY $1,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. RE:M8191387 CITY OF KENT GRNRA SOUTH STORMWATER PUMP STATION.CITY OF KENT IS ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY,AND THESE COVERAGES ARE PRIMARY AND NON-CONTRIBUTORY,IF REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION See Attachments 16565891 CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 220 FOURTH AVENUE SOUTH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN KENT WA 98032 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE: ©1988`2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2J-GLSA-1 1 18L293 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - AUTOMATIC STATUS IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that: a. You agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part; and b. Has not been added as an additional insured for the same project by attachment of an endorsement under this Coverage Part which includes such person or organization in the endorsement's schedule; is an insured, but: a. Only with respect to liability for"bodily injury", "property damage" or"personal injury"; and b. Only as described in Paragraph (1), (2) or(3) below, whichever applies: (1) If the "Written contract requiring insurance" specifically requires you to provide additional insured coverage to that person or organization by the use of: (a) The Additional Insured - Owners, Lessees or Contractors - (Form B) endorsement CG 20 10 11 85; or (b) Either or both of the following: the Additional Insured - Owners, Lessees or Contractors - Scheduled Person Or Organization endorsement CG 20 10 10 01, or the Additional Insured - Owners, Lessees or Contractors - Completed Operations endorsement CG 20 37 10 01; the person or organization is an additional insured only if the injury or damage arises out of"your work" to which the "written contract requiring insurance" applies; (2) If the "written contract requiring insurance" specifically requires you to provide additional insured coverage to that person or organization by the use of: (a) The Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization endorsement CG 20 10 07 04 or CG 20 10 04 13, the Additional Insured - Owners, Lessees or Contractors - Completed Operations endorsement CG 20 37 07 04 or CG 20 37 04 13, or both of such endorsements with either of those edition dates; or (b) Either or both of the following: the Additional Insured - Owners, Lessees or Contractors - Scheduled Person Or Organization endorsement CG 20 10, or the Additional Insured Owners, Lessees or Contractors - Completed Operations endorsement CG 20 37, without an edition date of such endorsement specified; the person or organization is an additional insured only if the injury or damage is caused, in whole or in part, by acts or omissions of you or your subcontractor in the performance Miscellaneous Attachment: M482524 Certificate ID: 16565891 of"your work"to which the "written contract requiring insurance" applies; or (3) If neither Paragraph (1) nor(2) above applies: (a) The person or organization is an additional insured only if, and to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of"your work" to which the "written contract requiring insurance" applies; and (b) The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured will be limited to such minimum required limits of liability. For the purposes of determining whether this limitation applies, the minimum limits of liability required by the "written contract requiring insurance"will be considered to include the minimum limits of liability of any Umbrella or Excess liability coverage required for the additional insured by that"written contract requiring insurance". This endorsement will not increase the limits of insurance described in Section III - Limits Of Insurance. b. The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or"personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities. c. The insurance provided to the additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured during the policy period. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured under which that person or organization qualifies as a named insured, and we will not share with that other insurance. But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured, or is any other insured that does not qualify as a named insured, under such other insurance. 4. As a condition of coverage provided to the additional insured by this endorsement: a. The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the 'occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence" or Miscellaneous Attachment: M482524 Certificate ID: 16565891 offense. b. If a claim is made or"suit" is brought against the additional insured, the additional insured must: (1) Immediately record the specifics of the claim or"suit" and the date received; and (2) 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 connection with the claim or"suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d. The additional insured must tender the defense and indemnity of any claim or "suit'to any provider of other insurance which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to other insurance available to the additional insured which covers that person or organization as a named insured as described in Paragraph 3. above. 5. The following is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed, during the policy period and: a. After the signing and execution of the contract or agreement by you; and b. While that part of the contract or agreement is in effect. CG D6 04 08 13 Miscellaneous Attachment:M482524 Certificate ID: 16565891 Miscellaneous Attachment: M467648 Certificate ID: 16565891 POLICY NUMBER: TC2J-CAP-131J3858 COMMERCIAL AUTO ISSUE DATE: 01/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM SCHEDULE OF ADDITIONAL INSURED PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT. PROVISIONS 1. The following is added to Paragraph c. in A. 1., Who Is An Insured, of SECTION II-COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization designated in the Schedule Of Additional Insured Persons Or Organizations who you are required under a written contract or agreement, that is signed by you before the "bodily injury" or"property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that designated person's or organization's liability for the conduct of another"insured". 2. The following is added to Paragraph 5., Other Insurance, in B., General Conditions , of SECTION IV - BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance , this insurance is primary to and non-contributory with applicable other insurance under which the person or organization designated in the Schedule of Additional Insured Persons Or Organizations is a named insured when a written contract or agreement with you, that is signed by you before the"bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. CA T6 00 02 16