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Home My WebLink AboutPW15-059 - Insurance Certificate - Insurance Certificate for 6/30/2020 - 6/30/2021o-Qo*CERTIFICATE OF LIABILITY INSURANCE o o F... o Eott oIoI NUMBERI REVISION NUMBER: DATE(MM/DDI/YYY) 061o912020 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ALTERNEGATIVELY THISFICERTITHEUPONNOCONFERSDFORMATIONOFINAASISSUEDCATElsFIBYPOLtCTESTHEAFFORDEDOREXTENDCOVERAGETHEORAMNOTDOESRMATIVELYEND,AFFICERTIFICATE AUTHORIZEDTNSURER(S),THE ISSUINGBETWEENCONTRACTA SUBROGATION lS WAIVED, subiect to the terms and conditions ol the pol , certain policies may require an endorsement. A statement on ons or tfanthis certilicate does not confer to the certilicate holder in lieu of such (800) 363-010s(866') 283-7t22 E-MAIL ADDBESS: NAIC #INSURER(S) AFFORDING COVERAGE PFODUCER Aon Risk services Northeast, rnc New York NY office one Libertv Plaza 165 eroadwly, suite 3201 New York NY 10006 usA 79445Pi ttsbuTNSURER A: t'lati ona'l Uni on Fi re Ins Co INSURER B: INSURER C: INSI.JRER D: INSURER E: INSUFER F: INSURED verizon communications rnc. 1095 nvenue of the Americas NeW YorK NY 10036 USA LIMITSrgllut EIF IMM/DD/YYYYIPOLICY NUMBERINSDTYPE OF INSURANCE 5,000,EACH OCCURBENCE $s,000,000DAMAGE IO HbN I EU PRFiIISFS /Fr nccrrroncel $10, 000MED EXP (Any one person) $s,000,000PERSONAL & ADV INJUHY $s,000,000GENERAL AGGREGATE $s,000,000PRODUCTS - COMP/OP AGG uo/ 3u/ zuzu 06/ 3U/ ZUZLGL].228890 X COMMERCIAL GENERAL LIABILITY Standard Contractual Liability X X X XCU is lncluded CLAIMS-MADE OCCUR LIMITAPPLIES PER: LOC OTHER: PRO. JECT $s ,000 , 000COMBINED SINGLE LIIVIT BODILY INJURY ( Per Person) BODILY INJURY (Per accident) PROPERW DAMAGE 06/30/2020 06/30/2020 06/30/2020 06/30/2020 06/30/202r 06/30/202L 06/30/202L 06/30/202L cA 4594298 AOS cA 4594299 MA cA 4594300 see Next Page A A A A AUTOMOBILE LIABILITY ANYAUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON-OWNED AUTOS ONLY X EACH OCCURRENCE AGGREGATE OCCUR CLAIMS.MADE UMBRELLA LIAB EXCESS LIAB DED IOTH.IEtrPER STATUTE E.L. EACH ACCIDENT E.L. DISEASE.EA EMPLOYEE E.L, DISEASE-POLICY LIMIT N/A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPBIETOR / PARTNER / EXECUTIVE OFFICEFUI\4EMBER EXCLUDED? (Mandatory in NH) lf ves- describe under DFscRrPTroN oF oPERATtcNS betovr tr udes: cel I co Partnershi p dba veri zon wi rel ess, 180 EA 4 corners, Location code: t02484, contract No.: Tev, wa ssots. city of Kent is included as nddition Tiw. ttre ltamed rnsirred parties listed herein waive oiitv listed herein for'recovery of damages to the ahd'airtomobile Liability policies, and, as further I city of Kentcity clerk -6%/%*-,/Cz-tt-% ngto4, s n vallev noad. gedminster, New lersey 07921. ite addiess: '26800 lvlaple valley alack oiamo d with resoect to the General Llabl llty pol'l s aqainst the certificate Holder and eac-h ese"damaqes are covered by the above-referen written-contract between the parties. INSU rigSE, lvlapl e pe rm i tted i onal rnsual Liabili moreit lsRemarksbeattachedspace required)VEHICLES 1 Addltlonal Schedule,mayOFDESCRIPTIONOPERATIONSLOCATIONS(ACORD 01, washisuINred nd391teNameSicyre 7 alRoad SIVa Ia 1 cedEXtten ht thbv redt tedm1I byrety Attn AUTHORIZED REPRESENTATIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WTH THE POLTCY PROVISIONS. 220 Fourth Avenue Kent wA 98403 usA +NNF- NooO F*r) oz d) (rto 'F oo CERTIFICATE HOLDER CANCELLATION 01988-2015 ACORD CORPORATION. All rights reserved' The ACORD name and logo are registered marks of ACORD ?wt{- os1 ACORD 25 (2016/03) AGENCY CUSTOMER lD: 570000027366 LOG #:rqrCOG ADDITIONAL REMARKS SCHEDULE Page - of _ AGENCY Aon Risk Services Northeast, Inc NAMED INSUFED Verizon Communications Inc. POLICY NUMBER See certificate Number: 570082L17224 CARRIEF See Certificate Numbert S7OOg2tL7224 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS TITLE: THIS ADDITIONAL KSREMAR ISFORM scHA EDULE TO FORMACORD NFORM BER:UM 25ACORD FORM ofCertificate Liabi nsuranceitv TNSURER(S) AFFORDTNG COVERAGE NAIC # INSURER INSURER INSI]RER ADDITIONAL POLICIES If a policy below does not include certificate form for policy limits. limit information, refer to the corresponding policy on the ACORD INSR LTR Tl?E OFINSURANCE ADDL INSD SUBR wvD POLICYNI]MBER POLICY EFTECTIVE DATE (MM/DD/YYt'Y) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY A cA 459430L ruH - erimary 06/30/2020 06/30/2021. A cA 4594302 NH - Excess 06/30/2020 06/30/2021. ACORD 101 (2008/01) The ACORD name and logo are registered marks ol ACORD @ 2008 ACORD CORPORATION. Atl rights reserved. POLICY NUMBER: GL 172-88-90 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED . OWNERS, LESSEES OR CONTRACTORS . SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization{s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. l't coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than COMMERCIAL GENERAL LIABILITY cG 20 10 04 13 that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "pioperty damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any Person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Name Of Additional lnsured Person(s) Or Organization(s)Location(s) Of Covered Operations Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Per the contract or agreement. lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations cG 20 10 04 13 @ lnsurance Services Office, lnc.,2O12 Pagelof2 tr C. With respect to the insurance afforded to these additional insureds, the following is added to Section lll - Limits Of lnsurance: lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreemenu or 2. Available under the applicable Limits of lnsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations. Page 2 of 2 6 lnsurance Services Office, lnc.,2O12 cG20100413 tr POLICY NUMBER: GL 172-88-90 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETEDOPERATIONS LIABILITY COVERAGE PART SCHEDULE COMMERCIAL GENERAL LIABILITY cG 20 37 0413 which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section lll - Limits Of lnsurance: lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of lnsu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of lnsurance shown in the Decla- rations. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED . OWNERS, LESSEES OR CONTRACTORS . COMPLETED OPERATIONS A. Section ll - Who ls An lnsured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. l't coverage provided to the additional insured is required by a contract or agree- ment, the insurance afforded to such addi- tional insured will not be broader than that Location And Description Of Completed Operations Or Organization(s) nsu Per the contract or Agreementny person or organization whom you become igated to include as an additional insured as a result any contract or agreement you have entered into n eth laDec ratronsebhonifSnotOWhanbovethSShedulcerenutoiredocetenfoatrmomplq cG 20 37 04 13 O lnsurance Services Office,lnc-, 2O12 Pagelofl tr