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Home My WebLink AboutL15-059 - Insurance Certificate - Verizon Wireless - Insurance Certificate for 6/30/2020-6/30/2021DATE(MM/DDI/YYY) 0610912020 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. NEGATIVELYRMATIVELY THE HOLDER,UPONCONFERSANDAINFORMATIONOFAStsISSUEDTHIS THEBY ESPOLICIAFFORDEDCOVERAGEORTHEALTEREXTENDAMNOTDOESAFFIEND,ORCERTIFICATE REINSU AUTHORIZEDTHEBETWEENISSUINGR(S),A CONTRACT SUBROGATION lS WAIVED' subiect to cerlificate does not confer rights to the the ierms and conditions ol the policy, certain policies certificate holder in Iieu ol such endorsement(s). oranstatementA thon sendorsement.anrequiremay (800) 363-o1os(866) 283-7L22 E-MAIL ADDRESS: NAIC #INSURER(S) AFFORDING COVERAGE nisk services Northeast, rnc York t'tv officeribertv Plaza eroadway, suite 3201 York NY 10006 usA PRODUCEH NEW e 165 NEW union Fire rns co Pi ttsbu hINSUFEBA: NAtiONA INSURER B: INSURER C: INSUBER D: INSUFER E: INSUFER F: INSURED zon conmunications rnc 1095 Avenue of the emericas New York NY 10036 usA MAY PERTAIN, THE INSURANC SUCH POLICIES. LIMITS SHOW TOOFIESTO TORESPECT HICH THISREWITHDOCUMENTOFCONTRACTANYOTHORORTERMCONDITIONREOUANYREMENTICATED.IND ITHSTANDINGNOTW IS ECTSUBJ ALLTO TERMS,THEIESHEREINDESCRIBEDEBYAFFORDEDPOLICTHEBEMAYORISSUEDCERTIFICATEareshownREDUCEDPAIDBYCLAIMS.itsLimNHAVEMAYBEENOFANEXCLUSIONSCONDITIONSD LIMITSPOLICY NUMBERTYPE OF INSURANCE $s,000,EACH OCCURRENCE $s,000,000 $10MED EXP (Any one person) X 5 ,000 ,PERSONAL & ADV INJURYX GENERAL AGGREGATE $5,000,PFODUCTS - COMP/OP AGGX COMMERCIAL GENERAL LIABILITY Standard Contraclual LiabilitY XCU Coveraqe is lncluded GEN'LAGGHEGATE LIMIT X APPLIESI CLAIMS.MADE OCCUR PER: LOCPOLICY OTHER: PRO- JECT COMBINED SINGLE LIMIT $s,000, BODILY INJURY ( Per person) X BODILY INJURY (Per accident) PROPERTY DAMAGE 06/30/202L 06/30/202L 06/30/202L 06/30/202 06/30/202 06/30/2 06/30/2 c^ 4594299 MA cA 4594300 see Next Page CA s94298AUTOMOBILE LIABILITY SCHEDULED AUTOS NON.OWNED AUTOS ONLY AUTOS ONLY HIRED AUTOS ONLY ANYAUTO OWNED A A A A EACH OCCURHENCE AGGREGATE UMBFELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE PER STATUTE E-1. EACH ACCIDENT E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT N/A EMPLOYERS' LIABILITY ANY PROPRIETOR / PAFTNER / EXECUTIVE below describe EXCLUDED? OPEFATIONS / LOCATIONS / .lity po1icy DESCRIPTION ress: 400Add i abi Remarks Schedule, may be altached moJe space is requiled) noton vallev noad, eedminster, Nl is includeil as an AdditionalNamed rnsured rncludes: verizon wire O792I. RE: site Name: Ramsay, Site rnsured with respect to the General L (ACORD t0l, Addltional less(vAW), LLc dba verizon wireless, Address: 180-washi w. cowe St., Kent, wA 98032. city of Kent ,lcfu CERTIFICATE OF LIABILITY INSURANCE c) tro!t op oI NUMBER:17232 CANCELLATION Nf)NN C!oo F-0 oz !) (lto = c)o +{:q E-.Ei :T- CERTIFICATE HOLDER @1988-2015 ACORD CORPORATION. All rights reserved' The ACORD name and logo are registered marks ol ACORD t-15*5*l SHOULD ANY OF TfIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE iiprnrrtoH DATE THEFEoF, NortcE wLL BE DELIvERED lN AccoRDANcE wlrH THE POLTCY PROVISIONS. -M*%g*-4*a't-% AUTHOHIZED REPFESENTATIVEci ty 220 Kent ttvA 98032 usA of rent4th Avenue south ACORD 25 (2016/03) AGENCY CUSTOMER lD: 570000027366 LOC #: ADDITIONAL REMAR KS SCHEDULE Page - of _ AGENCY Aon Risk Services Northeast, Inc NAMED INSURED verizon Communications rnc POLICY NUMBER See certificate Number| 570082AL7232 CARRIER See certificate Number; SZOOBZ!17232 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL FORMREMARKS AIS SCHEDULE TO ACORD FORM, NUMBER:FORM ACORD 25 TITLEFORM olCertificate lnsurance rNsuRER(S) AFFORDTNG COVERAGE NAIC # INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, certificate form for policy limits. refer to the corresponding policy on the ACORD INSR LTR TYPE OFINSURANCE ADDL INSD SUBR wvD POLICYNUMBER POLICY EFT'ECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY A cA 4594301 ruu - erimary 06/30/2020 06/30/202t A cA 4594302 NH - Excess 06/30/2020 06/30/202L ACORD 101 (2008/01) The ACORD name and logo are registered marks ot ACORD @ 2008 ACOHD CORPOBATTON. Ail rights reserved. POLICY NUMBER: GL 172-88-90 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED . DESIGNATED 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. ln the performance of your ongoing operations; or 2, ln connection with your premises owned by or rented to You. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. lf coverage provided to the additional insured COMMERCIAL GENERAL LIABILITY cG 20 260413 is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than 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 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 lnsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations. Name Of Additional lnsured Person(s) Or Organization(s): contract or agreement you have entered into' lude as an additional insured as a result of anyAny person or organization whom you become o bligated to inc oarati snownshnDtheeclanobeWIbenifshowoteedultodthiSchSnatiformnorecompleterequr cG 20 260413 0 lnsurance Services Office, lnc.,2O12 Pagelofl D o-fu CERTIFICATE OF LIABILITY INSURANCE .g:F cos L o)Io ! CERTIFI NIJMBER: DATE(MM/DD//YYY) 061o912020 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. NEGATIVELYAFFIRMATIVELY E HOLDER.THNOONFERScoNINFORMATIONAASISSUEDTHIS BY POLICIESTHECOVERAGETHEAFFORDEDDEXTENALTERORORAMNOTDOESEND,CERTIFICATE AUTHORIZEDISSUINGINSUERER(S),THBETWEENCONTRACTA ortsanstatementA thisontreendorsement.ancerlainconditionsandtheofmayrequtermsthepolicy,policiestotsSUBROGATIONWAIVED,subiect tn suchoftocertificatetheholderlieu endorsement(s).notdoes confercertilicate rights (800) 363-0105r366) 283-7L22 NAIC #INSURER(S) AFFORDING COVERAGE PRODUCER Aon Risk services Northeast, rnc ttew vork NY office one Liberty Plaza 165 eroadway, suite 3201 New York NY 10006 usA union Fire rns co ttsbuTNSUREFA: ttatiOna tNsuFEFB: AIU rnsurance company 380can Home Assurance coINSUREFC: Ame 2384rtNsuFERD: New Hampshire Insurance company INSURER E: INSURER F: York NY 10036 usA rv'l INSURED Mcrmetro Access Transmi ssion ces coro. avenue bf the Anericas ERAGES PPOLICYDNAMEISSUEDLISTEDts ISPECTRESHICHTHTOMENTITHNOTWINDICATED.THEISECTSUBJALL TERMS,TOINREMAYEcRTIFICATE ateshownLimitsIONSEXCLUSAND LIMITSPOLICY NUMBERTYPE OF INSURANCE $5,000,000EACH OCCURRENCE $s,000,DAMAGE TO REN I hU PREMISES {Ea occurrence) $10,MED EXP (Any on€ Person) 5,000,PERSONAL & ADV INJUHY $s , 000 ,000GENERAL AGGREGATE $s,000,000PRODUCTS - COfuIP/OP AGG u6/ 3U/ ZvZV ao/ 3u/ zuz LGL1;/2669U X COMMERCIAL GENERAL LIABILITY XCU Coverage is lncluded GEN'LAGGREGATE LIMIT X X APPLIEST CLAII\4S-MADE OCCUR X PER: LOCPRO- JECTPOLICY OTHER: $s,000,000COMBINED SINGLE LIMIT BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERry DAMAGE (Per accident) 06/30/2021" 06/30/202L 06/30/202L 06/30/202t 06/30/2020 06/30/2020 06/30/2024 06/30/202A cA 4594298 AO5 cA 4594299 MA cA 4594300 see Next Page SCHEDULED AUTOS NON"OWNED AUTOS ONLY X AUTOS ONLY HIRED AUTOS ONLY AUTOMOBILE LIABILITY ANYAUTO OWNED A A A A EACH OCCURRENCE AGGREGATE OCCUR CLAIMS.MADE UMBRELLA LIAB EXCESS LIAB RETENTION]ED CTH.X PER STATUTE $1 , 000 ,000E.L. EACH ACCIDENT $1, 000 , 000E.L. DISEASE-EA EMPLOYEE $1,000 , 000E.L. DISEASE.POLICY LIMIT 06/30/2020 06/30/2020 06/ 30/ 202r 06/30/2021 wc045886576 AOS wc045886575 CA N/A B c WORKERS COMPENSATION AND EMPLOYEHS' LIABILITY ANY PROPRIETOR/ PARTNEF / EXECUTIVE OFFICEFUMEI\4BER EXCLUDED? (Mandatory in NH) ll ves. describo under DESCRIPTION OF OPERATIONS b€IOW -M-%%*Jntut-% toiotin Servonal rrizon Access Tr s are included erimary and Non rvices co emol oveesicy shall Access boards udes: Mcrmetrocers, officials,ity iolicy. rhe I i sted herei n. attachedbe moretf requiled)RemarksAddltlonal spaceSchedule,101 mayLOCATIONSVEHICLES ce s ciThe oftysansmlVEdbaansmtTTonssrSE''|1nc rp wl ht resrednsuasAddintansslonsagecommt RecttoeacrntbutoIrancensuCotyIasI'I IGeneIraILabi app vtypooffi abi I u red redits'l L INNamed sutKenWA 1Genera DESCFIPTION OF AUTHORIZED REPRESENTATIVE itional rns SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE iiprnartol DATE THEREoF, NortcE wlLL BE DELIVEFED lN AccoFDANcE wlrH THE POLTCY PROVTSTONS. citv of Kent, wAlttir: clerk 220 Fourth Avenue South Kent wA 98032 UsA $Nooo NoooNn oz o) oo ,F q) C) CERTIFICATE HOLDER CANCELLATION @1988-2015 ACORD CORPORATION' All rights reserved' The AGORD name and logo are registered marks of ACORDACORD 25 (2016/03) AGENCY CUSTOMER lD: 570000027366 LOC #:.qcoGo'ADDITIONAL REMARKS SCHEDULE eage _ of _ AGENCY Aon Risk Services Northeast, Inc NAMED INSURED MCImetro Access Transmission POLICY NUMBER See certificate Number: 570082085024 CARRIEH See certificate Number: 570082095024 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL MARKSRE FORM ts SCHEDULEA ACORDTO FORM, NUMBER:FORM ACORD 25 TITLE:FORM ofCertificate rancelnsu rNsuRER(S) AFFORDTNG COVERAGE NAIC # INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit certificate form for policy limits. information, refer to the corresponding policy on the ACORD INSR LTR TYPE OFINSURANCE ADDL INSD SUBR wvD POLICY NUMBER POLICY EFT'ECTIVE DATE (MrwDD/YYYY) POLICY EXPIRATION DATE (M1\4/DD/YYYY) LIMITS AUTOMOBILE LIABILIW A cA 4594301 Nu - erimary 06/30/2020 06/30/2021 A cA 4594302 NH - Excess 06/30/2020 06/30/2021 WORKERS CO[4PENSATION B wc0458865 79 NY 06/30/2020 06/30/2021 B N/A wco45886577 FL 06/30/2020 06/30/202L D wc045886578 MA, ND, OH , WI , WY 06/30/2020 06/30/202L B wc045886574 NJ,TX,VA 06/30/2020 06/30/202L ACORD 101 (2008/01) The ACORD name and logo are registered marks ot ACORD @ 2008 ACORD CORPORATTON. Att rights reserved. POLICY NUMBER: GL 172-88-90 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. ln the performance of your ongoing operations; or 2. ln connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. ll coverage provided to the additional insured COMMERCIAL GENERAL LIABILITY cG 20 260413 is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than 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 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 agreemenq 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. Name Of Additional lnsured Person(s) Or Organization(s): Any person or organization whom you become obligate d to include as an additional insured as a result of any contract or agreement you have entered into' thtn Dece la tioa NSWsbehownifshnotaownbovemthleteStshedcleUrmatontoredcolnfoprequr cG 20 260413 O lnsurance Services Office, lnc., 2012 Pagelofl tr The following is added to the Other lnsurance Condition and supersedes any provision to the contrary: Primary And Noncontributory lnsurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your COMMERCIAL GENERAL LIABILITY cG 20 01 04 13 policy provided that: (1)The additional insured is a Named lnsured under such other insurance; and (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribu- tion from any other insurance available to the additional insured. POLICY NUMBER: cL 172-88-90 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY . OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETEDOPERATIONS LIABILITY COVERAGE PART cG 20 01 04 13 @ lnsurance Services Office, lnc., 2O12 Page 1 of 1