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Home My WebLink AboutPW15-281 - Insurance Certificate - T-Mobile USA, Inc. - Spring Brook Park Recovable Right-of-Way - 05/01/2021DATE (MM/DDIYYYY) 0412812021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PO THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RE HOLDER. THIS LICIES BELOW. PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certificate holder is an SUBROGATION lS WAIVED' subject to the ADDITIONAL INSURED, the policy(ies) must terms and conditions of the policy, certain have ADDITIONAL INSURED provisions or be endorsed' lf policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 20443r, Continental Casua PRODUCER Lockton Companies Three City Place Drive, Suite 900 St. Louis MO 63141-7081 (314) 432-0500 35289nental lnsurance 35877 2 lts Subsidiaries and Affiliates 12920 SE 38th Street Bellevue WA 98006 lNsuRED T-Mobile US, lnc. PERTAI NAMRED EDHAVETHIS WITHENT TORESPECTCONTRACTANYOTHERORMDOCUORTERMOFCONDITIOND,TE ANDNOTWITHST ANYING REQUIREMENTPERIODNDICA INHERE SUBJECTIS TOBYAFFORDEDPOTHEDESCRILICIESBEDORYMATHECEINSURANISTHTECERTIFICAMAISSUEDBEN,rcHWH LIMITSPOLICY NUMBERTYPE OF INSURANCE sEACH OCCURRENCEX $ $ $ $ $ $ N COMMERCIAL GENERAL LIABILITY X AGGREGATE LIMIT APPLIES PER: X[--_-l pno-| | JEcr CLAII\4S-l\ilADE OCCUR LOCPOLICY OTHER: $000 0 $ XXXXXXXINJURY (Per person)X BODILY INJURY (PET $ $ $ 05/0105/01 N N 7012343878AAUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS NON-OWNED $5 000EACH OCCURRENCEX $5 UMBRELLA LIAB EXCESS LIAB $ 05t01t2021 05/01 N N cuE 7014886953 SIR applies per policy terms & conditions DED X RETENTION $ 1O,OOO B B B $ $000E.L. DISEASE - EA $ o5to112021 o5to1t2021 05t01t2021 05/01 05/01 05i01 (AOS) (cA) (AZ;MA,OR,Wr) 701 2343895 7012343881 7012447142N/A N B Bc ANY PROPRIETORYPARTNER/EXECUTIVE OFFICER/I!IEI/lBER EXCLUDED? (Mandatory in NH) N describe undet WORKERS AND EMPLOYERS' DESCRtpTtON OF OpERATTONS / LOCATTONS / VEHICLES (ACORD 101, Additional Remarks schedule, may be attached if more space is The Certificate Holder and other entities defined by written contract, statute, permit application.or written agreement are.additional insureds on.a primary ;ifi il;:;;;t'.iki,it,irv olJii ,irUlr s;;"rifiJniiiiy dno are additiohai'insured under auiomobile liability as re-quired by written contract. Waiver of suoiiiiation ipdiiedunoer geniiaTti;bititi;;d ;"tomooile tiioititv is reggiled by_written contract. -.See Attached Endorsements** sE04637F/ shearer - snrino"uroor pa'rk/ RoW aaiacent ioltjodz sE 2obtn siieli, kenl, wn Seoaogdfl carrison creeld RoW adjacent to 10702 SE 224thPlace, Kent, WA SE053168/ Emerald PArU ROW adjacent to SE 21gth Place & 116th Avenue SE, Kent' wA required) a,iQo'\-"CERTIFICATE OF LIABILITY INSURANCE o 1988-2015 5t1t2022 R 1 3601 343 City of Kent Attn: Public Works Director 220 Fourth Avenue South Kent WA 98032 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) The ACORD name and logo are registered marks of AGORD TtoN. All hts reserved Attachment Code : D590641 Master lD:1358772, Certificate lD: 13601343 @roofior$ IMPORTANT NOTICE Dear Certificate Holder for T-Hobile and its subsidiaries (including Sprint): Ci ty of Kent Attn 220 Fourth Avenue Kent WA 98032 If we do not rece'ive Your the cl i ent' s next renewal , Publ'ic Works Director South In our continued effort to provide t'imely certificate delivery, Companies is transitioning to paperless def ivery of Certificates goi ng forward. Loc kton of Insurance To ensure future renewals of Please contact us via one of 13501343 . Ema'i1: stl-edel ivery@lockton. con . Phone: 31.4-812-3888 thi s certi fi cate, we need You the methods below, ref erenc'in re gC ma'i1 address. erti fi cate ID ema'il address via one of the above methods prior to '-'a r-ri 1'l tc.r 'l anaar naad lha -at+ifi:a+a If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further act'ion is needed' The above inbox is for collecting enafl addresses for renewal electronfc certificate delfvery 1NLY. You will not receive a response fron this inbox. Thank you for your cooperati on. Lockton Companies Lockton Companies T'hree CityPlace Dr, SLrite 900 / St. Louis, MO 63 I 4l-7088 3 | 4-432-0500 / lockton.com POLICY HOLDER NOTICE _ COUNTRYWIDE Attach ^cfiffi"Master lD:1358772, Certificate lD: 13601343 It is understood and agreed that: lf the Named lnsured has agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if the lnsurer cancels a policy term described on that Certificate of lnsurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective' lf notice is mailed, then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record will be sufficient to prove notice. Any failure by the lnsurer to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon the lnsurer or the Agent of Record. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated lnsurers, itakes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA75014XX (01-2015) Endorsement Effective Date: 0510112021 Endorsement No: Page: 1 of 1 Undenivriting Company: Continental CasualtyCompany Policy No: 7012343900 Policy Effective Date: 0510112021 @ Copyright CNA All Rights Reserved. Attachment Code : D559289 Master lD:1358772 , Certificate lD: 13601343CNA NOTICE OF CANCELLATION TO CERTIFICATEHOLDERS It is understood and agreed that: lf you have agreed under written conhact to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of lnsurance, and if we cancel a policy term described on that Certificate of lnsurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. lf notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. All other terms and conditions of the policy remain unchanged. iThis endorsement, which forms a part of and is for attachment to the policy issued by the designated lnsurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA68021XX (02-2013) EndorsementEffectiveDate: 0510112021 Endorsement No: Undenltriting Company: Continental CasualtyCompany Policy No:7012343878 Policy Effective Dale 05101 12021 Policy Page: @ Coovrioht CNA All Riohts Reserved