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Home My WebLink AboutCAG2020-385 - Insurance Certificate - MCImetro Access Transmission Services Corp. - Liability Coverage - 06/30/2021,^4corcE CE RTIFICATE OF LIABILITY INSURANCE o cott ot, o ! 9 ffiNU CANCELLATION @1988-2015 ACORD COHPORATION. All rights reserved' The ACORD name and logo are registered marks ot ACORD o o(o(o F-N cooONr) Iz o o(, Eoo CERTIFICATE HOLDER o ddcc c o E c e cc E c DATE(MM/DD/YYYY) 06t1412021 LY THENOONLYMAfiER BY POLICTTHE ESAFFORDEDORTHALTERCOVERAGEEEXTENDORAFFIRMATIVELYNEGATIVEAMEND,NOTDOESCERTIFICATE AUTHORIZEDtNsuRER(S),THE ISSUINGBETWEENCONTRACTANOTDOESCONSTITUTECERTIFICATETHISOFNSURANCEBELOW REPHESENTATIVE OR PRODUCER, AND THF CERTIFICATE HOLDER. oranA onstatement thisondorsement.ancertainconditionsandtheofpoliciesrequiremaytermspolicy,thetolsSUBROGATIONsubiectWAIVED, lieuin sucholcertificatetheholdertonotdoesconlercertificato (800) 363-010s(866) 283-7L22 E-MAL ADDRESSI NAIC #tNsuRER(S) AFFORDING COVEBACE ttew York ttV Office one Libertv Plaza 165 eroadwby, suite 3201 r.rew York NY 10006 USA PRODUCER Risk services Northeast, rnc 19399AIU InSUranceINSURER A: re Ins Co oonalINSURER Br Na UN on INSURER C! INSUREF D: INSUFER E: INSTJRER F: INSURED Mcrmetro Access Transmi ssion services coro, 1095 Avenue bf the nmericas ttew York NY L0036 USA PERTAIN, THE INSURANCE H POLICIES, LIMITS SHOWN CE THISRESPECTWITHrcHTOWHDOCUMENTOROTHEBOFCONTRACTANYORTERMITIONCONDDINGSTANREQUANYREMENTDICATED,IN NOTWITH THEALLHEREINTO TERMS,SUBJECTDIESDESCRIBEDAFFORDETHBYPOLICEBEMAYMAYISSUEDORRTIFICATECECLArMs.EN EREDUC BYD PAID shownLimits asaleMAYBEHAVEOFSUCANIONSCONDDtroNsEXCLU$ LIMITSPOLICY NUMBERTYPE OF INSUFANCE 5,EACH OCCURRENCEX 5 ,000 , MED EXP (Any ons Person) X PERSONAL & ADV INJUBY GENERALAGGREGATE $s , 000,PRODUCTS . COMP/OP AGGX COMMEFCIAL GENEFAL LIABILITY XCU Covsrage is lncluded X LIMIT PBO. JECT Loc CLAII/IS.MADE OCCUR APPLIES PER: POLICY OTHEB: $s,000,SINGLE LIMIT BODILY INJUFTY ( Per porson) X BODILY INJUBY (P€r accidant) 06/30/2022 06/30/2022 06/30/2022 06/30/202 06/30/202 4594299 MA 4594300 see Next 45I B B B AUTOMOBILE LIABILITY SCHEDULED AUTOS NON.OWNED AUTOS ONLYONLY AUTOS ONLY HIREDAUTOS ANYAUTO OWNED EACH OCOURRENCE AGGBEGATE OCCUF CLAIMS.MADE UMBRELLA LIAB EXCESS LIAB X $1, 000 ,E.L, EACH ACCIDENT N 000E.L. DISEASE"EA EMPLOYEE 06/30/2022 E.L.LIMIT 06/30/202L AO5 16393206 CA N/AA/ PARTNER / EXECUTIVE EXCLUDED? in EMPLOYERS' LIABILITY ANY Mclmetro Access Transmission Services corp. .dba Ve fficials. boards, commissions, employeqg and-agent icv. thd ceneral Liabil ity po'licy shall apply as hi: rei n . / VEHICLES RemarkeOF respect to each rizon Access Transmission se s are included as ndditional Primary and ruon-contri butorY may be attached lf more aPacg raqui16d) ttamed rnsured includes: Kent. t,liA. its officers, o the Geneia'l liability Polndditional rnsured Iisted rhe wi thce to city ofrvr ces. rnsured Insu ran SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EiFrnnrroN DATE THEREoF, NorlcE wlLL BE oELIvERED lN AccoRDANcE wrH THE POLICY PROVISIONS. -e%g*rf*A*t-,^ AUTHORIZEDcitv of Kent, wAattir: clerk 220 Fourth Avenue south Kent wA 98032 usA ffi ACORD 25 (2016/03) AGENCY CUSTOMER lD: 570000027366 LOC #:z-t.4^Co.Rb@ ADDITIONAL REMARKS SCHED ULE Page - of _ AGENCY Aon Risk services Northeast, Inc NAi/ED INSUFED Mclmetro Access Transmi ssion POLICY NUMBER see certificate Number: 570087766019 CARRIEF see certificate Numberi 570097166019 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS REMARKS FORM IS A SCHEDULE TO FORM NUMBER: THIS FORM, lnsuranceACORD 25 FORM TITLE: Gerliticate of TNSURER(S) AFFORDTNG COVERAG E NAIC # INSURER INSURER INSURER ADDITIONAI, POLICIES If a policy below does not include certificate form for policy limits. limit information, I'efer to the corresponding policy on the ACORI) INSR I,]TR TYPE OF INSURANCE ADDL INSD SUBR wvD POLICY NTIIVIBI!R POLICY EFFECTIVE DATE (MM/DD/YVYY) PT,LICY EXPIRATION DATO (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY B 4594301 Ntt - primary 06/30/2021 06/30/2022 B 4594307 NH - Excess 06/30/2Q2J"06/30/2022 WORKERS COMPENSATION A L6393207 NY 06/30/202r 06/30/2022 A r-6393208 WI 06/30/2021 06/30/2022 A L6393205 NJ,TX,VA 06/30/zOZt 06/30/2022 ACORD 101 (2008/01) The ACORD name and logo are regl$l€red marks ot ACORD @ 2008 ACORD CORPORATTON. All rights rsserved. POLICY NUMBER: GL 172-88-90 TH|S ENDORSEMENT QHANGES THE POLICY. PLEASE READ lT 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 wiitr resp6ct 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 behalfl 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 is required by a contract or COMMERCIAL GENERAL LIABILITY cG 20 26 12 19 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 agreemenU or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance' ffi Name Of Addltional Insured Person(s) Or Organization(sl: 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' aratDecl tonswilbshoenWnethnhowabovehedScunotifstoredmcoletesle,thinformationrequrp ffi cG 20 26 12 19 @ lnsurance Services Office, lnc', 2O18 Page 1 of 1 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 LIOUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART POLICY NUMBER: cL 172-88-90 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 availableto an additional insured under your policy provided that: (1lThe additional insured is a Named lnsured under such other insurance; and COMMERCIAL GENERAL LIABILITYcc 20 01 12 19 (2) You have agreed in writing in a contract or agreement that this insurance would beprimary and would not seek contribution from any other insurance available to the additional insured. cG 20 01 12 19 @ lnsurance Services Office, lnc., 2018 Page 1 of 1 MSC#I7755 Aon Risk Services PO Box 1447 Lincolnshlre, lL 60069 ffi,,38 City of Kent, WAFim Attn: Clerk 220 Fourth Avenue South Kent WA 98032 RECEIVED JUN 2 3 2021 CITV OF KENT CITY CLERK MDG2021 00004392 01 th,,lll'llrth1h,llrr;llllllhlll,,ll;,lllllllllpllltlltlthl ffi ffi