HomeMy WebLinkAboutPW16-292 - Insurance Certificate - WaveDivision Holdings, LLC - Liability Coverage - 02/01/2022WLLIS TOWERS WATSON
26 CENTURY BLVD.
6TH FL, SUITE 101
NASHVILLE, TN 37214
144231A8 0.458
ltrrtrltrlr,,ll,lrrrll,illllrlrllililtl,ltl,ll,rtlllltll1tlt,,ill
CITY OF KENT
22O 4TH AVE S
KENT, WA 98032-5838
14423
1 ol 4 14423
PW16-292
Fage 1 of, 2o.fu CERTIFICATE OF LIABILITY INSURANCE DATE (MMiDDTVYYY)
oL/28/2022
THIS CERTIFlCATE ts ISSUED AS A MATTER OF INFORMANON ONLY AND CONFEBS NO BIGHTS U PON THE CERTIFICATE HOLDER THIS
DOESCERTIFICATE NOT AFFIRMATIVEL Y OR NEGA TIVEL Y AM END,EXTEND OR ALTER TH E COVE RAGE AFFORD ED SY THE POLTCTES
B ELOW THIS CERTIFICATE OF INSURANCE DOES NOT co NSTITUTE A CONTRACT ETWEEN THE ISSUING rNsuRER(S),AUTHO RIZED
R EPRESENT ATIVE OR PRODUC ER,A ND THE CEHTIFICA TE HOLDER"
lf tho certificate an ADDITIONAL tNs u RED,the policy(ies)musl NSURED provlsions or
It SUBROGATlON ts W AIVED,subiect to the torms and condltlons ot the po cerlaln pol lcles may req ulre an €ndorsemenl,A slatement onlhisdoesnotconlerhtstotheholderlnlieusuch
PBOOUCER
WlJ.Lis Tor€rs lfatson Nolthsastr Ine
c./o 26 Century FIvd
P.O. Box 305191
Nashvl.Ile. TN 3?2305191 USA
l{illis llowcre t{atson C6!tifl-cat6 Ccnler
1-87?-9{5-7378 1-89 8-46?-2378
colh
National girc Inguranca Conu)any of,2047e
INSUREO
lfaveDLvj"sion Holdings, fI€
3?00 Mont€ Vil-!,a Parkvay
Botholl. WA 98021
INSUREFB; Contin€ntal Casualty Company 20443
M!rk61 Anrerioan Insurance Cotq)any 28932
Va1l6y Forg€ Insurance Comltany 20508
E, ZurLch Anorl€an In€urance Conpany 16535
F
cov TE NUMBER: r{238{5304 NUMBER
rNSntTp tNcnTYPE OF INSURATICE LltdTs
DICATED.
ISTHIS CEHTIFYTO THETHAT OFPOLICIES BANCEINSU LISTED BELOW BEENHAVE THETO NSU NAMRED DE FOBABOVE POLICYTHE PERIOD
ANDINGNOTWITHST RANYIN IREMENTEOU RMTE CONDITIONOR ANYOF CONTRACT ROTHE WITHDOCUMENT RESOR PECT WHTO THIStcHEHTIFICAMAYTEISSUEBEDOBMATHINSURANCEAFFORDEDETHEBYPERTAIN,ESPOLtCt HERDESCRIBED INE SUBJECTIS ALLTO TERMS,THE
EXCL OF SUCHUSIONSCONDITIONSAND POLtCtES.SHOWNLIMITS HAVEMAY EENB BYREDUCED PAID CLAIMS.
EACH OCCUBBENCE 1.000,000
u
P 1r 000, 000$
MED EXP (Anv one per6on)x5,000$
PERSONAL A ADV INJURY t, oo0, 000$
GENEBAL AGGFEGATE 2,000, o00$
PRODUCTS. COMP/OP AGG 2, OO0, 000$
A
COMMEBCIAL GENEBAL LIABILITY
x
AGGBEGATE LIMIT APPLIES PER:
xl.-'-i pno-
i ] JECT
X
CLAIMS.MADE occt.tR
LOCPOLICY
Y 605'.r236936 02/oL/2022 02/or/2023
$
corItra s,000, 000$
BOOILY INJURY (Per person)$
BODILY INJURY (P6r accident)$
B
ANY AUTO
OWNEO
AUIOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON.OWNED
AUTOS ONLY
x
AUTOMOBILE UABILITY
Y 6072883128 02/oL/2022 02/ot/2023
PHOI.'EH I Y DAMAGE
-e-eJ-.assFei-U.- ..
$
x x EACH OCCURRENCE 10,000, 0o0UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE AGGFEGATE
c
X DED p6195111pry g 10, 000
uKr,M6MM7000044 5 a2/0r/2022 02/oL/2023 10,000, 000
$
tsts tt
STATI ITF UI H.Ftr
E.L. EACH ACCIDENT
E.L. DISEASE. EA EMPLOYEE $
\ivoFKERS COt PEilSATtOt'l
AI{D EMPTOYEFSI LIABILITY
ANYPROPRI ETOHi PARTNEB/EXECUIIVE
OFFICEFiMEMEEREXCLUOEO?
(Mandetory ln NH)
under
OF OPERATIONS b6low
Y/Nn
ll yes, de$cribe
DESCBIPTION
N A
E.L. DISEASE. POLICY LIMIT $
D gtoF Gap Lialril-l'ty 605?375 660 02/0t/2022 02/aL/2A23
BI by Discase Agg
Each Person
Each Ocourrence
$1.000,0o0
$1,000,000
$1,000.0o0
OFOPEFATIONSi LOCATIONS/VEHICLES (ACORDl0l,AddltlonalRffiarkssoheduls,maybeattacheditmorespacsisrequirsd)
SNE AITACIIED
DESCRIPTION
TE
@ 1988.2016 ACORD CORPORATION. Atl rights reserved.
The ACORD name and logo are reglstered marks of ACORD
sR rD: 221{392.1 BArcH: 239262A
2ot4 14423
SHOULD ANY OFTHE ABOVE DESCBIBED POLICIES BE CANCELLED BEFOFE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WTH THE POLICY PROVISIONS.
CLty of R6nt
220 4eh Av.nue South
K€nt, wA 98032 //4
AUTHORIZED FEPRESENTATIVE
ACORD 25 (2016/03)
AGENCY GUSTOMER ID:
LOC #:
AGENCY
witLis Towera watson North€astr Inc.
POLICY NUMBER
See Page 1
NAMED INSUFEOwaveDLvial,on Holdinga, I"tc
37OO Monte Villa Darkway
Bothell, HA 99021
NAIC CODE
See Page L EFFECTIVEOATE: See Page 1
CARRIER
gee Pag€ 1
OR ADDITIONAL REMARKS SCHEDULE zolz
@ 2008 ACOHD CORPOHATION, All rights reserved.
The ACOFD name and logo are registered marks ol ACORD
sR ID: 22L43924 EATCH: 239262a CERT: w23846304
Page
THIS ADDITIONAL HEMARKS
FORM NUMBER: 2s FORM TITLE:InsulanceCertificate of
FORM IS A SCHEDULE TO ACORD FOBM,
Tlre General tlabiLity and Automobite tiability policies inc.lude an autc'matLc Addj.tional fnsured endotsement that
provided Additionat Insured statuc ta The City Of Kent, Its Elected and/or ApPointed Officials, its Of,f,icers'
Employees, Agenta, Volunteerd, And Repregentatives, only when thefe is a written contract that requirea 6uch statua'
and only sith regard to srork performed, on behalf, of the nmed insured. The Gcnefa]. Liability poliey containa a epecial
endorsement with Primary and Noncontrlbutory wording, rthen required by t{ritt€n contract.
INSURER AI'FORDING coVEF,trGE: Zurich Artrerican Insurance CornPany
PoLICY NITMBER: AEc 9546362-02 EE.F DATE: A2/OL/2O22 ExP DATE: O2/OL/2O23
NAIC*:16535
TYPE OF INSURANCE:
1st Excess Liability
LIMIT DESCRTPIIONI
$15,000.000 xs
LIIIIT AI{OT'NT
$10, 000, 0oo
ACORD 101 (2008101)
CT(A CNA PARAMOUNT
Amendmentto Policy Declarations - Named lnsured
Endorsement
It is understood and agreed as follows:
The PolScy Declarations is amended as follows:
A. Addition of Named lnsureds:
The following are added as Named lnsureds
I
-
Name and Address of Named lnsured
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Copyright CNA All Rights Reserved,
Policy No: ir, r,l 5 I i -r {j l) i t1
Endorsement No:
Eftective Date: Lr:i rl 1 / 1iiJ2
3of 4 14423
CNA CNA PARAMOUNT
Amendmenlto Policy Declarations - Named lnsured
Endorsement
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lnsured Name; l1r.l, I.,:J E 1l'' L[' I I I' -]i,-1,
PolicyNo: (jrr!l,i ji;! -1tr
Endorsernent No:
Etfective Date: () . / I tI I ii'i ::HAhTFI rl\lr
LI'
Copyright CNA All Righls Reserved.
CNA CNA PARAMOUNT
Amendmentto Policy Declarations - Named lnsured
Endorsement
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i'jTa",,fl Policy No:
Endorsement No
Effective Date:
i-l 1 :':,i:,.i 1:'
Page -i of 4
ft;.\.TIi t,t.Al_ FIhE It.l;]-rh3J.tCE r-,F
lnsured Name: IGIDI.r,TE l-li )LI,Il'11-;S,
HAKTFI }Rt:
Tt
Copyright CNA All Fight$ Reserved.
0!it-)1 / )i)J :
4 ot 4 14423
CNA CNA PARAMOUNT
Amendment to Policy Declarations - Named lnsured
Endorsement
6l-:'0 {.llLLEtiE Rtr E tlTE -1100
FfiIt{cETr-)N, NLT 0854 0-662!)
B.Deletion of Named lnsured:
The following are deleted as Named lnsurcds:
Allother terms and conditions of the Policy remain unchanged.
endorsement which forms a part of and is issued by the designated lnsurers, takes effect on the effectiveattachmentto the
with saidandunless another effective date is shownof said at the hour stated in said
|NA62lr-rrJxt( o9-1:
Page "1 of 4
lrlA"TIr-NAl- FII{E ll'l'jl-lRAf.lf-:E iiF tlAFTFi]RD
lnsured Name: IL$IATE HCLDIIIGS, LP
Copyright CNA All Bights Reserusd,
PolicyNo: 60572369-16
Endorsement No:
Effective Date: a2/ 0r / 2a22