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HomeMy WebLinkAboutCAG2019-389 - Insurance Certificate - Robert Half International - Liability Coverage - 06/01/2022ApprovalOriginator:Department: Date Sent:Date Required: Authorized to Sign: Director or Designee Date of Council Approval: Grant? Yes No Type:Review/Signatures/RoutingComments: Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category: Vendor Number:Sub-Category: Project Name: Project Details: Agreement Amount: Start Date: Basis for Selection of Contractor: Termination Date: Local Business? Yes No* Business License Verification: Yes In-Process Exempt (KCC 5.01.045) If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace. Notice required prior to disclosure? Yes No Contract Number: Agreement Routing Form For Approvals, Signatures and Records Management This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms. Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20 Budget Account Number: Budget? Yes No Dir Asst: Sup/Mgr: Dir/Dep: rev. 20210513 FOR CITY OF KENT OFFICIAL USE ONLY (Optional) * Memo to Mayor must be attached SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/31/2022 Arthur J.Gallagher &Co. Insurance Brokers of CA,Inc.License #0726293 500 N.Brand Boulevard,Suite 100 Glendale CA 91203 Robert Half Certificates 818-539-1463 818-539-1801 roberthalf_certificates@ajg.com Federal Insurance Company 20281 ROBEHAL-03 Safety National Casualty Corporation 15105RobertHalfInternationalInc 2613 Camino Ramon San Ramon,CA 94583 595162316 A X 2,000,000 X 2,000,000 X Stop Gap Em.Liab 10,000 X in OH,WA,WY,ND 2,000,000 2,000,000 X Y 3579-66-87 6/1/2022 6/1/2023 2,000,000 Employer Liability 1,000,000 A 1,000,000 X Y 7323-32-17 6/1/2022 6/1/2023 Comp/Coll.Ded:1,000/$1,000 A X X 5,000,0007921-71-07 6/1/2022 6/1/2023 5,000,000 X 0 B X N See Attached Supplemental 6/1/2022 6/1/2023 1,000,000 1,000,000 1,000,000 The City of Kent are deemed Additional Insured on the above referenced General Liability and Auto Liability on a primary and non-contributory basis as required by written contract for liability arising out of Named Insureds'acts or omissions.Please refer to attached Chubb General Liability form 80-02-2367 for scope of Additional Insured status.Should the General Liability policy be cancelled before the expiration date thereof,the issuing company will mail thirty (30)days written notice to the Certificate Holder. City of Kent 220 4th Ave S.,4th Floor Kent WA 98032 2022-2023 RHI Workers Compensation Policy Numbers Policy#States Eff. Date Exp. Date Issuing Company NAIC # Robert Half International Inc./Protiviti Inc./Protiviti Government Services, Inc. LDS4064812 AOS: AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY 6/1/2022 6/1/2023 Safety National Casualty Corp 15105 PS 4064813 WI 6/1/2022 6/1/2023 Safety National Casualty Corp 15105 Additional Insured - Scheduled Person Or Organization continued 80-02-2367 (Rev. 5-07) Endorsement 1 Liability Insurance Form Page 3579-66-87 SFO FEDERAL INSURANCE COMPANY JUNE 1, 2015 TO JUNE 1, 2016 JUNE 10, 2015 JUNE 1, 2015 ROBERT HALF INTERNATIONAL, INC This Endorsement applies to the following forms: Name of Company Endorsement Policy Number Effective Date Policy Period Date Issued Liability Insurance Insured GENERAL LIABILITY Who Is An Insured the following provision only: them but they are insuredAdditional Insured -you are Scheduled Person Or Organization by this policy. Is An Insured, However, the person or organization is an insured is added ; withobligated pursuant to a to shown or agreement to are insureds is•if or organizations the extent the person or organ Persons and then only contract in the Schedule provide Under Who ization . described in the Schedule; such insurance s only if as is afforded • for eement; and did not occur, in whole requires the person or • agr act an insured loss, cost or expense for injury or to• status as to damages, or agreement or in part, before the of with respect that contract damage which this insurance applies. such ; execution the be affordedto the extent organizationto contract orivities • person is more specificallyidentified under this provision: of the No section organizationis an insured under any other provision Whothat or (regardless of any limitation applicablethereto). Is An Insured • expense for injury absence of , to which this insurance person would have in the or contr or agreement.This limitation does not apply cost or with act to any assumption of liability(of another applies,that the respect damage such contract or agreement. liabilityfor damages organization in to the or organization)by them a person or , loss, Reference Copy JUNE 1, 2022 TO JUNE 1, 2023 JUNE 1, 2022 JUNE 1, 2022 Additional Insured - Scheduled Person Or Organization last page 80-02-2367 (Rev. 5-07) Endorsement 2 Liability Insurance Form Page Liability Endorsement (continued) Conditions from insurance availableto such Other Insurance – person Primary, Noncontributory case Insurance – Scheduled Person Or Organization this insurance is primary and we a contract or added to the th shown are obligated,pursuant to will not seek contribution or you Conditions, the following provision is agreement, afforded by If organization. with Schedule Schedule Under in the primary insurance such as is to condition provide titled policy, then in suchthis Other Insurance. e person or organization Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Reference Copy PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY ARE INSUREDS ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN INSURED. HOWEVER, NO PERSON OR ORGANIZATION IS AN INSURED UNDER THIS PROVISION WHO IS MORE SPECIFICALLY DESCRIBED UNDER ANY OTHER PROVISION OF THE WHO IS INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY LIMITATION APPLICABLE THERETO).   COMMERCIAL AUTOMOBILE – BLANKET ADDITIONAL INSURED – POLICY EXCERPT Insured Robert Half International, Inc Policy Number 7323-32-17 Policy Effective June 1, 2022 – June 1, 2023; 12:01am Standard Time Form Number 16-02-0292 (rev. 11-16)   BUSINESS AUTO COVERAGE FORM This endorsement modifies the Business Auto Coverage Form. 2. BROAD FORM INSURED D. Persons And Organizations As Insureds Under A Written Insured Contract Paragraph A.1 – WHO IS AN INSURED – of SECTION II – LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed under an express provision in a written "insured contract", written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an "insured". However, such person or organization is an "insured" only: (1) with respect to the operation, maintenance or use of a covered "auto"; and (2) for "bodily injury" or "property damage" caused by an "accident" which takes place after: (a) You executed the "insured contract" or written agreement; or (b) The permit has been issued to you.