The URL can be used to link to this page

Home My WebLink AboutCAG2020-164 - Insurance Certificate - CivicPlus, LLC - SeeClickFix Liability Coverage - 04/30/2022 FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: ILS/TD Agreement Routing Form Dir Asst: • For Approvals,Signatures and Records Management Dir/Dep: IMC KE N T This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional) WASHINGTON Sheet forms. Originator: Department: Daniel Blincoe IT Date Sent: Date Required: > 07/01/2022 0 CL Authorized to Sign: Date of Council Approval: C aDirector or Designee N/A Budget Account Number: Grant?[:]Yesallo 52001770.64260.1800 Budget?W]Yes:No Type: N/A Vendor Name: Category: CivicPlus, Inc Contract Vendor Number: Sub-Category: = 2285068 Insurance Cert 0 Project Name: SeeClickFix E c Project Details: Updated Certificate of Insurance for CivicPlus. C ber Liability � p Y Y = coverage is 04/30/22-04/30/23, all others 05/17/22-05/17/23. c 40 40 Agreement Amount: $0 Basis for Selection of Contractor: Direct Negotiation 47 `Memo to Mayor must be attached i Start Date: multiple Termination Date: multiple Im Q Local Business?F_1Yesallo* If meets req uiremen ts per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions'form on Cityspace. Business License Verification:Yes:ln-Process:Exempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: F]Yes�✓ No CAG2020-164 Comments: <<For Retention Only; No Signature Required>> 3 Mike Carrington, IT Director a� a a, 3 Date: c in Date Routed to the City Clerk's Office: ac«w»373__,0 Visit Documents.KentWA.gov to obtain copies of all agreements rev.20210513 Page 1 of 2 DATE(M9I/DDIYYYY) ACaR" CERTIFICATE OF LIABILITY INSURANCE 05/2)0/2022 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. 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 endorsements. PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc PHONE 1-877-945-7378 C 1-888-c67-2375 c/o 26 Century Blvd E-!NA L P.O. Box 305191 A Dp certificatesgwillis.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAICAt INSURER A: Great Northern Insurance Company 20303 INSURED INSURERB: Federal Insurance Company 20282 Civ302 cPlue, LTC Street, Endurance American Specialty Insurance Core 41718 302 S 4th Streat, Suit® 500 INSURER C: P y Manhattan, KS 66502 INSURER D: INSURER E: INSU F, COVERAGES CERTIFICATE NUMBER:W24806582 REVISION NUMBER: 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 W11CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TFE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSp TYPE OFINSURANCE ADOL SF1BR. POLICY EFF POLICCY,XP LIMITS POLICYNU1,18ER MMID0I1 f MMODIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RE NTF V CLAIMS-MADE X OCCUR 2,000,000 A MED EXP(Any one person) $ 10,000 3602-53-12 05/17/2022 05/17/2023 PERSONAL&ADV INJURY )$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE_ $ 2,000,000 X POLICY a JEGx LOG PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER' $ AUTOMOBILE LIABILITY C BINEDSI GLCLIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per acgldsn.(y. I I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED 11ETENT ION G - $ WORKERS COMPENSATION XPER AND EMPLOYERS'LIABILITY 1,000,000 STAIUTE OF B ICER/MEMBEREXCLUDED?ANYPROPRIETOR/PARTNERIEXECUTIVE Y❑ N I A E.l,EACH ACCIDENT $ (23) 7174-92-49 05/17/2022 D5/17/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 II yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ C Cybsr Liability PRO30018745600 04/30/2022 04/30/2023 Each Claim/Aggregate142,000,000 (Tech E&O Aggregate/ dad f$1,000,000/$25,00 I I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Division Branch: CivicSsrvice - Project Location:Kent, WA City of Kent, WA as Additional Insured Coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. General Liability policy shall be Primary with any other insurance in force for or which may be purchased by CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Kent, Washington AUTHORIZED REPRESENTATIVE Attn: Brian Rambonga 220 Fourth Avenue South Kent, WA 98032 01988-2016 ACORD CORPORATION, All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR XD: 22596306 BATCH: 2534245 2 of 2 4936 AGENCY CUSTOMER ID: LOC#: ACO'RV ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. CivicPlus, LLC 302 B 4th Street, Suite 500 POLICY NUMBER Manhattan, KS 66502 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Additional Insured. ACORD 101 (2008/01) ®2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 22596306 BATCH: 2534245 CERT: W24806562