Loading...
HomeMy WebLinkAboutPW18-228 - Insurance Certificate - T-Mobile US, Inc. - Liabiltiy Coverage - 05/01/2023 PW18-228 o�® CERTIFICATE OF LIABILITY INSURANCE 5/1/2024 4/0 DATE 04/03/202202Y) 3 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 endorsement(s). CONTACT PRODUCER Lockton Companies NAME: FAX Three City Place Drive,Suite 900 A/CONN E A/C No St. Louis MO 63141-7081 E-MAIL (314)432-0500 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Continental Casualty Company 20443 INSURED T-Mobile US, Inc. INSURER B: The Continental Insurance Company 35289 1358772 Its Subsidiaries and Affiliates INSURER C: Transportation Insurance Company 20494 12920 SE 38th Street INSURER D: Bellevue WA 98006 INSURER E INSURER F COVERAGES TMOBI CERTIFICATE NUMBER: 13601343 REVISION NUMBER: XXXXXXX 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. i TR ADDL SUB DD POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY /Y MM/ YYY A X COMMERCIAL GENERAL LIABILITY 7012343900 05/01/202 05/01/2024 EACH OCCURRENCE $ 10 000 000 �OCCUR DAMAGE 3(RENTED CLAIMS-MADE PREMISE Ea o rre $ 10000000 MED EXP(Any oneperson) $ 25,000 Y N PERSONAL&ADV INJURY $ 10,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20,000,000 POLICY❑ PE �LOC PRODUCTS-COMP/OP AGG $ 2O 000 000 CT OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 7012343878 05/01/202 05/01/202 Ea accident X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED N N BODILY INJURY(Per accident) $ XXXXXXX AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED Peracadent $ XXXXXXX AUTOS ONLY AUTOS ONLY $ XXXXXXX B X UMBRELLA LIAB �OCCUR CUE 7014886953 05/01/202 05/01/202 EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB N N SIR applies per policy AGGREGATE $ 5,000,000 g terms&conditions $ DE D X RETENTION$10,000 _ WORKERS COMPENSATION X PTA TE OE H g AND EMPLOYERS'LIABILITY YIN 7012343895�ACS) 05/01/202 05/01/202 $ 2,000��� g ANY PROPRIETOR/PARTNER/EXECUTIVE NIA N 7012343881 CA) 05/01/202 05/01/202 E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? 7012447142 AZ,MA,OR,WI) 05/01/202 05/01/202 E.L. 2,000,000 C (Mandatory in NH) .L.DISEASE-EA EMPLOYEE If yes,describe under $ `Z 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder and other entities defined by written contract,statute,permit application or written agreement are additional insureds on a primary and non-contributory basis under general liability and are additional insured under automobile liability as required by written contract.Waiver of Subrogation applies under general liability and automobile liability as required by written contract.""See Attached Endorsements— SE04637F/Shearer-Springbrook Park/ROW adjacent to 10007 SE 200th Street,Kent,WA SE04099F/Garrison Creek/ROW adjacent to 10702 SE 224th Place,Kent,WA SE05316B/Emerald PArk/ROW adjacent to SE 219th Place&116th Avenue SE,Kent,WA CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13601343 AUTHORIZED REPRESENTATIVE City of Kent Attn: Public Works Director 220 Fourth Avenue South Kent WA 98032 ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code : D590641 Master ID: 1358772, Certificate ID: 13601343 LOCKIM City of Kent Attn: Public Works Director 220 Fourth Avenue South Kent WA 98032 IMPORTANT NOTICE Dear Certificate Holder for T-Mobile and its subsidiaries (including Sprint): In our continued effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance going forward. To ensure future renewals of this certificate, we need your email address. Please contact us via one of the methods below, referencing Certificate ID 13601343 • Email: stl-edelivery@lockton.com • Phone: 3 74-8 72-3888 If we do not receive your email address via one of the above methods prior to the client's next renewal, we will assume you no longer need the certificate. If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. The above inbox is for collecting email addresses for renewal electronic certificate delivery ONLY. You will not receive a response from this inbox. Thank you for your cooperation. Lockton Companies Lockton Companies Three CityPlace Dr, Suite 900/ St. Louis, MO 63141-7088 314-432-0500/ locicton.com Attachm'Ci278 Master ID: 1358772, Certificate ID: 13601343 POLICY HOLDER NOTICE—COUNTRYWIDE It is understood and agreed that: If the Named Insured has agreed under written contract to provide notice of cancel lation to a party to whom the Agent of Record has issued a Certificate of Insurance,and if the Insurer cancels a policy term described on that Certificate of Insurance 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. If notice is mailed,then proof of mailing to the last known mailing address of the Certificate holder on file with the Agent of Record wi I I be sufficient to prove notice. Any failure by the Insurer to notify such persons or organizations will not extend or invalidate such cancellation,or impose any liability or obligation upon the Insurer or the Agent of Record. iThis endorsement,which forms a part of and is for attachment to the policy issued by the designated �I nsurers, !takes effect on the Policy Effective date of said policy at the hour stated in said policy,unless another Form No: CNA75014XX(01-2015) Policy No: 7012343900 Endorsement Effective Date: 05/01/2023 Policy Effective Date: 05/01/2023 Underwriting Company: Continental Casualty Company ©Copyright CNA All Rights Attachment Code : D559289 Master ID: 1358772, Certificate ID: 13601343 CNA NOTICEOF • TO CERTIFICATEHOLIDERS It is understood and agreed that: If you have 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 we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium,then notice of cancellation wil I be provided to such Certificateholders at least 30 days in advance of the date cancellation is effective. If notice is mailed,then proof of mailing to the last known mailing address of the Certi fi catehol der 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. This endorsement,which forms a part of and is for attachment to the policy issued by the designated ,Insurers, itakes effect on the Policy Effective date of said policy at the hour stated in said policy,unless another Form No: CNA68021XX(02-2013) Pol icy No:7012343878 Endorsement Effective Date: 05/01/2023 Po I i cy Eff e cti ve Da te:05/01/2023 Endorsement No: Policy Page: Underwriting Company: Continental Casualty Company ©CoovriRht CNAAII Riehts