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HomeMy WebLinkAboutCAG2023-297 - Insurance Certificate - Dillon & Darby Stearns - Liability Coverage for Frager Road Gate - 05/11/2023 McCormick, Melissa From: Rolcik-Wilcox, Cheryl Sent: Tuesday, May 16, 2023 8:55 AM To: City Clerk Cc: Martindale, Delores; Duran, Lizeth Subject: FW:Another Insurance Requirements Question! Attachments: COI - City of Kent.pdf Hi Melissa - Can you please place the attached insurance COI and this email with contract CAG2023-297-Dillon & Darby Stearns? Let me know if you have any questions or need more info! Thank you! Q N Cheryl From: Rolcik-Wilcox, Cheryl Sent:Tuesday, May 16, 2023 8:48 AM To:Wi, Ellaine <EWi@kentwa.gov> Cc: Martindale, Delores<DMartindale@kentwa.gov>; Duran, Lizeth <LDuran@kentwa.gov> Subject: RE:Another Insurance Requirements Question! Thank you Ellaine! I just spoke to Dillon and he advised that it will renew annually and he will send the update for our files when he gets the renewal COI. Q I really appreciate all of your help with this!!!! From: Wi, Ellaine <EWi@kentwa.gov> Sent:Tuesday, May 16, 2023 8:31 AM To: Rolcik-Wilcox, Cheryl <CRolcik-Wilcox@kentwa.gov> Cc: Martindale, Delores<DMartindale@kentwa.gov>; Duran, Lizeth <LDuran@kentwa.gov> Subject: RE:Another Insurance Requirements Question! Hi Cheryl, Yes, the policy and coverage are sufficient. However, I do show that the policy expires on 6/1/2023. If it's going to take longer to build the gate, they'll have to extend the policy. Otherwise, it should be fine. Let me know if you need anything else. Ellaine Wi, Risk Manager Risk Management Division I Human Resources Department Phone (253) 856-5285 1 Fax (253) 856-6270 ewi(@KentWA.gov CITY OF KENT,WASHINGTON KentWA.aov Facebook Twitter YouTube PLEASE CONSIDER THE ENVIRONMENT BEFORE PRINTING THIS E-MAIL. From: Rolcik-Wilcox, Cheryl <CRolcik-Wilcox@kentwa.gov> Sent:Tuesday, May 16, 2023 8:17 AM To: Wi, Ellaine <EWi@kentwa.gov> 1 Cc: Martindale, Delores<DMartindale@kentwa.gov>; Duran, Lizeth <LDuran@kentwa.gov> Subject: RE:Another Insurance Requirements Question! Hi Ellaine - Dillon Stearns sent over the attached COI. Will this be sufficient coverage for the license agreement? Thank you! Q N Cheryl z A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/11/2023 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). PRODUCER CONTACT ERIN PHILLIPS NAME: HOE FAX StateFarm LEE THORNTON STATE FARM INSURANCE (PA ICNNo Ext: 206 878 2520 A/c No): 22235 7TH AVE S STE A E-M RESS, ERIN@AGENTLEE.NET DES MOINES WA 98198 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER B: DILLON&DARBY STEARNS INSURER C: 24519 FRAGER RD S INSURER D: KENT WA 98032 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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. INSR ADD SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMAIE TI CLAIMS-MADE OCCUR PREM SESOEa olccur ence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- PRODUCTS-COMP/OP AGG POLICY JECT LOC $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Per accident $ �/ $ X UMBRELLA LIAB /� OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESS LIAB CLAIMS-MADE Y N 47-C6-S970-4 06/01/2022 06/01/2023 AGGREGATE $ 3,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) FRAGER ROAD GATE LICENSE NUMBER:CAG2023-297 PERMIT NUMBERS:CNST-2222920 and CNST-2222921STU CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF KENT ACCORDANCE WITH THE POLICY PROVISIONS. 220 FOURTH AVE S AUTHORIZED REPRESENTATIVE KENT WA 98032 �2Gf1i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1001486 132849.14 04-13-2022