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Home My WebLink AboutCAG2020-164 - Insurance Certificate - CivicPlus, Inc. - SeeClickFix Liability Coverage - 04/30/2023 Page 1 of 2 DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/15/2023 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 pollcy(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 Willie Tourers Watson Certificate Canter NAME: Willie Towers Watson Northeast, Inc. c/o 26 Century Blvd PHONE . 1-877-945-7378 (AC,Nult 1-888-467-2378 P.O. Box 305191 E-MAILQ ESS; certific8tsm0w.11ia.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC k INSURER A: American Casualty Company of Reading Panne 20427 INSURED INSURERS: Endurance American Specialty Insurance Cam 41718 CivioPlus, LLC and ita direct and indirect aubsidiaries 302 S. 4th Street Suite 500 INSURERC: Manhattan, KS 66502 INSURER D: INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER:W28971560 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY I'EPIO[.l 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 R EDUCED p BpY PAID CLAIMS. ILH-S TYPE O-INSURANCE � L B POLICY NUMBER INM�WYYFYY MMti YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE ] OCCUR IS DAMAGE a accurrur:9s] $ 100,000 A MED EXP(Any one person) $ 15,000 7037146004 05/17/2023 05/17/2024 PERSONAL&ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 HX POLICY E � LOC PRODUCTS-COMP/OP AGG $ 2,000,00e OTHER: $ AUTOMOBILE LIABILITY Ca BINtr�Oj)SINGLE LIMI I $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS $ HIRED NON-OWNED PgOPEF�i�TTY DAMAGE AUTOS ONLY AUTOS ONLY LI?er @9.0,,. n11. $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE_ _ _ $ DED II RETENTION$ $ WORKERS COMPENSATION X O - AND EMPLOYERS'LIABILITY Y/N TATU7 ER_ A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDE1 N/A 7037146021 05/17/2023 05/17/2024 1,000,000 I(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II yea,describe under 11000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ B ICyber Liability PR030018745601 04/30/2023 04/30/2024,8ach Claim/Aggregate $2,000,000 (Tech EGO :Aggregate/ ded $1,000,000/$25,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Division Branch: CivicService - 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 ` �F 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD as ID1 24142486 aATcH: 2974895 1787: 2 of 2 AGENCY CUSTOMER ID: _ LOC#: A`QR" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. CivioPlua LLC and its direct and indirect subsidiaries 302 S. I 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: 24142486 BATCH: 2974895 CBRT: W28971560 1787 2 of 2