Loading...
HomeMy WebLinkAboutCAG2022-111 - Insurance Certificate - MacLeod Reckord, PLLC - Liability Coverage - 09/01/2023 MACLREC-01 LBERNHARDSEN ,4coR0 CERTIFICATE OF LIABILITY INSURANCE DATE 911/2 DIYYYY) 9/1/2023 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 NAME: Mill Creek-AAA Insurance Agency PHONE FAX 2911 1/2 Hewitt Ave (A/C,No,Ext): (877)222-4678 (A/C,No): Everett,WA 98201 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:AmGuard Insurance Company INSURED INSURER B:Everest Indemnity Ins CO Macleod Reckord PLLC INSURER C: 110 Prefontaine Place South,Suite 600 INSURER D: Seattle,WA 98104 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM DD YYY MM DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR MABP443916 9/1/2023 9/1/2024 DAMAGE TO RENTED X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY El PECOT- LOC PRODUCTS-COMP/OP AGG $ 200,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO X X MABP443916 9/1/2023 9/1/2024 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ent $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE X X MAUM444197 9/1/2023 9/1/2024 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ 1,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ 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 $ B Errors&Omissions X BORAAEP000437231 8/30/2023 8/30/2024 Ea Claim/Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Kent Parks,Recreation and Community Services is named as additional insured Insurance shall not be cancelled by either party,except after thirty(30)days prior written notice by certified mail,return receipt requested,has been given to the City of Kent Project:Milwaukee II Green River Trail Alignment CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent Parks,Recreation&Community Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y Y ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Ave A Kent,WA 98032 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MABP443916 BUSINESSOWNERS BP 04 48 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Persons Or Or anization s : City of Kent Parks, recreation & Community Services Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph C. Who Is An In- sured in Section II— Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for"bodily injury", "property dam- age" or"personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. BP 04 48 01 06 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ BUSINESSOWNER'S BP99 213 02 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNER'S COVERAGE FORM Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in SECTION III — COMMON POLICY CONDITIONS is amended by the addition of the following: We waive any right of recovery we may have against any person(s) or organization(s) for whom you have agreed to waive such right of recovery in a written contract or agreement because of payments we make for injury or damage arising out of your ongoing oper- ations or"your work" done under a contract with those person(s) or organization(s) and included in the "products-completed operations hazard". BP 99 213 02 17 Includes copyrighted material of the Insurance Services Office, Inc., used with its permission. Page 1 of 1 8/31/23,2:09 PM MACLEOD RECKORD PLLC 4 STATE OF WAS HINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage August 31 , 2023 WA UBI No. 602 870 639 L&I Account ID 354,845-01 Legal Business Name MACLEOD RECKORD PLLC Doing Business As MACLEOD RECKORD PLLC Workers' Comp Premium Status: Account is current. Estimated Workers Reported Quarter 2 of Year 2023"4 to 6 Workers" (See Description Below) Account Representative Employer Services Help Line, (360)902-4817 Licensed Contractor? No What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51 .1 2.050 and 51 .16.190). https://secure.I ni.wa.gov/verify/Details/I iabilityCertificate.aspx?U BI=602870639&LIC=&VIO=&SAW=false&ACCT=35484501 1/1