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HomeMy WebLinkAboutPW13-167 - Insurance Certificate - Qwest Corporation, CenturyLink Communications, LLC - Liability Coverage - 09/01/20203 `CC' ® DATE(MM/DD/YYYY) A 40 ,. CERTIFICATE OF LIABILITY INSURANCE F08/31/2023 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). CONTACT PRODUCER NAME: MARSH USA LLC. PHONE FAX CA License#0437153 c No Ext• A/C No): 1301 5th Avenue,Suite 1900 E-MAIL ADDRESS: Seattle,WA 98101-2682 Attn:Seattle.certrequest@marsh.com/Fax:212-948-4326 INSURER S AFFORDING COVERAGE NAIC# CN102197661-STND-ALL-23-24 INSURER A:Greenwich Insurance Company 22322 INSURED INSURER B:XL Specialty Insurance Co. 37885 Lumen Technologies,Inc. 36420 and all subsidiaries,including but not limited to: INSURER C:Allianz Underwriters Ins Co Clwest Corporation;Embarq Corporation;Level 3 Communications,LLC and INSURER D CenturyLink Communications,LLC 100 CenturyLink Dr. INSURER E: Monroe,LA 71203 INSURER F COVERAGES CERTIFICATE NUMBER: SEA-003510161-34 REVISION NUMBER: 0 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 ADDL SUER r POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYYA X COMMERCIAL GENERAL LIABILITY RGD500033311 09/01/2024 EACH OCCURRENCE $ 3,000,000 D DAMAGE TO RENTE 500,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 15,000,000 X POLICY PRO ❑ LOC PRODUCTS-COMPIOP AGG $ 15,000,000 JECT OTHER: A AUTOMOBILE LIABILITY RAD500033411 09/01/2023 09/01/2024 Ee aBcideDISINGLE LIMIT $ 2,000,000 X ANY AUTO Auto Physical Damage-Self Insured BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE X HIRED X NON-OWNED Per accident $ AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR U5Z000023220 09/01/2023 09/01/2024 PE.L. 00CURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE EGATE $ 10,000,000 DED RETENTION$ _ B WORKERS COMPENSATION ER RWD500032911(ADS) 09/01I2024 TATUTE OERH AND EMPLOYERS'LIABILITY RWR500033011 WI 09/01/2023 09/01/2024 1,000,000 B YIN N ( ) ACH ACCIDENT $ ANYPROPRI ETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? N N/A RWE500033111 WA 09/01/2023 09/01/2024 1,000,000 (Mandatory in NH) ( ) E.L.DISEASE-EA EMPLOYEE $ B If yes,describe under RWE500033211(OH) 09/01/2023 09/0112024 E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below C Technology E&O Incl. U5Z000023220 09/01/2023 09/01/2024 Each Claim/Aggregate 10,000,000 Cyber/Privacy Liability Retention 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Franchise Agreement.CITY OF KENT is included as Additional Insured on the General,Automobile,and Umbrella Liability Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 AUTHORIZED REPRESENTATIVE of Marsh USA LLC ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0001224 SP 0303 -001-P01224-1 CITY OF KENT Attn: City Clerk 220 Fourth Avenue South Kent, WA 98032 0303-01-00-0001224-0001-0002675 AGENCY CUSTOMER ID: CN102197661 LOC#: Seattle ACo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA LLC. Lumen Technologies,Inc. and all subsidiaries,including but not limited to: POLICY NUMBER ©west Corporation;Embarq Corporation;Level 3 Communications,LLC and Centurytink Communications,LLC 100 CenturyLink Dr. CARRIER NAIL CODE Monroe,LA 71203 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance ----- GENERAL LIABILITY-------------------- Automatic Additional Insured's Primary Coverage Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. Coverage provided by the above General Liability policy shall be primary and is limited to liability arising out of Named Insured's ownership and/or operations. Any insurance carried by the additional insured shall not be contributory insurance. Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)—any person or organization with whom you have entered into a contract or agreement,or by statute,law or code of ordinance. Separation of Insureds Applies. Insurance covers incidents that occur within 50'of railroad property,any railroad exclusions have been deleted per endorsement CG2417. -------------------AUTOMOBILE LIABILITY------------------- Any person or organization you are required in a written contract,agreement,statute,law or code of ordinances provided the"bodily injury"or"property damage"occurs subsequent to the executive of the contract,agreement,statute,law or code of ordinances. Lessor-Additional Insured and Loss Payee-All Lessors Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)—Any person or organization with whom you have waived prior to the"accident"or the"loss" under a contract with that person or organization,or under statute,law or code of ordinances. ---------WORKERS'COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS COMPENSATION AND EMPLOYER'S LIABILITY(OH&WA-SELF-INSURED- $1,000,000 RETENTION) -------- Waiver of Our Right to Recover from others Endorsement—Where required by written agreement signed prior to loss,or required by statute,law or code of ordinances executed prior to loss. ------------------- EXCESS/UMBRELLA------------------- Coverage applies per occurrence.Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement.Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-Any person or organization with whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Separation of Insureds Applies. -------------------COMMERCIAL CRIME-FIDELITY BOND------------------ Carrier:XL Specialty Insurance Company Policy Number:ELU19204423 Effective Dates:09/01/2023-09/01/2024 Deductible:$2,500,000 Each Occurrence:$15,000,000 -------------------U.S.PROPERTY------------------- Carrier:Allianz Underwriters Insurance Company Policy Number:U5Z000023220 Effective Dates:09/01/2023-09/01/2024 Limit:$25,000,000 Deductible:$25,000,000 Property Coverage:"All Risk"of Direct Physical Loss or Damage to All Real and Personal Property,including Boiler&Machinery,Earthquake,Flood and Wind-Replacement Cost Basis,and Business interruption-Actual Loss Sustained. Loss Payee or mortgagee as required by written contract/loan agreement to the the extent of your insurable interest.Waiver of Subrogation-Any person or organization whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Other deductibles may apply as per policy terms and conditions. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights u� The ACORD name and logo are registered marks of ACORD 0303-01-00-0001224-0002-0002676 00 Marsh Dear Certificate Holder: To streamline certificate delivery for our clients and in an effort to support our firm's commitment to sustainability,going forward,we will only be providing renewal certificates of insurance electronically. If you need to continue receiving a copy of the attached certificate, please send an email to USOperations.email@marsh.com and include the following: --Certificate#(Shown below Insured Name—e.g.,ABC-1.2.3456789-01) -- E-Mail for future delivery For your convenience, If we do not receive your response, we will conclude that you no longer require proof of insurance from the named insured and will remove you from our records. Thank you, US Operations, Marsh USA, LLC 6a Ma f P9�I. rir)xr7