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HomeMy WebLinkAboutCAG2022-480 - Insurance Certificate - ASM Affiliates, Inc. - ACORD Liability Coverage - 09/10/2023 A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/08/2023 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 Lena Marrujo NAME: FALCON WEST INSURANCE BROKERS,INC. PNHCONN Ext: (619)297-9181 A/XC,No): (619)297-3366 License#0616640 E-MAIL lenam@falconwest.com ADDRESS: 2525 Camino Del Rio S Ste 100 INSURER(S)AFFORDING COVERAGE NAIC# San Diego CA 92108 INSURERA: Ironshore Specialty Insurance Company 25445 INSURED INSURER B: Wesco Insurance Co 25011 ASM Affiliates INSURER C: 2034 Corte Del Nogal INSURER D: INSURER E: Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 WA 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE X OCCUR PRIM SES Ea oNcE ence $ 500,000 X General Liability Deductible$5,000 MED EXP(Any one person) $ 25,000 A X Pollution Liability Deductible$5,000 Y Y IEPICCVJSWO01 09/10/2023 09/10/2024 PERSONAL&ADV INJURY $ 5,000,000 MOTHER LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 5,01)(),l)()0 JECT: Pollution Liability $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y WPP 198571801 09/10/2023 09/10/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LAB CLAIMS-MADE IEELCASCVJSX001 09/10/2023 09/10/2024 AGGREGATE $ 5,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability Each Incident Limit $5,000,000 A IEPICCVJSWO01 09/10/2023 09/10/2024 Aggregate Limit $5,000,000 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Clark Lake Park-Ruth Property Cultural resource survey Park Planning and Development for CITY OF KENT,WASHINGTON are Additional Insured on the General Liability policy and provided a Waiver of Subrogation on the General Liability and Workers'Compensation ATIMA accordance with the policy provision,per written contract. This Certificate of Insurance shall provide that there will be no cancellation or reduction of coverage without thirty(30)days prior written notice to Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Park Planning and Development for CITY OF KENT WASHINGTON ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent WA 98032 LWAAA,,�_ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD