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HomeMy WebLinkAboutCAG2023-383 - Insurance Certificate - PPC Solutions Inc. - Liability Coverage - 04/01/2024 PPCSOLU-01 KPHILLIPS1 ,4coR0 CERTIFICATE OF LIABILITY INSURANCE DATE(M/202 YYY) 3/282024 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 Debbie Johnston,CRM,CPCU,CIWCS,CPIW,ARM,AMIM,AINS NAME: Alliant Insurance Services,Inc. PHONE FAX 818 W Riverside Ave Ste 800 (A/C,No,Ext): (208)770-3844 (A/C,No):(509)325-1803 Spokane,WA 99201 ADDRESS:debbie.johnston@alliant.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Allied World Surplus Lines Insurance Company 24319 INSURED INSURER B:RLI Insurance Company 13056 PPC Solutions,Inc. INSURER C:Allied World Insurance Company 22730 18303 E Appleway INSURER D: Spokane Valley,WA 99016 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 5200427601 4/1/2024 4/1/2025 DAMAGE TO RENTED 1,000,000 X PREMISES Ea occurrence $ X $5,000 Ded Per Occur 10,000 MED EXP An one person) $ X IncludesE&O PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X PECOT- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO X CAP9509902 4/1/2024 4/1/2025 BODILY INJURY Perperson) $ X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED Ix NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ent $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE 5201190801 4/1/2024 4/1/2025 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 5200427601 4/1/2024 4/1/2025 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Employers Liability is WA Stop Gap only. Workers Compensation coverage is not provided. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Avenue South Kent,WA 98032 AUTHORIZED REPRESENTATIVE i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Blanket Basis —Any entity that the named insured Any through written contract or agreement agrees to include as an additional insured. Item 4.b. of Section IV—commercial liability conditions is amended by the addition of the following: (3)this insur- ance is primary and /or noncontributory to any coverage afforded to the"additional insured" if a written contract or agreement states the named insured agrees to name a person or entity as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodilyinjury"or " damage" or "personal and advertising injury" p y ry caused, in whole or in part, by: property damage"occurringg after: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of yourongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by otherthan another contractor or subcontractor law; and engaged in performing operations for a principal as a part of the same project. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III— Limits Of Insurance: Whichever is less. If coverage provided to the additional insured is required by a contractor agreement, the most we will pay on behalf of the additional insured is the This endorsement shall not increase the amount of insurance: applicable Limits of Insurance shown in the 1. Required by the contract or agreement; or Declarations Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: CAP9509902 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - CERTIFICATE OF INSURANCE OR WRITTEN CONTRACT - FOR YOUR NEGLIGENCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS INDEMNITY COVERAGE COMMERCIAL GENERAL LIABILITY COVERAGE FORM The provisions of the Coverage Form apply unless modified by this endorsement. Endorsement Effective: 4/1/24 Named Insured: PPC Solutions, Inc. Additional insured for liability coverage provided under this policy shall include: 1. Any organization named as an additional insured on a Certificate of Insurance issued for this policy and received by us prior to the date of loss, but only for liability for your negligence to which this insurance applies; or 2. Any organization you are obligated to name as an additional insured pursuant to a written contract signed by both you and the organization prior to the date of loss, but only for liability for your negligence to which this insurance applies. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS OF THIS POLICY REMAIN UNCHANGED. TRS 700 (01/20) Page 1 of 1