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HomeMy WebLinkAboutCAG2022-197 - Insurance Certificate - FieldTurf USA, Inc. - Liability Coverage - 05/01/2024 Page 1 of 2 DATE(MMIDDNYYY) lb. R ' CERTIFICATE OF LIABILITY INSURANCE 05/02/2024 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd AHONE Et. 1-877-945-7378 aC No: 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURERS)AFFORDING COVERAGE NAIC# INSURERA: XL Insurance America Inc i 24554 INSURED INSURERS: Travelers Property Casualty Company of Amej 25674 Fieldturf USA Inc c/o sports Division INSURERC: Tarkett Inc. INSURER D: 7445 Cote-de-Liesse Road, Suite 200 Montreal, QC H4T iG2 CAN INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W33470757 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. _-. . ._,..,..TYPEOFINSURANCE_.,.,_. _.._.-- . .. INSR ADDLSUBR, pOLiCY EFF POLICY EXP LTR POLICY NUMBER MM DD/YYYY i MM DD/YYYY ! LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RE d _ CLAIMS-MADE X OCCUR PREMISES Ea occurrence)_ I$ 500,000 A — MED EXP — 10,000 An ( Y one person) I) $ Y US00010327LI24A 105/01/2024105/01/2025'; PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X� - PRO. ; POLICY JECT _ LOC PRODUCTS-COMPIOP AGG ;$ 2,000,000 I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 acadent) X! ANY AUTO BODILY INJURY(Per person) $ :�IAUTOS . BODILY INJURY(Per accident) $ AUTOS ONLYAUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ HIRED NON-OWNED TC2JCAP-823K312A-TIL-24 05/01/2024I05/01/2025, BODILciINJU S OWNED SCHEDULED Y I $ A X'. UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 r� ' EXCESS LIAB CLAIMS-MADE U5 0 0010 615LI24A 05/01/2024 05/O1/2025.AGGREGATE 1,000,000 _._.. --- DED X'RETENTION$10,000 ;$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X' STATUTE I ER B ANYPROPRIETOR'PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA' UB-8P793534-24-51-K .05/01/2024 05/01/2025 " " - - -- (Mandatory In NH)II E.L.DISEASE-EA EMPLOYEE' 1,000,000 SC _ DESC $ describe under RIPTION OF OPERATIONS below I I E.L.DISEASE•POLICY LIMIT !$ 1,000,000 B Workers Compensation & UB-8P760619-24-51-R 05/01/2024105/01/2025'E.L. Each Accident 1$1,000,000 '.Employer's Liability E.L. Disease-Pol Lmt $1,000,000 Work Comp - Per Statute ,E.L. Disease-Each Emp$1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WC Policies: Policy # UB-8P793534-24-51-K - covers all other states. Policy # UB-8P760619-24-51-R - covers AZ, MA, WI only. Project: Rogan Park Maintenance. 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. City of Kent AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South, {u Kent, WA 9.8032 � t ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sR ID: 25802065 BATCH: 3445037 6005: 2 of i AGENCY CUSTOMER ID: _ LOC#: ACo c ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMEDINSURED Willis Towers Watson Northeast, Inc. Fieldtur£ USA Inc c/o Sports Division POLICY NUMBER Tarkett Inc. See Page 1 7445 Cote-de-Liesse Road, Suite 200 CARRIER NAIL CODE Montreal, QC H4T 1G2 CAN 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 Certificate Holder (City) is included as an Additional Insured on the General Liability and Automobile Liability policies, as respects to the liability arising out of ongoing and completed operations performed on the project specified in the construction contract for the period of time required within the contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insureds, where required by written contract executed prior to loss and permitted by law. ACORD 101 (2008/01) c0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 25802065 BATCH:3445037 CERT: w33470757 f 6005: 2 of 5 I +� Page 1 of 2 AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) �.�►"' 05/02/2024 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 rC/AAdEA0T Willis Towers Watson Certificate Center Willis Towers Watson Northeast, Inc. PHONE c/o 26 Century Blvd A/ x ; 1-877-945-7378 FAX No: 1-886-467-2378 P.O. Box 305191 AIL ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# --.- __��._�__,__•__ _ -.. INSURERA: XL Insurance America Inc 24554 INSURED Fieldturf USA Inc INSURERS: Travelers Property Casualty Company of Amei 25674 c/o Sports Division INSURERC: - Tarkett Inc. INSURER D 7445 Cate-de-Liesse Road, Suite 200 ... . .. _,._...._-_.-_--..---... ---------. . Montreal, QC 114T 1G2 CAN INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W33470755 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 _.-__.,._._ ,-_.-w - -- EACH OCCURRENCE LTR TYPE OF INSURANCE INSD i POLICY NUMBER 1 LIMITS BR� POLICY EFF -POLICY EXP T MMiDD/YYYY MMJDDlYYYY i X COMMERCIAL GENERAL LIABILITY ',$ 1,000,000 CLAIMS-MADE i X�T— PR OCCUR MA RENTED 500,000-- ; EMISES�a occurrence2I$�-----_ _ A MED EXP(Any one person) $ 10,000 Y US00010327LI24A 05/01/202405/Ol✓2025 PERSONAL&ADV 1,000,OtlO INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ; GENERAL AGGREGATE ;s 2,000,000 PRO- POLICY JECT LOC ; PRODUCTS-COMP/OP AGG $ -- 2,000,000 i OTHER: i$ AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT 5,000,000 X ANY AUTO BODILY INJURY(Per person) �I$ B OWNED SCHEDULED iy TC2JCAP-823K312A-TIL-24 05/01/2024! UTOS ONLY 05/02/2025i BODILY INJURY fPer accident);$ HIRED NON OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE � jeer accident,,, I$ 1$ A X i UMBRELLA LIAB X! OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE US00010615LI24A 05/01/2024 05/Ol/2025 AGGREGATE i$.._.._-. 5,000,000 DED X; RETENTION$ 10,000 $ ----- WORKERS COMPENSATION B AN PROPMEM HREXCLUDED?ECUTIVE Y/N NIA UB-BP793534-24-51- X SEATUTE �RH ' E.L.EACH ACCIDENT $ 1,000,000 K 05/02/2024 05/01/2025 -- ... -- (Mandatory In NH) ET E.L.DISEASE-EA EMPLOYEE$ 1,000,000 yes,describe under D!ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Workers Compensation a UB-SP760619-24-51-R 105/01/2024105/0l/2tl25;E.L. Each Accident j$110001000 ,Employer's Liability E.L. Disease-Pol Lmtl$1,000,000 'Work Comp - Per Statute iE.L. Disease-Each Emp$1,000,000 DESCRIPTION OF OPERATIONS,'LOCATIONS VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Wilson Playfields Maintenance. 13028 S.E 251st Street, Kent WA 98031. WC Policies: Policy # US-8P793534-24-51-K - covers all other states. Policy # U73-8P760619-24-51-R - covers AZ, MA, WI only. 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. City of Kent AUTHORIZED REPRESENTATIVE 220 , Ave. S Kent, WA 98032 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR YD: 25802065 BATcB: 3445037 6005: 3 of 5 AGENCY CUSTOMER ID: LOC#: Ac R° ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMEDINSURED rieWillis Towers Watson Northeast, Inc. c/o Sport USA inc c/o Sports Division POLICY NUMBER Tarkett Inc. See Page 1 7445 Cote-de-Liesse Road, Suite 200 Montreal, QC R4T ZG2 CAN 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 The City of Kent is included as Additional Insured on the General Liability and Automobile Liability policy, as respects to the liability arising out of ongoing and, completed operations performed on the project specified in the construction contract for the period of time required within the contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insured, where required by written contract executed prior to loss and permitted by law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 25802065 SATCH:3445037 CERT: W33470755 6005: 3 of! Page 1 of 2 AC© DATE(MMIDONYYY) �- CERTIFICATE OF LIABILITY INSURANCE F05/02/2024 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd A C N .E t: 1-877-945-7378 A!C No: 1-888-467-2378 P.O. Box 305191 A DRIESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: XI. Insurance America Inc 24554 INSURED INSURERB: Travelers Property Casualty Company of Ames 25674 Fieldturf USA Inc c/o Sports Division INSURER C: Tarkett Inc. INSURER D: 7445 Cote-de-Liesae Road, Suite 200 -- Ull---_..----- ---...-----_._----- -...._..._._... ..-....-__.. ..._-----,-..........-------- ._......_..._....-.._.. Montreal, QC H4T IG2 CAN INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER:W33470756 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 _ ...._.._..._..._ ........_._. .._.... .._...__.-- . .*ADLSl18'RI.. ............_ .._._..._..-.._...._ _,_.._. --- POLICYEFF._. LICYEXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYY MM DDIYYYY x! COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 500,000 _ CLAIMS-MADE E ! OCCUR PREMISES Ea occurrencel $ A MED EXP(Any one person) $ 10,000 Y US00010327LI24A OS/O1/2024 05/Ol/2025 PERSONAL&ADV INJURY $ 1,000,000 GE_ML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE � $ 2,000,000 XI POLICY i i JE O LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 _ I LE accll eED _ X ANY AUTO BODILY INJURY(Per person) is B OWNED —! SCHEDULED I Y I AUTOS ONLY AUTOS TC2JCAP-823K312A-TIL-24 05/01/2024 105/01/2025 BODILY INJURY(Per accident)r$ HIRED �� NON-OWNED PROPERTY DAMAGE $ i AUTOS ONLY AUTOS ONLY ;-,-(Per acci, glr .,_ X 4 UMBRELLA LIAB A '; OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE US0001061SLI24A i 05/01/2024 05/01/2025 j AGGREGATE $ 1,000,000 DED ` i RETENTION$10,000 j $ WORKERS COMPENSATION PER OTH- I AND EMPLOYERS'LIABILITY UB-8P793534-24-51-K 05 01 2024 E. STATUTE_ ER OFFICE OFFICER/MEMBER NH)EXCLUDED? YIN ❑ / / 105/01/2025 E.L.EACH ACCIDENT .$ 1 000 000 B ANYPROPRIETORlPARTNE EXECUTIVE DESCRIPTION OF OPERATIONS 1,000,000 o IN7A. II yes,describe under ;E.L DISEASE EA EMPLOYEEi$ ONS below E.L.DISEASE•POLICY LIMIT !$ 1,000,000 B !Workers Compensation 6 li UB-8P760619-24-51-R Io5/01/2024I05/01/2025'E.L. Each Accident �$1,000,000 Employer's Liability :E.L. Disease-Pol Lmt �$1,000,000 Work Comp - Per Statute ! 'E.L. Disease-Each EmR$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) WC Policies: Policy # UB-8P793534-24-51-K - covers all other states. Policy # UB-SP760619-24-51-R - covers AZ, MA, WI only. Project: Wilson Playfield 1 AC Maintenance City of Kent is included as Additional Insured on the General Liability and Automobile Liability policy, as respects 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. City of Kent AUTHORIZED REPRESENTATIVE 220 4th Avenue S Kent, WA 98032 O 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD sa -To: 25802065 BATCH: 3445037 6005: 4 of 5 AGENCY CUSTOMER ID: LOG#: ACO® ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Fieidturf USA Inc C/o Sports Division POLICY NUMBER Tarkett Inc. See Page 1 7445 Cote-de-Liesse Road, Suite 200 CARRIER NAIC CODE Montreal, QC 84T 1G2 CAN 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 to the liability arising out of ongoing and completed operations performed on the project specified in the construction contract for the period of time required within the contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insured, where required by written contract executed prior to loss and permitted by law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 25802065 BATCH: 3445037 CERT. W33470756 6005: 4 of 5 Page 1 of 2 AC"R" CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) �"" '! 05/02/2024 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 Willis Towers Watson Certificate Center Willis Towers Watson Northeast, Inc. NAME: __ PHONE . 1-877-945-7378FA c/o 26 Century Blvd A/ N A C No: 1-888-467-2378 P.O. Box , TN ADDRESS: certificates@Willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICk INSURERA: XL Insurance America Inc 24554 INSURED - Fieldturf USA Inc INSURERS: Travelers Property Casualty Company of Ames 25674 c/o Sports Division INSURERC: Tarkett Inc. INSURER-- 7445 Cote-de-Liesse Road, Suite 200 -.__..._.__._..,....__.— _..__....__-..., _ Nantreal, QC K4T 1G2 CAN INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W33470758 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, DL SUBRI..... ......._ - _ LTR' TYPE OFINSURANCE AD ! POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY POLICY NUMBER MMIDD/YYYY MMODIYYYY LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE t X i OCCUR DAMAGE R N 500,000 PREMISES(Ea occurrence) I$ A i i �— _ 10,000 Y i MED EXP(Any one per $ US00010327LI24A 05/02/2024 05/01/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRO- GERAL AGGREGATE 1$ 2,000,000 EN X POLICY JECT LOC -__--__-- L PRODUCTS-COMP.rOP AGG is 2,000,000 OTHER: $ AUT OM OBt LE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 2� ANY AUTO LEaacctdentj__�- - - BODILY INJURY(Per person) $ B OWNED SCHEDULED Y TC2JCAP-823K312A-TIL-24 05/01/2 024 1 05/01/2025; BODILY INJURY(Per accident);$ AUTOS ONLY AUTOS HIRED j NON-OWNED PROPERTY DAMAGE AUTOS ONLY I ':AUTOS ONLY Per acoident)-. $ A X UMBRELLA LIAB X; OCCUR _ EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE US00010615LI24A 05/O1/2024 05/O1/2025_ _...__-_.___ AGGREGATE $ 1,000,000 -DE D ! RETENTION$10,000 $ WORKERS COMPENSATION PER ;OT - AND EMPLOYERS'LIABILITY Y r N X STATUTE ER H B jANYPROPRIETOR!PARTNER/EXECUTIVE ! E.L.EACH ACCIDENT $ 1,000,000 ICER/Mt?MBEREXCLUDED? !N/A i UH-8P793534 _._ (Mandatory in NH) -24-51-K 05/OS12024 O5/O1/2025 II yes,describe urKler I i E.L.DISEASE-EA EMPLOYEE'$ 11000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B ;Workers Compensation & UB-8P760619-24-51-R j05/02/2024I05/01/2025 E.L. Each Accident '.$1,000,000 Employer's Liability ( E.L. Disease-Pol Lmt !!$1,000,000 j Work Comp - per Statute IE.L. Disease-Each Emp$1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Wilson Fields/Hogan Park AC Maintenance & GMAX WC Policies: Policy # UB-8P793534-24-51-K - covers all other states. Policy If US-8P760619-24-51-R - covers AZ, MA, WI only. 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. City of Kent AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South Kent, WA 98032 Gx ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SR ID: 25802065 BATca: 3445037 6005: 5 of 5 AGENCY CUSTOMER ID: LOC#: ACo® ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMEDINSURED Fieldturf USA Inc Willis Towers Watson Northeast, Inc. _..__.-. c/o Sports Division POLICY NUMBER Tarkett Inc. 7445 Cote-de-Liesse Road, Suite 200 See Page 1 Montreal, ¢C H4T IG2 CAN CARRIER NAIC CODE See Page 1 ]See Page 11 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 The City of Kent is included as Additional Insured on the General Liability and Automobile Liability policy, as respects to the liability arising out of ongoing and completed operations performed on the project specified in the construction contract for the period of time required within the contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insured, where required by written contract executed prior to loss and permitted by law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 25802065 BATCH: 3445037 CERT: W33470758 6005: 5 of WILLIS TOWERS WATSON 26 CENTURY BLVD, 6TH FL, SUITE 101 NASHVILLE,TN 37214 6005 2 MB 0.568 6005 IIIII�"�I'�IIIII�'III'�I'III�I�II�I�III'I�I'I'i'I"I'I�II'���i�l CITY OF KENT 220 4TH AVE S KENT, WA 98032-5838 6005: 1 of 5