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HomeMy WebLinkAboutPW16-030 - Insurance Certificate - Republic Services - Garbage Services - 06/30/24 1 A 0® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 706/30/2024 (MM/ Y) 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 endorsements . PRODUCER CONTACT NAME: CANNON COCHRAN MANAGEMENT SERVICES, INC. 17015 NORTH SCOTTSDALE ROAD PHONE(A/C No.Ext): FAX(A/C No.Ext): SCOTTSDALE,AZ 85255 E-MAIL ADDRESS:certificateteam ccrosi.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Co. 22667 INSURED INSURER B: indemnity Insurance Co of North America 43575 REPUBLIC SERVICES,INC. INSURER C: Illinois Union Insurance Company27960 18500 N.ALLIED WAY INSURER D: PHOENIX,AZ 85054 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2480982 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 (MMIDDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY HDO G48921000 06/30/2024 06/30/2025 EACH OCCURRENCE $10,000,000 E]CLAIMS-MADE M OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $10,000,000 MED EXP(Any one person) PERSONAL&ADV INJURY $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $30,000,000 POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $20,000,000 OTHER: A AUTOMOBILE LIABILITY ISA H10740083 06/30/2024 06/30/2025 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $10,000,000 X OWNED AUTOS X SCHEDULED BODILY INJURY(Per person) ONLY AUTOS BODILY INJURY(Per accident) X HIRED AUTOS ff]NON-OWNED ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ B WORKERS COMPENSATION Y/N N/A WLR C57256862-ADS 06/30/2024 06/30/2025 X PER OTHER AND EMPLOYERS'LIABILITY WLR C57257672-OR 06/30/2024 06/30/2025 STATUTE A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $3,000,000 A OFFICER/MEMBER EXCLUDED? SCF C57257726-WI 06/30/2024 06/30/2025 WCU C57257829-OH XS 06/30/2024 06/30/2025 E.L.DISEASE-EA EMPLOYEE $3,000,000 A (Mandatory in NH) TNS C57194790-TX NS/XS 06/30/2024 06/30/2025 E.L.DISEASE-POLICY LIMIT $3,000,000 C If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Division Number:4176-Named Insured Includes:Kent-Meridian Disposal Company-Dba:Kent-Meridian Disposal//Allied Waste Services of Kent//Republic Services of Kent CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF KENT ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 220 4TH AVENUE SOUTH KENT,WA 98032 United States ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACO® ADDITIONAL REMARKS SCHEDULE Page 2of2 AGENCY NAMED INSURED REPUBLIC SERVICES, INC. POLICY NUMBER 18500 N.ALLIED WAY See First Page PHOENIX,AZ 85054 CARRIER NAIC CODE See First Page EFFECTIVE DATE: ADDITIONAL REMARKS CERTIFICATE NUMBER: 2480982 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The following provisions apply when required by written contract.As used below,the term certificate holder also includes any person or organization that the insured has become obligated to include as a result of an executed contract or agreement. GENERAL LIABILITY: Certificate holder is Additional Insured including on-going and completed operations when required by written contract. Coverage is primary and non-contributory when required by written contract. Waiver of Subrogation in favor of the certificate holder is included when required by written contract. AUTO LIABILITY: Certificate holder is Additional Insured when required by written contract. Coverage is primary and non-contributory when required by written contract. Waiver of Subrogation in favor of the certificate holder is included when required by written contract. WORKERS COMPENSATION AND EMPLOYERS LIABILITY: Waiver of Subrogation in favor of the certificate holder is included when required by written contract where allowed by state law. Stop gap coverage for ND and WA is covered under policy no.WLR C57256862 and stop gap coverage for OH is covered under policy no.WCU C57257829,as noted on page 1 of this certificate. TEXAS EXCESS INDEMNITY AND EMPLOYERS LIABILITY: Insured is a registered non-subscriber to the Texas Workers Compensation Act. Insured has filed an approved Indemnity Plan with the Texas Department of Insurance which offers an alternative in benefits to employees rather than the traditional Workers'Compensation Insurance in Texas.The excess policy(TNS C57194790)shown on this certificate provides excess indemnity and Employers Liability coverage for the approved Indemnity Plan. Contractual Liability is included in the General Liability and Automobile Liability coverage forms.The General Liability and Automobile Liability policies do not contain endorsements excluding Contractual Liability. Separation of Insured(Cross Liability)coverage is provided to the Additional Insured,when required by written contract, per the Conditions of the Commercial General Liability Coverage form and the Automobile Liability Coverage form. Re: City of Kent Franchise Agreement Additional Insured includes:The City of Kent, its officers,elected or appointed officials,employees,agents and volunteers,when required by written contract. Includes all customers serviced under the franchise agreement. ACORD 101(2008/01) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD