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HomeMy WebLinkAboutPW15-059 - Insurance Certificate - Verizon Communications, Inc - SEA 4 Corners - 6/30/24 t�vtll5-6s0( ✓ DATE 8/2 024YYY) CERTIFICATE OF LIABILITY INSURANCE O(SM 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 a2 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 NAMEACT 'a Aon Risk services Northeast, Inc. P N (866) 283-7122 FAX (800) 363-0105 d New York NY Office (A C.No.Elf): ((A/C No.); p One Liberty Plaza E-MAIL O 165 Broadway, Suite 3201 ADDRESS: _ New York NY 10006 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Liberty Mutual Fire Ins CO 23035 Verizon Communications Inc. INSURERB: 1095 Avenue of the Americas New York NY 10036 USA INSURER C: INSURER D: INSURER E: INSURER F: f� COVERAGES CERTIFICATE NUMBER: 570106444154 REVISION NUMBER: 'I 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYVXL LIMITS X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $5,000,000 -DAMAGE TO RENTED CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence $5,000,000 X Standard Contractual Liability MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $5,000,OOO X XCU Coverage is Included GENERAL AGGREGATE $5,000,000 d- GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑PRO ❑LOC PRODUCTS-COMP/OPAGG $5,000,OOO a JECT O OTHER: r` u� A AUTOMOBILE LIABILITY As2-691-550588-124 06/30/2024 06/30/2025 COMBINED SINGLE LIMIT $5,000,000 AOS Ea accident A 2-691-550588-134 06/30/2024 06/30/2025 BODILY INJURY(Per person) X ANY AUTO A5 Z OWNED SCHEDULED NH - Primary BODILY INJURY(Per accident) A AUTOS ONLY AUTOS TL2-691-550588-184 06/30/2024 06/30/2025 PROPERTY DAMAGE HI RED AUTOS NON-OWNED NH - Excess Per accident) ONLY AUTOS ONLY N UMBRELLA LIAB HOCCUR EACH OCCURRENCE U EXCESS LAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND PER STATUTE ORH- EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below _ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Named insured includes: cellco Partnership dba Verizon wireless, 180 washington valley Road, Bedminster, New jersey 07921. RE: site Name: SEA 4 corners, Location code: 102484, Contract No.: 79134, site Address: 26800 Maple Valley Black Diamond Road SE, Maple valley, WA 98038. City of Kent is included as Additional insured with respect to the General Liability policy. where permitted by law, the Named Insured parties listed herein waive all rights against the Certificate Holder and each t- Additional insured party listed herein for recovery of damages to the extent these damages are covered by the above-referenced General Liability and Automobile Liability policies, and, as further limited by written contract between the parties. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ft— EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LJ n� X, City Of Kent AUTHORIZED REPRESENTATIVE 'k Attn: City Clerk Fourth Avenue Ken IQL �/lt. Kent WA 98403 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: T132-691-550588-144 COMMERCIAL GENERAL LIABILITY CG20101219 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 Any person or organization whom you become obligated All location(s)where work is being done for the to include as an additional insured as a result of any location. contract or agreement you have entered into. 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 "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs) to be performed by or on behalf of the in the performance of your ongoing operations for additional insured(s) at the location of the the additional insured(s) at the location(s) covered operations has been completed; or designated above. 2. That portion of "your work" out of which the However: injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organizationother than another contractor or subcontractor insured only applies to the extent permitted by engaged in performing operations for a principal law; and 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 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 Policy Number T132-691-550588-144 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization whom you become Per the contract or agreement obligated to include as an additional insured as a result of any contract or agreement you have entered into. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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 is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or m part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included 1. Required b the contract or agreement; or in the products-completed operations hazard". q y g However: 2. Available under the applicable limits of insurance; 1. The insurance afforded to such additional insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. 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 37 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or _ a 0 m 0 0 m v 0 m 0 0 0 0 0 0 0 0 0 Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19