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HomeMy WebLinkAboutCAG2022-174 - Insurance Certificate - JWC Environmental, Inc - Frager Road Pump Station Equipment Purchase - 7/1/24 2-0 2 ,- I I �"�1 ® E ATE(MM/DD/YYYY) �`�n CERTIFICATE OF LIABILITY INSURANCED7/DP/2D24 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 'D NAME: Aon Risk Services South, Inc. POE (g66) 283-7122 FAX (800) 363-0105 d charlotte NC office (A/C.No.Ext): (ac.No.): 32 MSC# 17693 EMAILss: 0 Po BOX 551343 Atlanta GA 30355 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: XL Insurance America Inc 24554 JWC Environmental Inc. INSURERB: Travelers Property Cas Co of America 25674 2850 S. Red Hill Avenue, Suite 12S INSURERC: The Standard Fire Ins Co 19070 Santa Ana CA 9270S USA INSURER D: The Travelers Indemnity Co of CT 25682 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570107072253 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY USOUU10299LI24A EACH OCCURRENCE $5,000,000 CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence $5,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $5,000,000 L GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 r- X POLICY ❑PRO ❑LOC PRODUCTS-COMP/OPAGG $5,000,000 0 JECT 0 OTHER: � B AUTOMOBILE LIABILITY TC23CAP-9D895220-TIL-24 07/01/2024 07/01/2025 COMBINED SINGLE LIMIT $2,000,000 Ea accident) .. BODILY INJURY(Per person) D X ANYAUTO Z OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY AUTOS PROPERTY DAMAGE V HIRED AUTOS NON-OWNED (Per accident) ONLY AUTOS ONLY i fy UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION C WORKERS COMPENSATIONAND UB6N6649782451K 07 01 2024 07 Ol 2025 X PER STATUTE OTTH- EMPLOYERS'LIABILITY Y/N AOS D ANY PROPRIETOR/PARTNER!EXECUTIVE E.L.EACH ACCIDENT IER $5,000,000 OFFICER/MEMBER EXCLUDED? N/A UB7N8514192451R 07/01/2024 07/Ol/2025 E.L.DISEASE-EA EMPLOYEE $5,000,000 (Mandatory in NH) AZ,MA,WI If yyes,describe under E.L.DISEASE-POLICY LIMIT $5,000,000— DESCRIPTION OF OPERATIONS below = DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 115716 Project: Frager Sewer PS - Kent, WA. City of Kent required by the written contract with insured is included as Additional insured under General Liability policy as per ISO forms CG 20 10 12 19 and CG 20 37 12 19 to the extent required by the contract. City of Kent is also Additional insured under the Automobile Liability policy in accordance with the policy •-- provisions to the extent required by the contract. General Liability policy evidenced herein is Primary and Non-Contributory ll to other insurance available to an Additional insured, but only in accordance with the policy's provisions. Irp o CERTIFICATE HOLDER CANCELLATION o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 5 . EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE N POLICY PROVISIONS. ril o City of Kent AUTHORIZED REPRESENTATIVE 220 Fourth Avenue South Kent WA 98032 USA ��//� y/� o [_XKl9Z ��iliPX /�GG �!7dQ o ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD