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HomeMy WebLinkAboutCAG2023-369 - Insurance Certificate - Rodarte Construction, Inc - Washington Avenue South Pump Station - 6/20/2024 /3/2A6 Zo e CERTIFICATE OF LIABILITY INSURANCE DAT 7/3/2 D/YYYY) /3/2024 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). CONTACT PRODUCER NAME: Arthur J. Gallagher Risk Management Services, LLC PHONE 425-454-3386 FAXNo:425-451-3716 E-MAIL 777 108th Avenue NE, Suite 200 C Ext: L Bellevue WA 98004 — INSURERS AFFOROINGCOVERAGE NAIC4 INSURER A:Zurich American Insurance CompanyComparry 16535 INSURED RODACON-01 INSURER B:Zenith Insurance Company 13269 Rodarte Construction Inc. INSURER C:American Guarantee and Liability Ins Co 26247 17 E Valley Hwy East -- Auburn,WA 98092 uNsuilER D:Lexington Insurance Cowany_____ i 194_37_ INSURER E:Travelers Commercial Casualty Company 40282 INSURER F: COVERAGES CERTIFICATE NUMBER:761994295 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE W POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y GLO-0961239-00 6/20/2024 6/20/2025 EACH OCCURRENCE $1,000.000 CLAIMS-MADE OCCUR PREMISES Ea occur ence $300,000 MED E_X_P(Any one person) _$10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 X POLICY❑ PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 JECT OTHER: B AUTOMOBILE LIABILITY BAP 0961238-00 6/20/2024 6/20/2025 COMBINED SINGLE LIMIT $1,000,000 Ea accident)__ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY IPer accident) C X UMBRELLA LIAR X OCCUR SXS 0961240-00 6/20/2024 6/20/2025 EACH OCCURRENCE_ $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DIED RETENTION$ $ A WORKERS COMPENSATION GLO-0961239-00 6/20/2024 6/20/2025 X I PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE_EA EMPLOYEE $1,000,000____ _ If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Environmental Liability 015136160 6/20/2024 6/20/2025 Each Loss/Annual Agg. $2M/$4M E Property QT-630-5Y153301-TIL-24 6/20/2024 6/20/2025 1Building $691,100 $302,812 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:19-3031 /Washington Avenue South Stormwater Pump Station.Additional Insured Status applies per attached form(s).Waiver of Subrogation applies per attached form(s). 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 400 West Gowe AUTHORIZED REPRESENTATIVE Kent,WA 98032 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD