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HomeMy WebLinkAboutCAG2023-645 - Insurance Certificate - Lumen Technologies - 9/1/24 0001283 SP 0250 -CO1-P01283-1 CITY OF KENT Attn: City Clerk 220 Fourth Avenue South Kent,WA 98032 0250-01-00-0001283-0001-0003059 ,4co CERTIFICATE OF LIABILITY INSURANCE DATE9/2024 /YYYY) 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 MARSH USA LLC. NAME: CA License#0437153 PHONE FAX (A/C, /C No Ext: A/C No 1301 5th Avenue,Suite 1900 E-MAIL Seattle,WA 98101-2682 ADDRESS: Attn:Seattle.certrequestCa)marsh.com/Fax:212-948-4326 INSURER(S)AFFORDING COVERAGE NAIC# _ CN102197661-STND-ALL-23-24 INSURER A: Greenwich Insurance Com an 22322 INSURED Lumen Technologies,Inc. INSURER B: XL Specialty Insurance Co. 37885 and all subsidiaries,including but not limited to: INSURER C: Allianz Underwriters Ins Co 36420 Qwest Corporation;Embarq Corporation;Level 3 Communications,LLC and INSURER D: CenturyLink Communications,LLC 100 CenturyLink Dr. INSURER E: Monroe,LA 71203 INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-003510161-38 REVISION NUMBER: 0 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 EFF POLICY EXP LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY RGD500033312 0111112014 1110111025 EACH OCCURRENCE $ 3,000,000 CLAIMS-MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 15,000,000 N POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 15,000,000 OTHER: $ A AUTOMOBILE LIABILITY RAD500033412 09/01/2024 09/01/2025 COMBINED SINGLE LIMIT $ Ea accident 2,000,000 X ANY AUTO Auto Physical Damage-Self Insured BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident C X UMBRELLA LIAB X OCCUR U5Z000023220 09/01/2024 09/01/2025 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I RETENTION$ $ B WORKERS COMPENSATION OMP A N TIOI N RWD500032912(AOS) 09/01/2024 09/01/2025 X SPERTATUTE EORH B AND EMPLANYPROPRIETOR/PARTNER/EXECUTIVE Y/N RWR500033012(WI) 09/01/2024 09/01/2025 B OFFICER/MEMBEREXCLUDED? � N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) RWE500033112(WA) 09/01/2024 09/01/2025 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 B If yes,describe under RWE500033212(OH) 09/01/2024 09/01/2025 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Technology F&O incl. U5Z000023220 09/01/2024 09/01/2025 Each Claim/Aggregate 10,000,000 Cyber/Privacy Liability Retention 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Franchise Agreement.CITY OF KENT is included as Additional Insured on the General,Automobile,and Umbrella Liability Policies if required by written contract or agwLinent subject to the policy terms and cundiliuns. CERTIFICATE HOLDER CANCELLATION CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 AUTHORIZED REPRESENTATIVE of Marsh USA LLC ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102197661 LOC#: Seattle A ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA LLC. Lumen Technologies,Inc. and all subsidiaries,including but not limited to: POLICY NUMBER Qwest Corporation;Embarq Corporation;Level 3 Communications,LLC and Century ink Communications,LLC CARRIER NAIC CODE 100 CenturyLink Dr. Monroe,LA 71203 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance -------------------GENERAL LIABILITY------------------- Automatic Additional Insured's Primary Coverage Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. Coverage provided by the above General Liability policy shall be primary and is limited to liability arising out of Named Insured's ownership and/or operations. Any insurance carried by the additional insured shall not be contributory insurance. Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-any person or organization with whom you have entered into a contract or agreement,or by statute,law or code of ordinance. Separation of Insureds Applies. Insurance covers incidents that occur within 50'of railroad property,any railroad exclusions have been deleted per endorsement CG2417. -------------------AUTOMOBILE LIABILITY------------------- Any person or organization you are required in a written contract,agreement,statute,law or code of ordinances provided the"bodily injury'or"property damage"occurs subsequent to the executive of the contract,agreement,statute,law or code of ordinances. Lessor-Additional Insured and Loss Payee-All Lessors Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-Any person or organization with whom you have waived prior to the"accident"or the"loss" under a contract with that person or organization,or under statute,law or code of ordinances. ---------WORKERS'COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS'COMPENSATION AND EMPLOYER'S LIABILITY(OH&WA-SELF-INSURED- $1,000,000 RETENTION) --------- Waiver of Our Right to Recover from others Endorsement-Where required by written agreement signed prior to loss,or required by statute,law or code of ordinances executed prior to loss. --------------------EXCESS/UMBRELLA Coverage applies per occurrence.Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement.Waiver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation)-Any person or organization with whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Separation of Insureds Applies. -------------------COMMERCIAL CRIME-FIDELITY BOND -- Carrier:XL Specialty Insurance Company Policy Number:ELU199086-24 Effective Dates:09/01/2024-09/01/2025 Deductible:$1,000,000 Each Occurrence:$15,000,000 ----------------U.S.PROPERTY------------------ Carrier:Allianz Underwriters Insurance Company Policy Number:UV000023220 Effective Dates:09/01/2024-09/01/2025 Limit:$25,000,000 Deductible:$25,000,000 Property Coverage:"All Risk"of Direct Physical Loss or Damage to All Real and Personal Property,including Boiler&Machinery,Earthquake,Flood and Wind-Replacement Cost Basis,and Business Interruption-Actual Loss Sustained. Loss Payee or mortgagee as required by written contract/loan agreement to the the extent of your insurable interest.Waiver of Subrogation-Any person or organization whom you have entered into a contract or agreement,but only to the extent required by such contract or agreement.Other deductibles may apply as per policy terms and conditions. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD 0250-01-00-0001283-0002-0003060 ' Marsh Dear Certificate Holder: ' To streamline certificate delivery for our clients and in an effort to support our firm's commitment to sustainability,going for-ward,we will only be providing renewal certificates of insurance electronically. If you need to continue receiving a copy of the attached certificate, pleasesend an email to U5(]peraLiono.enuai|@nnarsh.connand include the following: —Certificate#(Shown below Insured Name—e.g',/\Q[-1Z3455789-Ql\ — E-Mail for future delivery For your convenience, If we do not receive your response,we will conclude that you no longer require proof of insurance from the named insured and will remove you from our records. Thank you, BS Operations, Marsh USA, LL[ *business oa Marsh McLennan