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HomeMy WebLinkAbout102619 CENTURYLINK - INSURANCE CERTIFICATESHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: � � Carrier: XL Specialty Insurance Company� to the executive of the contract, agreement, statute, law or code of ordinances.� 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 Effective Dates: 09/01/2020 - 09/01/2021� 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” � � --------- WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY AND EXCESS WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY (OH & WA - SELF-INSURED - � 2 Basis, and Business Interruption - Actual Loss Sustained.� Each Occurrence: $15,000,000� Limit: $25,000,000� 2 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 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 Seattle Additional Insured as respects your interest in the operations of the Named Insured as required by contract or agreement. � Automatic Additional Insured’s Primary Coverage� by the additional insured shall not be contributory insurance.� 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 �� �� � -------------------- GENERAL LIABILITY --------------------� Certificate of Liability Insurance � CN102197661 � per endorsement CG2417. � required by such contract or agreement. Separation of Insureds Applies. � -------------------- AUTOMOBILE LIABILITY --------------------� -------------------- COMMERCIAL CRIME - FIDELITY BOND --------------------� 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 under a contract with that person or organization, or under statute, law or code of ordinances.� Lessor - Additional Insured and Loss Payee - All Lessors � -------------------- U.S. PROPERTY --------------------� 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 -------------------- EXCESS/UMBRELLA --------------------� $1,000,000 RETENTION) ---------� Deductible: $25,000,000� Policy Number: U5Z000023190001� 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 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.�� Marsh USA Inc.� Carrier: Allianz Underwriters Insurance Company� 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 Qwest Communications International Inc.;� CenturyLink, Inc.; Embarq Corporation;� Including Qwest Government Services, Inc.� and All Affiliated, Subsidiary & Associated Companies� Denver, CO 80202 1801 California Street, Suite 1150� � Policy Number: ELU16972420 � prior to loss.� 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 25 Effective Dates: 09/01/2020 - 09/01/2021� � (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY B C kbh 3,000,000 09/01/2021 RGD500033308 Katie Stephens X RWE500033108 (WA) SEA-003475093-47 1,000,000 10,000,000 RWR500033008 (WI) X 37885 10,000,000 1801 California Street, Suite 1150 Retention of Marsh USA Inc. Seattle, WA 98101-2682 N X CONTRACTUAL LIABILITY 09/01/2020 20 09/01/2021 09/01/2020 09/01/2021 09/01/2021 RAD500033408 Technology E&O incl. B 15,000,000 3,000,000 X RWE500033208 (OH) 36420 XL Specialty Insurance Co. 1,000,000 X C X 08/25/2020 5,000,000 09/01/2020 10,000,000 09/01/2020 RE: P871 RENEWAL. SERVICE AGREEMENT TO PROVIDE MAINTENANCE OF EQUIPMENT & SOFTWARE FOR CUSTOMER-PROVIDED EQUIPMENT AT VARIOUS BUILDING LOCATIONS. THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS & EMPLOYEES ARE ADDITIONAL INSUREDS PER THE GENERAL LIABILITY BLANKET ADDITIONAL INSURED ENDORSEMENT AS RESPECTS THEIR X 09/01/2020 P.O. BOX 580 FORT COLLINS, CO 80522 CITY OF FORT COLLINS PURCHASING INTEREST IN THE OPERATIONS OF THE NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT. X A B Allianz Underwriters Ins Co CN102197661-STND-ALL-20-21 Each Claim/Aggregate 10,000 09/01/2021 2,000,000 U5Z000023190001 Cyber/Privacy Liability B Auto Physical Damage - Self Insured 15,000,000 22322 500,000 1,000,000 09/01/2021 X RWD500032908 (AOS) CA License #0437153 Marsh USA Inc. X 1301 5th Avenue, Suite 1900 Attn: Seattle.certrequest@marsh.com / Fax: 212-948-4326 Qwest Communications International Inc.; CenturyLink, Inc.; Embarq Corporation; Including Qwest Government Services, Inc. and All Affiliated, Subsidiary & Associated Companies Denver, CO 80202 X U5Z000023190001 09/01/2020 215 NORTH MASON, 2ND FLOOR X 09/01/2020 09/01/2020 cont A . 09/01/2021 09/01/2021 Greenwich Insurance Company