HomeMy WebLinkAbout2026_PSE_PWD4216_ROW__Arlington COI New ,acoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1164 � 5/1/2026 04/28/2025
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 Lockton Companies,LLC NAME:
DBA as Lockton Insurance Brokers,LLC in CA PHONE FAX
IA/C.NCA license#OF15767 E-MAILo Ext: A/C No
3657 Briarpark Dr.,Ste.700 ADDRESS:
Houston TX 77042 INSURERS AFFORDING COVERAGE NAIC#
(866)260-3538 INSURER A: Old Republic Insurance Company 24147
INSURED INFRASOURCE SERVICES,LLC INSURER B:ACE Property and Casualty Insurance Company 20699
1367186 A QUANTA SERVICES COMPANY INSURER C:
14103 STEWART ROAD
SUMNER WA 98390 INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 15484057 REVISION NUMBER: XXXXXXX
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 ADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY MWZY 313093 25 05/01/202 06/01/2026 EACH OCCURRENCE $ 5,000,000
A CLAIMS-MADE�OCCUR MWZX 313095 25 05/01/202 06/01/202 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1,000,000
MED EXP An one person) $ Excluded
Y N PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000
POLICY❑ JE� ❑LOC PRODUCTS-COMP/OP AGG $ 5,000,000
OTHER $
BINED
A AUTOMOBILE LIABILITY MWTB 313092 25. 05/01/202 06/01/202 Ee C.d.n SINGLE LIMIT $ 5,000,000
A X ANY AUTO MWZX 313091 25 05/01/202 06/01/202 BODILY INJURY(Per person) $ XXXXXXX
X OWNED SCHEDULED Y N BODILY INJURY(Per accident) $ XXXXXXX
AUTOS ONLY AUTOS $ XXXXXXX
X HIRED X NON-OWNED PROPERTY AMAGE
AUTOS ONLY AUTOS ONLY Per accident
$ XXXXXXX
B X UMBRELLA LIAB X LAIMS-M
CUR XEU G27972032 010 05/01/202 06/01/202 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB ADE Y N AGGREGATE $ 5,000,000
DED I RETENTION$ $ XXXXXXX
WORKERS COMPENSATION X PER OTH
LITE
OFFICER/MEMBER EXCLUDED? -
A AND EMPLOYERS'LIABILITY Y/N MWC 313094 25 05/01/202 05/01/202
A ANY PROPRIETOR/PARTNER/EXECUTIVE 1 N/A N MWC 313094 26 05/01/202 06/01/202 E.L.EACH ACCIDENT $ 1,000,000
(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
A Stop Gap Liability MWC 313094 25 05/01/202 05/01,1202 $1,000,000 Each Accident
A N N MWC 313094 26 05/01/202 06/01/202 $1,000,000 Disease-Policy Limit
$1,000,000 Disease-Ea. Emp
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Additional Insured in favor of City of Arlington(on all policies except Workers'Comp/EL and Stop Gap Liability)where and to the extent required by written contract.
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.
15484057 AUTHORIZED REPRESENTATIVE
City of Arlington
238 N Olympic Avenue
Arlington WA 98233
c 988-20 5 ACORD All rights reserve
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD