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5279
Contract Number: Vendor Sub�ect: Department: File Class Begin Date: End Date: Review Date: Vault Date: Comments: 5279 ANDERSEN CONSTRUCTION Right of Entry - 9/11 Memorial Legal LEG 12-1 8/7/2013 8/31/2013 2015 CLOSED RIGHT OF ENTRY City of Bremerton Property Tlus Right of Entry is made effective the date fully executed below, between the Crty of Bremerton , (heremafter, "Owner"), and Andersen Construction, (heremafter, "Entrant") WHEREAS, Owner owns certam real property located m Kitsap County, commonly located and known as Evergreen Rotary Park, (heremafter Property), and WHEREAS, On February 1, 2012 the Bremerton Crty Council approved the September 11 Memonal design concept, and WHEREAS, Entrant desires to perform volunteer services on Owner's Properiy, and WHEREAS, To accomplish tlus service, Owner and Entrant des�re to enter into an agreement for construchon of the September 11 Memonal at the Property pursuant to RCW 35 21 278, and WHEREAS, Owner is v�nllmg to grant to the Entrant access to the Property for the purpose of construction of the September 11 Memonal upon the terms and condrtions of this Right of Entry, and WHEREAS, Entrant is solely responsible for compliance wrth all local, state and federal rules associated wrth their work, and will obtam and comply with any required permrts for such work, NOW, THEREFORE, in consideration of the terms and condrtions herem, Owner, hereby grants to Entrant, its agents, employees and representatives ingress and egress over, under, across, and upon the Property under the terms and condrtions contamed herein as follows 1 Owner grants to Entrant a non-exclusive nght of reasonable access to the Property for the purpose of construction of the September 11 Memonal wrth all necessary equipment and materials Construction shall be m accordance wrth the design concept approved by the Bremerton City Council 2 Entrant agrees to provide its employees engaged m the pro�ect wrth accident/in�ury msurance under its current workers' compensation msurance 3 The term of this Right of Enhy shall commence on the date of execution by the Owner and shall expire on August 31, 2013, or the earlier completion of the work, wluchever comes first, unless otherwise extended by the Parties in wrrtmg 4 To the extent authorized by law, Entrant shall mdemrufy, defend and hold Owner harmless from and agamst any claims, loss, costs, legal action, liabilrty, or expense on account of personal injury to any persons or damage to or destruchon of property, resulting from the 0 Entra� or it� age�s negligent exercise of the aghts herein granted, except such clainns, costs, damage, injury or expense not caused by the negligence of the Entraut. Tf LS FURTHER SPECIFICALLY AND EXI'RES3LY UNDERSTOOD THAT THIS INDEMNIFICATION CONSTITUTES TI� CONTRAGTOR'S WAIVER OF �Y UNDER IlJDUSTRIAL INSURANCE. TITLE 51 RCW, SOLII.Y FOR 'fHE PiJRPOSE OF THIS INDEMIVIFICATION. THE PARTIES ACKNOWI.EDGE THAT Tf�Y HAVE MUTUALLY NEGOTIATED THIS WANER. The provisions of this section shall survive the expiration or termination of this �� 5. Insm�ance. The Entrant s�hall procure and maintain for the duration of this a�ement, insuram� against claims for injuries to persons or damage to property that may azise from or in co�ection with the performance of the work contemplated herein by the Entiant, its agents, rep�tatives, employees or subcontractors. �td-r�r,: �R�. �a.i0�aer-j �+o WF.e�.� o..l��( . .�cw��� .�wc. �r. �6 ��u� �. Before beginning the work on the project de�ribed in this agc�eement, the Contractor shall provide a Certificate of Insurance evidencing: � A. Commercial General Liabilitv insurance written on an occutrence basis with linnits no less than $1,000,000 combined single lianit per ocx�nrence and $1,000,000 aggregate for personal injury, bodily inJ�Y � Pl'oP�Y �Se. The City, its offcials, employees, agents and volnnt��s shail be named as an additional insured on the insurance policy, as respects work performed by or on behalf of the Entrant and a copy of the endorsement naming the City as additional insured shaU be attached to the Cedificate of Insivanc�. Any payment of deductible or self insured retention shall be the sole responsibility of the Entiant The E�rirant's ins�nance shall contain a clause stating that coverage shall apply separatiely to each insured against whom claim is made or suit is brought, except with resPects to the limits of the insurer's liability. The Ent�aat's insurance shall be p�imary insurance as re.specb the City, aad the City shall be given thirly (30) calendar days prior written notice by certified mail, retum re�eipt requested, of airy cancellation, suspension or material change in coverage. � :�� � � /', /'� _/ . � / ' � �. ''�'' ��� r �:� � , ANDERSEN CONSTRUCTTON a c-�� �� a-► Its - a'�e4-�J s � �. • Date: ? ( 3 Fa APPROVED AS TO FORM B Crty A orney R V.egal�L.egal�Departments-General�Pazks\911 Memonal Right of Entry and Waiver of WC Immumty doc DATE (MMlDD/YYYY) oRlJ® CERTIFICATE OF LIABILITY INSURANCE a/25�2ozo 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 pollcy(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 Ileu of such endorsement(s). PRODUCER 1.•V IYIMI.I NaME: Certificate Department Arthur J. Gallagher & Co. PHONE Fax Insurance Brokers of CA Inc LIC #0726293 r • 415-391-1500 ac No :415-391-1882 1255 Battery Street, Suite 450 aDoaless: cssfcerts a' .com San Francisco CA 94111 RECEIVED ,,,�„o�o,�, �«„o,,,.,�,,,,,,�o�„� .,, INSURED Andersen Construction Company dba Andersen Construction 6712 N, Cutter Circle Portland OR 97217 COVERAGES A�U d ��0 INsuRERA: National Union Fire Insurance Com an of Pittsbu U d ANDECON•Ot INsuaea a � New Hampshire Insurance Colnaanv City of Bremerton City Attorneys Office CERTIFICATE NUMBER: 1042672698 XL Insurance America. Inc. INSURER D _ _ - _ - REVISION NUMBER: 19445 24554 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 TFiE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICV EFF POLICY EXP I LIMITS LTR INSD WVD POLICY NUMBER MMlDDlYYYY MMlDD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y GL329-21-17 9/1/2020 911I2021 EACH OCCURRENCE $2,000,000 __ CLAIMS•MADE X OCCUR _ DAMAGETORENTED PREMISES {Ea occurrence)_ MED EXP (Any ono person) $1,0_00,000 $ 10,OD0 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,OOD,000 POLICY u jE� u LOC PRODUCTS-COMPlOPAGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y CA 454-47-73 9l1/2020 9!1/2021 COMBINED SINGLE LIMIT (Ea occident) -_ $2,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE 1Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY C UMBRELLA LIAB X OCCUR Y Y US00086221LI20A 911/2020 9/1/2021 EACH OCCURRENCE $10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIA9 CLAIMS -MADE DED I RETENTION$ $ g B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANYPROPRIETORIPARTNER/EXECUTIVE ❑ OFFICER/MEMBEREXCLUDED? (Mandatory In NH) NIA Y WC 025-89-3596 -OR & ID "STOP GAP" LIABILITY - WA 9/1/2020 9/1/2020 9f1/2021 9/1/2021 X STATUTE ER E.L. EACH ACCIDENT - - ------ ---- - -- — E.L. DISEASE • EA EMPLOYEE _ — $ 1,000,000 -- --- - ----- $ 1,000,000 II yes, describe under DESCRIPTION OF OPERATIONS bebw E.L. DISEASE •POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be etteched If more space Is required) ADDITIONAL INSURED(S): City of Bremerton The Producer will endeavor to mail 30 days written notice to the Certificate Holder named on the certificate if any policy listed on the certificate is cancelled prior to the expiration date. Failure to do so shall impose no obligation or liability of any kind upon the Producer or otherwise alter the policy terms. Project or Job #: RE: 1500 Park Ave, Bremerton, WA 98337 Project: RE: 1500 Park Ave, Bremerton, WA 98337 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street Bremerton WA 98337 AUTHORIZED REPRESENTATIVE USA `� �^ ����� � 7 `��`, f ACORD 25 (20y6/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PC�LI�Y NUMBER: tsL j2g-21-1 % C()MnlIERCIAL QEI�EitAL LIABILITTY CG 2b 10 04� 1 � i"hil �I������IVI�P�`�' ���.N i'HE P�LI�Y. f�L��� �.[� IT ��.��FIJ�,�.Y. This endarsornant modifies insurance provided under the foliawing: COMMERCfAL GENERAL LIABILITY COVERAr9E PART SCHEDULE Hama of ,�.ddi[ional Insured Personts) (Jr ®rganlzatian{s� • 1' i• a t 1 # # #` 1 1 # ## _ ► k # St1 1 •e #rt � � 1 Locationls) Df �ouered [nformation required to complete this Schedule, ff not shown above, will be shown in t17e Declarations, A. Saction ii - 'iNho le An Insured is amended to that which you are required by the contract include as an additional insured tho porson;s) or or agreement to provide for suri� edtiitlonal organizationts) shown in the Schodule, but cnly insurad, with r®spcct to liability for "bodily injury", B. With raspart to t;h�e insuranc® afforded t'o thr�se "proporty damage" or "personal and advortising additional insurads, eh® following additional injury" caused, in whola or in part, by: exclusions apply: 1. Your acts ar emissions; or This it�ar,tranre does net apply to "bodily injury" �. Tho acts or omissions of those acting on or "property damage" occurring after: your behalf; 1. Alf work, including materials, parts or in the performance of your ongoing operations equipment fr.rrnishod in connection with such for the additional Insuredis) at thv locations) work, an the project (other than service, designated abavo, rnaintonance or rapairsl to be performod by or on behalf cf thrs additional insureds) at Howev®r: the location of the wavered operations has 1. The insurance afforded to such additional been completed; ar insured only applies to the extent permitted 2. That portion of "your work" out of whicl�r lay law; and the injury or damage arises has been p�,tt tc 2. if coveraga provided to ti,e additional its intended use by any person or insured is rectuired lay a contract or organization other than another contractor or agreement, the insurance afforded to such subcontractor ertigsged in performing additional insured will not be brander than operations for a principal as a part of thG same prajert. CG 20 10 04� 13 4 Insurance 5orvicas Office, Inc., 2©12 Page 1 of 2 3` of 27 429 G. With respect to the insurance afforded to these additional insureds, the following is added to Section iMl - Limits !?f Insuranoe: If covoragp provided to tha additional insured is requird fay a contract or agreement, the mast we will pay on laehalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Rage 2 of 2 �. Available under the applicable Limits of Insurance shown in the beclaraticns; whichever is less. This er7dorsemcnt shall not increase the applicable Limits of Insurance shown in the Declarations. 4 Insurancea Services Office, lnc„ 2Q1 1 � /� ■ q' of 27 429 Pbt_tCY NUMBF..R: GL 329-21-i7 �iJi�MEROIAL GEfUEFIAL LIAC�ILFTY CG �O 37 ©G� 13 THE �f��R�EMEtVT �H�N��� TFiF PClLI�`�'. PLE��E �E�I� I-i' G,4,REFl�LLV. This endorsement modifies insurance pravided under the fallowing; CdMMERCIAL GENERAL LIABILITY COVERAGE FART PRODUCTS/COMPLEI"ED OPERATIONS LIABILITY COVERAGE PART Name Cif ddltional Insured Persan(s} Location And Liescription Of Completed Operations t?r i�rganiza#ian(s) ---- — --PER --ANY RERSON OR ORGANIZATION THE CONTRACT OR AGREEMENT.._ WHOM YOU BEGONE OBLIGATED TO INCLURtr AS AN ADDITIONAL INSUaED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTCt. Information required to romplei;e this Schedule, if not sl7owrl al>ove, will be sttc7wn in the ieclarations, A, Section It - Vlll7a Is An Insured is amended to include as an additional insured the persons} or organiration(s} shown in the Gchedulo, but only with respect to Eiability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at tl7e location dosignatad and described h� the Scf7edf.ile bf this endorsamertt performed For that additional insured and included in the "products-cofnplattad operations haZAl'd". However: 1. Tho insurance afforded to such addltianal insured only applies to the extent permitter) by law; and 2. If coverage provided to the additional hlsured Is required by a oontract or agree- ment,, the insf-rranGe afforded t:r� such addi- tional insured will not ha broader than that CG 20 37 CJ4 1 � which you agreement insured. are required by the contract ar to provide for such additional B. With respeot i:a tl�e insurance afforded to these addlticnal inscn'ods, the following is addod to Section I►) -Limits tJt insurance: li coverage pravided to the additional insured is required ny a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the oontract ar agreement; or 2, Available under the applica#�lo Limits of Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cahle Limits of Insurance shown in the Decla- rations, � Insurance Services Office, Inc., 2012 �.► ■ 5" of 27 429 P(7LICY NUMBER: GL 32g- 21 _ 1 ] COIVIMER�IAL GEI�ERA.L LIAOILIT�' CG 24 11 (74 rt 3 THIS E�I.��RSEtV1El��" �FiAIV+�S THE p�LI�Y. �l.E�SE RE,�� IT ��I�EFULLY. i, � This endarsement modifies insurance provided under the followln�: COMMERCIAL GENERAL LIABIUTY•COVERAGE PART Designation Of Rremises (Rar# Leased `To Yau): ANY PREMf3ES QR PART THEREOF LEASEp TO `YOU. r. � .. {. � .,. Additianal Premium: S I NCLUDED _.._ _...�.� �______�..m. �..�.�___ .�._..�r_......._ ._ information recluircd to complete this Schedule, if not shown abave, will be shown in tl1© t�eclaCations. A. Section II - Wha Is An Insured is amended to include as an additional insured tl�e persc�n(s) or orp�anizatian(s) shown in tho Schedule, but only with respect to liabi€ity arising out of the awnersh€�,, mfllntPnance ar use of that part of the premises (eased to you and sl}own in the CG�4110�13 Schedule and subjoct to the foiiowing additional exciusions; This insurance does not apply to, 1. Any "occurrence" which takes }�lac:e after you cease to be a tc,slnnt in that premises. 4� Insurencp Servic®s Office, Inc., 2012 Peye 1 of 2 6' of 27 429 �. Structural alterations, now construotion or demolition operations performed by or on behalf of the persons) or organization{s) shown in the Schedule, However: 1. The insurance afforded to such additional in- sured only applies io the extent permitted by law; and 2, If coverage provided to the additional in- sured is raquirHd by a cantract or ag- reerrc,nt, the insurance, afforded to suotr addltianal insured wifl net be taroader than tl�afi wtlioh yr�u ere ret{Uirt�d by the cantract or agreement to provide for such additional insured. �, With respect to the insurance afforded to these additional insureds, the following is added to Section lil � Lirvrtts Crf insurance; If coverage provided to the additional insured is required by a contract or agreerrrent, thc� rrrost we will pay on behalf of the additional insured is the amount of insurance: 1 , Required by the cantract or agreement; or 2, Available under the applicable Limits of Insurance shown in the Declarations; whicl7ever is less, This endorsement shall not increase the applioabla Limits cf insurance shown in the ®eclarafions, Insuranr.P Services 91'fire, Inc., 2412 � �! 7" of 27 429 � w. • M w � � 1 � �. __ w. _. This endorserr7ent modifies insurance provided under the folfawing: COMMERCIAL GENFRAi_ LIABiLITy COVERAGE PART E - �. a � � �*� , Information rer}uirad to complete this Schedule, If not shown above, will be shavvn in the I�aclarations• A. Section 11 -Who }s An lnsur®d is amended to in- clude as an addst:ianal insured any state or governmental agency or subdivision or positieal subdivision shown ir7 the Sohedulo, subject to the followsng provissons: 1. This insurance applies only with respeot to oport�tions parfarmed by you or on your b�- half for which the state or governmc�ntai agency ar subdivision ar political subcivision seas issued a permit ar authorization, However: a. The insurance afforded to such addltianas insured only ap�lios to the extent permit- ted by law; arld b. If coverage provided to the additional in- sured ss required by a contract or agree ment, the insurance afforded to such ad- ditional hisur�d will not be broader than that which you are required by the con- tract or agreement to provide for such additional insured. �. This insurance does not apply to: a. "Bodily injury", "properly damage" or "personas and advertising injury" arising ouk of aperafiians performed for the fed- eral government, state ar municipality; ar b. "Bodily injury" or "property damage" in- cluded within the "products -completed operations hazard". R. With respect to the insurance afforded to these adr#itianal insureds, the follawlnp is added to �ectior7 #II - I.imfts Of Insurance: If coverage provided to the additional h�surod is required by a contract or ac#raement, the most we wilt pay an behalf of 'the additional insured is the amount of insurance: 1. Required by the contract ar agreement; or ?. Available under the applic.abse Limits of in- surance shown in tJ�e peclarations; whichever is less, This endorsement shad not increase the applica- hle Limits of Insurance shown sn t#�e s]cclara- tions. CCw 20 12 04 13 � Insur'ance Services Office, Inc., 2012 4 ` � A 8' of 27 429 �r POLICY NUMBER: Oi. 3Z9- 21-17 G�MIV1lEf�t�tAf, �I"I+d�ti�l. LIABILITY CG 20 {71 b� 1 � iNl� ��It3��ENIEIVi CFI�N��� T�I� P€�LICY. �LEA�E F�Ei417 IT C�1REFl9LLY. ;' � � Thls endorsement modifies insurance provid©d undor tho fallowing: COMMERCIAL GENERAL L1ABIl_lTY COVERAGE PART PROL?UCTS/COMPLETE[ OPERATIONS LIABILITY COVERAGE PART The fallowing is added to the Other Insurance pc�liuy �,ravidc-:d that: Condition and supersedes any Rrovision fie the (1)'The additional insured is a Named Insured contrary: under such other insurance; and prirrrary And tlfoncontrlbutory Insurance This insurance is primary to and wiil not seek contribution from any ether insurance available to an additional insw�ed undor your CC; 20 0'I ifA 'f 3 {�) Yau have agreed in writing in a contract or agreement that this insurance would be primary and would not seek eontribu- i.ian free, any ether insurance availabie to the additional insured, Q Insurance Service9 Offico, Inc„ ?_012. 9" of 27 429 PULICY NUMC�SR: �L 329—Z1-17 COMIVIERGIAI., GENERAL LIABILITY GG 2� U�- 01� (79 This endorseinant n7c�diPlea hisurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRC?17UCT5/COMI�LBTCD OPERAT1ON5 LIABILITY COVERAGE PART r r • r .a y Information required to complete this Schedulo, if not shown above, will bo shown in the Declarations The following is added to Paragraph �. Transfer Of Rights Of Recovery Against Others Ta Us of �ec- tion IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or dftmage arising out of your ongoing opera- tions or "your work" dons under a conirart wlfh that person or organization and included in t17Q "products -completed apPrations hazard". This waiver applies only to the person or organization shown in the Schedule above. 0 Insurance Services Office, Inc., 2006 Page 1 of 1 0 10' of 27 429 �•• This endorsement, offective 12:01 Fi.iVi. 09/01/2020 forms a park of Palicy No. CA �+5� m �#% ��'3 issued to AhlbERSEN OQNSTRIJG'1" I Oid �UM)�AIdY This endvrsernent rrfodiftes insurance provided under the fallowttt�: BUSINESS AUTO COVERAGE FC►RNi E*313:�r�11111 � �R +li' � ''—� 1 * () M �I1 1 � � � a t � � � 6. SEC1'1O�! II - CQVERE� AUTOS LIABILITY �CiVERP��E, A. Oaver�ge, 1. � VVho Is Insured, is amended to add: d, Any person or organization, shown in the schedule agave, to wham you become ablic�ated to lncluda as an additional Insured under tl'ris policy, as a result of ar7y contract or agreement you enter into which requires you la furnish insurance to that parson ar organization of the type provided by this poiiay, but anly with respect to liability arising cut of use of a cavarad "auto". hlowever, the insurance provided will not exce©d the lesser of: (1) The coverage andlar limits of this policy, or (2) The coverage and/ar limits required by said contract ar agreement. RIZEa REPRESENTATIVE 87950 I9/14�) Inrludes copyrighted intorrnatlorl of Insurance Bervlces Qtiicc, Inc„ page 1 of 1 with ils purrnissian. 11" of 27 429 This er�dorsement,effective12:Q1A.M. ►. � : dti ��r� 09/01 /2020 farms a part of policy No. Cif 45� � �7 � 73 issued to ANDERSEN CONSTRUCTION COMPANY try NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSSURGH , PA This endnrscment modifies insurance provided under the following: F3USINESS AUTQ CQV�RA(aE FcJRi� Section IV -Business Auto Conditions, S., general Conditions, S., CDther Insurance, o., is amended by the addition of the following sentence; The insurance afforded under this policy to an additional insured will apply as pri►rtery insurance far such additional insured where sa required under an agreement executed prior tc the date of accident We willnot ask any insurer that has issued otherinsuranceto such additionaiinsured to Gantrlbute to the sattlernent of lass arising out of such ar;cident. All other terms and rnnditions remain unchanged. 744��5 (1(7/99) 12" of 27 429 r : ~l afriri �t<�ti This endorsement, effective 12:U1 A.M. p9/01/2p2p farms a part of policy Na. CA at5i+—�7�73 issued to AND��B�N CpNSTRl1CTIpN COMPANY This endorsement madifres insurance provided undt?r fhe t'ollowin�• �ecti�n 1V � business ,4utc� Conditic�ras, ,�, -Lass Conctitiores, 5. - Transfer of �.ights of Recr�very �l�ainst Others to 6Js, is amended to add: However, we wail waEve any right of reaover we have against any person ar organization with whoa► ycu have entered iota a rantract or agrQament because at payments we make under this Coverage farm arising auk of an "accident" or „loss" if: (1} The "accident" ar "lass" is due to operations und�artaken In aacordance wi#h the contract existing b©tween you and such person ar organization; and (Z) The con#roc# or agrEement was entered into prior to any "acciden#" ar "lass". No waiver of the righ# of recovery will directly or indirectly apply to your employees or erployees of the person or organization, and we reserve our rights ar lien to be reimbursed from any recovery funds obtained by any injured employee• �' r ��I� �i��.��� 1 r _ � � .. , 62887 (6195} 13° of 27 429 This endorsement changes the policy to vdhich it is attached effective on inception date of the policy unl©ss a different dais is indicated below. ("the (nliowing "attaching rhuse" Head be completed only when this endorsement is issued subsequent to pr�paratlan of tho pnllcy). This endorsement, effective 12;01 AM 09/01/2020 forms a part of PglEcy Na. UdC 0�5..139-35g�i . • ;ti � 5 � � � j _ � � We have the right to recover our payments from anyone liable for an InJury covered by this policy. We will not enforce our right against the person or organisation named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that rscluirea yo�t to obtain this agreement from us. This agreement shall Hat operate directly or indir8ctly to bonefit any one not Warned in the Schedule. . � � � r� �� � � M tF � t � � � � � _ « This form is Hat applicable in California, Kentt.tcicy, New Hampshlro, Naw Jersey, Texas, ar Utah. This form is Hat applicable in Missouri when there is a construction Cade an the policy and there is Missouri premium or exposure. � � �„___ �� OU Q3 �3 �outlterslgned by a�utharized Re}aresentative 14" of 27 429 _ R /� it . - . �.. � w __. ".. .- i, .F�� , � - � ;�� r �' t "� t t • ♦ t t t tt t •t a• tt E. t • t t, t t t t t. t t t PRODUCER Arthur J. Gallagher $� Co. Insurance Brokers of CA Inc LIC# 0726293 1255 Battery Street, Suite 450 San Francisco CA 94111 INSURED Andersen Construction Company dba Andersen Construction 6712 N, Cutter Circle Portland OR 97217 rnv��Ar:Fc �, � r � a � ��i['TTiLlfcTrift?!i NAPAE~yr Certificate Department -- __._ PHONE rnrr. No Exu• 415-391-1500 E-MAIL ADDRESS; gCSsfCeri9 ajg.com _ INSURER(S) AFFORDING wsuRERA: National Union Fire Insurer INsuRERB: New Ham shire Insurance INSUREflC: XL Insurance AmerlCa, InG INSURER D : of 415.391-1882 RYr1[79 23541 THIS IS TO CERTIFY ThIAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOp 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 OLAIMS. jI _ j`AO�L IL7R I TVPEDPINSURANCE IINSD SUBR wvD� _. _ _ _.__ POLICY NUMBER � POLICY EppF ji MM/pDtYYYY I POLICY EXP 11 MM/DD/YYYY i _ _ _ LIMITS A X COMMERCIAL GENERALLIABILITV Y � Y GL329-21-17 911/2020 9!1/2D21 EACHOCGURRENCE $2,DOO,OOp _ CLAIMS•MADE � " i_f'fiEMI5E5_(Eaoccurrance) DAMAGE TO RENTED � 1,DD0,000 l !OCCUR MED EXP (Any one person) $10,000 --{ I PERSONAL & ADV INJURY -- $ 2,D00,000 — GENERAL AGGREGATE $4 OOD,000 J GEN'LAGGREGATE LIMIT APPLIES PER: POLICY�j�� �LOC PRODUCTS-COMP/OPAGG $4,000,000 $ OTHER: i A AUTOM081LELIABILITY Y Y CA454.47-73 9/1/2020 9/1/2021 COMBINED SINGLE LIMIT CEa accident).. $2,000,000 ____ _ _ X ANY AUTO _ ____.__ BODILY INJURY (Per person) $ BODILY INJURY (Par accidan0 $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED — PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY {(?er accident) $ C UMBRELLALIAB X pCCUR Y Y US00086221LI20A 9/1/2020 911/2021 EACH OCCURRENCE $10,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 $ DED' � RETENTION$ I B WORKERSCOMRENSATION Y WC 025-89-3596 -OR & ID 9l112020 911/2021 X STATUTE �RH e AND EMPLOYERS" LIABILITY y r N "STOP GAP" LIABILITY - WA 9/1/2020 9/1/2021 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1 DD0,000 _ _.__. OFFICERIMEMBEREXCLUDED'? ❑ (Mandatory In NH) N / A __. _ __, ____,___ E.L. DISEASE EA EMPLOYEE $1,000,000 II yes, descrfbo undor ,DESCRIPTION OF OPERATIONS bebw E.L. DISEASE •POLICY LIMIT $ 1,ODD,000 DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES {ACORD 701, Additional Remarks Schedule, may be atlechad if mare space is required) ADDITIONAL INSURED(S): City of Bremerton The Producer will endeavor to mail 3D days written notice #o the Garkificate Holder named on the certificate if any policy listed on the certificate is cancelled prior to the expiration date. Failure to do so shall impose no obligation or liability of any kind upon the Producer or other✓ilse alter the policy terms. Project or Job #: RE: 1500 Park Ave, Bremerton, WA 98337 Project: RE: 1500 Park Ave, Bremerton, WA 98337 �+ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCQRDANCE WITH THE POLICY PROVISIONS. 345 6th Street Bremerton WA 98337 AUTHORIZED REPRESENTATIVE _ usA `� �-�. � r�� .�', •-r, �.� a ��� 15°or27 429 PdLICY NUMBER: CAL 329-Z1-1 % CfJMMERCiAL t3ENi:i1AL LIARILtiY CG241b0�1� i"F;I �NV���SF�lMEIVii ��i�iV�E� THE POLICY. PLAN~ R�A� IT' �A,l��FtlN,Ll', This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY CCJVERACF PART SC�iEi]ULE Name i}f Addi#ibnei insured Persanlsl dr Cirpanizattonis► � � � � , � � � �. Loco#fonts) Of havered Gpera#ions lnformatiart raqulred to complete this Schedule, ff not shown above, will be shaven in the Declarations, A. �ectian ii - Who Is An Insured is amended to that which you are required by the contract include as an additiona! insured the porsonis) or or agreement to provide for such Additional organizations► shown in the Schedule, but only insured. with respect to liability for "bodily injury", E. With respect to the insuranc© afforded to these "property damage" or "personal and advertising additional insureds, the fallowing additional injury" c;�used, in whole or in part, by; exclusions apply: 1. Your acts or omissions; ar This insl.rranHa does not apply to "bodily injury" 2. The acts or omissions of those acting on or "property damage" occurring after: your behalf; 1. Ali work, including materials, parts ar in the performance of your ongoing operations equipment furnished in connection with such for the additional Insureds) at the location(si work, on the project (ofiher than service, designated above, maintenance ar repairs) to he performed by or on behalf of the additional insuredjs) at However; the location of the Hovered operations has 1. The insuranc® afforded tH such additional been completed; or insured only applies to the extent permitted 2, That pardon Hf "your work" out of wl�ich by law; and the injury or damage arises has bean put to 2. if coverage provided fo the additional its intended t.rse by any person or insured is required toy a contract ar organization other than another contractor or agreement, the insurance afforded I:Cs such subcontractor engaged in performing additional insured will not be Broader than operations for a prirraipal as a part of the same project. i r: r � Insurance SorviHos Offiee, Inc., 2012 Imo-- t�� 'J 16` of 27 429 C. With respert to the insurance affnrdad to these additional insureds, the fallowing is added to section tll - Limits t7f Insurance: If coverage: prnvided to tho additional insured is required try a contract or agreement, the most wa will ;gay on behalf of the additional insured is the amoGint of insurance: 1. Rewired by the contract or agraontQnt; ar Page 2 of 2 �. Avfliiable under th® applicable Limits of Insurance shown in the Declarations; wttichr�ver is Icss. This e3�dorsefrient shall not increase the ap�,iicable Limits cif Insurance shown in the Declarations. � tnsuranco Services Office, Inc., 2C�1 r r r� ■ 17' of 27 429 PbLICY Ni1ME3F..R: GL 329-�1-i7 COMI�Ei1C1AL CENEi16lL LIAf31LITY CG20370413 THl� �I����S�NUIENi �HA�ICE� THE P�LM�V. PLEASE REACH li �,q��PIJLLY. This endorsement modifies insurance provided under the followirtcg: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIAt31LITY COVERAGE PART Name Cif ddltlanal Insured Persants) Location And bescriptian Of Completed C3peratians br Qrgani�atian(s) �. ANY P�RSflN flR ORGANIZATION PEi2 THE CONTE�ACT OR AC�REEh9ENT , WHOM YOU BECOh1E OBI_ I GATEi7 TO INCLUDE AS AN ADbITIONAL INSUI�Eb AS A f�ESULT OF ANY CONTRACT OR AGREEh1ENT YOU HAVE ENTEREia 1 NTO. Information required to camplei;e this Schedule, it not shown above, will be shown in kho iaeclarations. A. Section It - WI7o Is �!n Insured is amended to inrlude as an adrfitianal insured the persan(s) or organizatianjs) shown in the Schedule, but only with respect to liabiliky for "bodily inaury" ar "property damage" caused, hi whale or in park, by "your work" ai: the location designated and described In tlto Schedule of this endarsornerrt pUrformed for khat additional insured and included in the "products-cornplotod operations hazard". I-lawever: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agroe- ment, the insurance afforded tag suoh addi- tional insured will not ba broader than that which you are required agreement to provide insured. by the contract or #or such additional B. With respect to the Insurance afforded to these additional irtsurods, the: following is addod to Section ill -Limits Of Insurgence: If coverage provided to kho additional insured is required by a Contract ar agreement, kho mast we will pay on laehaif of the additional insured is the amount of insurance; 1. Required by the oontract ar agreement; ar 2. Available under the applicahla Limits of insu- ranca shown in the Declarations; whichever is lass. • This endorsement shall not increase the appli- cahle Limits of Insurance shown in the Decla- rations. � Insurance Servioos Office, Inc., 2012 �: ■ 18" of 27 429 POLICY NUMBEf�: GL ��9-�7 —rt7 C�MIVIERCl/AI� QENERAL InIAUILITY Cta 20 1'T 04 �S THIS hI�tV���" CHARI��S THE P�Lle✓'P'. PLE�,S� F3EA.� IT �AREFl1LLY. This endarsem®nt modifies insurance pravided under the fallowing: COMMERCIAL GENERAL LIARILITY•COVEI�AGE PART .n_.�._..�_,.._..... Designation Of Premises �Rart Leased 'd'r, You): ANY PREMISES OR PART THEREOF LEASEp TO YOU, • - r � .. mlt i 1 1� _� F 1f L A �M � rr I 1 � , � > � � � ■ A Additional Prerniurrr: S I NCLUdED __.__._.___.�__.____T._.,,...T...�.�--.-�-- .....-�— --- lnformation_required to complete this, Schedule, if not shown above, will be shown in fife Iaeclaratiois, A, Section 1i -Who Is An Insured is amended t:a include as an additional insured the Itersan(s) ar arganizatianls) shown in fife Schedule, but oitiy with rosl�ect to Ilebiiity ari$ing aut of the awitership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the foNowing additionai exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place �aftar you cease tct be a tenT�nt in that premises. Insurance Services Office, Inc., ZOO 2 #gage 1 of � 19' of 27 429 �. Structural alterations, new construction or dvmalltlan operations performed by ar on hehalf of the persan(s} ar organi�atian{s} shown in the Schedule. However; 1. The insurance afforded to such additional in- sured only applies to the extent pormittad by law; and 2, If coverage provided to the additional in- sr_Ired Is required tag a contract rar ag- reei77ent, the insurance afforded tc� such additional insured vvill not be broader than that which yr5u are required by the contract or agreement to provide far such additional insured, �, With respect to the insurance afforded to these additional insureds, the fallowing is added to Section III •Limits t�f insurance: If coverage provided to the additional insured is required by a contract ar agreement, the most wv will pay on bohali of the additional insured is Che amount of insurar7ee: 1, Required by the contract ar agreement; or 2. Available under the applicahle Limits of Insurance spawn in the Declarations; WlilaheVGf lS Ie55. phis endorsement shall not applicable Limits of Insurance Declarations, increase the spawn in the Page 2 of 2 � Insurance Services QPfice, Inc„ 2412 �� 2® '{ 1 04 13 j 20` of 27 429 w ,;: i f �� t., � �: i ��, �; "� , il;,r � � .= � � w 1, i °� i." W � °` � This endorsement modifiers insurance. provided under the fallowing: COMMERCIAL GENERAL LIABILITY C©VERAC,�E PART 1 Information required to aamplete this Schedule, If not shown above, wi11 bo shown in the baclarations. A. faction !I -Who is An Insured is amanded to in- clude as an additional insured any state or cdov®rnmerttal agency or subdivision or political subdivision shown in the Schedule, subject to the fallowing provisions: 1. (his insurance applies only with respect to apor�ntians performed by you or pn your be- half for whiah thc; state ©r gavernmontai agency ar subdivision or political subdivision has issued a permit or authprization. However; a. The insurance afforded to such ac►dltional insured only applies to the extent permit- ted by law; acid h. If aaverage provided to the aciditiana) in- sured is required by a cpntraat or agree rnent, the insurance afforded to such ad- ditional insured will not be broader than that whiah you are required by the con- i;rraat or agreement to pravida for such additional insured. 2, 'Phis insurance does not apply to: a. "Bodily injury" "properly damage" ar '°persona( rand advertising injury" arising out of operations performed for the fed- eral government, stata ar municipality; or b. "Bodily injury" ar "property damage" in- rluded witiain the "products-completod operations hazard". i3. With respect to the insurance afforded to thr�sc� additional insureds, the following is added to Section #IE -).units �f Ensurance: If coverage provided to tho adr�itional insured is required by a contraaat or agreement, tha most we will pay on behalf of the additional insured is the amount of insuran�,r�: 1. Required by ttte contract ar agreement; car ?. Available under the applicable Limits of In- surance shown in fibs f�eclaratians; whichever is less, (his endprsemant shall not increase the alaplica- hle Limfis of Insurance shown in the Declara- tions,. c� 2� � z n�. 1 � � InsUr'ance Services Office, Inc„ ?_U12 ..: ■ 21" of 27 429 POLICY NUMBER; GL 329-21-1% Ct�MM�1�CtA.k, CBNPt3Al. LIA�ILI'iY CG 20 01 Q4 13 1"HI� ��l���E(UIENi �h9,Ai�GI;� This ��LICY. pLE��� RE,41� IT G�I��FULL`d. This endorsemenfi modifies insurance providod under th© fallowing: CQMMERCIAL GEPJERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIAk31LITY CQVER/-AGE PART The following is added to the Other Insurance Condition and supersedes any provision tc the contrary: Primary A,nd Noncontributory Insurance This insurance is primary to and will not soak contribution from any other insurance available to an additional insured under your policy provided that: t9 }The additional insured is a Named Insured under such athor ictsura��ce; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribu- tion from any other insurance available to the additional insured. Ct� 20 01 Qq 1� � Insurance Services Office, !nc„ ?_01? Page 1 of 1 zz• or z� azs POLICY NUMB]=1�: t�L 329-21-17 CCIMMERGRAI, G�NERP+L LIA�it,liY QG 2� t7R� p� p9 This endorsemf;nt fnadifles insurance provided under the following: COMMFRCIAi_ GENPRAL LIABILITY COVPRAGI= PART PROC7UCT51COMPL�`iEb OPEiiATIONS 1n1ABILITY COV�RAGP PART Information required to campinte this Schedulo, if not shown above, will bo shawn in the Daclarations� The following is added to Paragraph �. Transfer t7f Rights Of Recovery Against Others To Us of Sec- tion IV - Conditions: We waive any right of recovery we may have against the person or organiLation shown in the Schedule above hecause of payments we make for injury or damage arising out of your ongoing opera- tions or "yor�r wnrk" done under a contract with that person or organization and included in the "products -completed operations hazard", This waiver applies only to the person ar orc�anizafiian shown in the Schedul© above. � �� �- ��. � ihsurance Services Office, Inc„ 20g8 Page 1 of 1 23" of 27 429 �r' This endorsenzant, effective 1 2:01 A.N). 09/01/2020 forms a part of Policy No.CA 454m��'�i3 issued to ANOERSEN CONS�'RUCTI{7N CpP1�AIdY i .,� i �, i � � � �, _ ��- �;� � � �� w ..�� This endUrsemGn# rr►odifies insurance provided under the iollnwlny.' BUSINESS AUTO COVERAGE FOt�M ,rr � .a � R ""1. 1 �ii i' ':R i i i ,_ i � N " y t � z�i. IET � j �� ■, a � d. Any person or organization, shown in the sohedula above, to wham you becorno obliclatad to Inoludo as an additional fissured under this policy, as a result of any contractor agreement you enter iota which requires you to •furnish insurance to that person or organization of the typo provided by this policy, but nnly with respect to liability arising au•C of uss of a covered "auto". However, the insurance provided will not axcoad the lesser of: (1) The coverage and/ar limits of thls policy, or (2) The coverage and/or limits required by said contract or agreement. a AUTHORIZED REPRESENTATIVE $7950 (9/14) Includes capyrlghted intan•nation of irlf,Ul'dt1C0 Serv(cus Office, (roc., page 1 of 1 vuith its permission. 24" of 27 429 �• This endorsement,effactive12:01A.M. 09/01/2020 forrnsa partof policy No. CA 454 � 47 � 73 issued to ANDERSEN CONSTRUCTION Cf?MPANY i.�y NATIONAL UNION F 1 RE INSURANCE COMPANY OF P I TTSSURGH , PA ►r , � sir. T/�is endorsernen� rnadifles insurance provided under the �allawing: PUSIIVESS AUTO COVERAGE FORM Section IV -Business Auto Conditions, D., General Conditirns, �., Other Insurance, o., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply cis primary insurance for such additional insured where so required under an agreement executed prier to the date of accident We will not ask any insurer that has issued other insurance to such additionaiinsured to contribute tv the settlement of lass erising out of sr�ch accident. AN other terms and canditions reinsin unrh®nged. 744�d�5 (1 Q/991 25` of 27 429 � <�iiM�. �, �,.: This endorsement, effective t2:U1 A.M. 09/n1/2020 farms a part of policy No. Cat 1t�?t -Id%, 73 issued to ANDERSEN CONSTRUCT I t7N COMPAfilY by NAT I tJNAL tJN 1 CN FIRE i NSURANCE Cf3MPA,NY OF P I TTSSURGH, PA This endorsement modifies Insurance provided under fhr� following.• Section iV d F3usiness ,4uto Conditions, �, -Loss Conditions, �. « Transfer of Rights Qf 1�ecovery �Ac�ainst Others t® tJs, is amended to add: However, we will waive any right of recover we have against any person car organization with wham you have entered into a contract ar agreomant because of payments we make under this Goverag® Form arising aut aF an "accident" or "Foss" if: (1} the "accident" ar "lase" is duo to aperaticns undertaken )n acoardance with the contract existing between you and such person car organization; and (2} The contract ar agrEemeni was entered into prier to any "accident" ar "lass" . Na waiver of the ricdht of recovery will directly or indirectly apply to year emplayees ar employees of the person or organization, and we reserve our rledhts or lien to be relrnbursed from any recovery funds obtained by any injured employee• 62897 (Ea/95} 26' oT 27 429 This endorsement changes the policy to vdhich it is attached effective an Inception date of the policy unless a different dale is indicated below. (The following "etiachinc� clause" need be cornpletad only when this endorsement is Issued subsoquonk to preparation of the policy). This endorsemenl, effective 12:d1 AM 09I01/2020 forms a pert of PalEcy No, WG 0�,�-8��359� -• r i i. ., � � i We have the right to recover our payments from anyone Ilsbl© far an [njury covered by this policy. We will not enforce our right against the person or argani�ation named in the Schedule. This agreement applies only to the extent that you perform war►< under a written Gnntract that requires you to obtain this agreen�ant from us, This agreement shah nai oraerate directly or indirectly ka benefit any one not Warned in the Schedule. � � � � � ; s N 1 � / � � i � it � � �. This form is nat applioable in California, E�entucky, New Hampshire, New aersey, Texas, ar Utah. This farm is not appliaaiafe in Missouri when there is a construction code an the policy and there is Miss�aurl premium or exposure. w� OQ� 113 •i3 �aunteralgnet# by �._4_...._�_..._....�._.���.._�._ _.___. (�d. 04I�4) �utteorizeef f�eprr:sentative 27" of 27 429