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HomeMy WebLinkAboutLIABILITY INSURANCE 1.1.2019AC"R" CERTIFICATE OF LIABILITY INSURANCE 1/1/2019 DATE (MM/DDNYYY) 10/31/2018 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 LOCKTON COMPANIES CONTACT NAME: 3657 BRIARPARK DRIVE, SUITE 700 HOUSTON TX 77042E 866-260-3538 PHONE FAX Ext): A/C No -MAIL ADDRESS: Y I' INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 1/ 2019 INSURED WASTE MANAGEMENT OF WASHINGTON, INC. 1300299 DBA BREM-AIR DISPOSAL INSURER B: Indemnity Insurance Co of North America 43575 INSURER C: ACE Fire Underwriters Insurance Company 20702 INSURER D : 9300 SW BARNEY WHITE ROAD BREMERTON WA 98312 INSURERE: INSURER F: DAMAGE TO RENTED PREMISES Ea occurrence $ 5,000,060 COVERAGES WASMA67 CERTIFICATE NUMBER: 15708436 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABI TY Y I' HDO 627873091 1/1/2018 1/ 2019 EACH OCCURRENCE $ 5,000, O CLAIMS -MADE CCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 5,000,060 MED EXP (Any one person) $ XXXX X XCU INCLUDED V X ISO FORM CG00010413 PERSONAL & ADV INJURY $ 5,000, GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6000 POLICY � JEo � LOC PRODUCTS-COMP/OPAGG $ 6 000 O $ OTHER: A AUTOMOBILE LIABILITY Y Y MMT H25097890 1/1/2018 1/1/2019 COMBINED SINGLE LIMIT $ Ea accident 1,000,091-1, BODILY INJURY (Per person) $ XXXX= XANY AUTO BODILY INJURY (Peraccident) $X==AUTOS X X OWNED SCHEDULED ONLY AUTOS PROPER DAMAGE $ XXXXXXX P.rr ac den X HIRED WNED AUTOS ONLY X AUS ONLY $ XXXXXXX X MCS -90 A X UMBRELLA LIAB X OCCUR Y Y XOO G27929242 003 1/1/2018 1/1/2019 EACH OCCURRENCE $ 15 000 0 AGGREGATE $ 15 000 0 0 EXCESS LIABCLAIMS-MADE DED RETENTION $ $ XXXXXXX A C WORKERS COMPENSATIONY AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIMB R/PARTUDED? ECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N /A WLR C6462278A (AOS)) WLR C64622778 cAZ,CA,&MA SCF 064622791 WI ) ( ) 1/1/2018 1/1/2018 1/1/2018 1/1/2019 1/1/2019 1/1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 3,000,00K E.L. DISEASE - EA EMPLOYEE $ 3,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 3,000,000 A EXCESS AUTO Y Y XSA H25097889 1/1/2018 1/1/2019 COMBINED SINGLE LIMIT LIABILITY $9,000,000 (EACH ACCIDENT) DESCRIPTION OF OPERATIgNIC LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) BLANKET WAIVE SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TOOE EXTENT REQUIRED BY WR EN CONTRACT WHERE PERMISSIBLE BY LAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITI N INSURED (EXCEPT FOR WORKERS' COMPEL) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION 15708436 CITY OF BREMERTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PUBLIC WORKS AND UTILITIES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 OYSTER BAY AVE. N. ACCORDANCE WITH THE POLICY PROVISIONS. BREMERTON WA 98312 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATIOIT All rights reserved. The ACORD name and logo are registered marks of ACORD