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HomeMy WebLinkAboutLIABILITY INSURANCE 1.1.2020 ACORN' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) klik...------- 1/1/2021 12/6/2019 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 3657 BRIARPARK DRIVE,SUITE 700 PHONE,Ext): FAX HOUSTON TX 77042 E-MAIL (ac,No): 866-260-3538 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED WASTE MANAGEMENT OF WASHINGT /'mac / + INSURER B: Indemnity Insurance Co of North America 43575 1300299 DBA BREM AIR DISPOSAL VL-I'1� ' INSURER C: ACE Fire Underwriters Insurance Company 20702 9300 SW BARNEY WHITE ROAD BREMERTON WA 98312 8 (1 INSURER D: ACE Property&Casualty Insurance Co 20699 JAN 0 2U20 INSURER E: INSURER F: COVERAGES WASMA67 CERTIFICATE IKl(MBF : 15708436 REVISION NUMBER: XXXXXXX tIL THIS IS TO CERTIFY THAT THE POLICIES OF INSUR I fl11 LbW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENIMMEMIWYMITION 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 ADDL SUBR POLICY EFF POLICY EXP LTR _ TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY y y HDO 671237345 1/1/2020 1/1/2021 EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE 7OCCUR Ea occur ence) $ 5,000,000 X XCU INCLUDED MED EXP(Any one person) $ XXXXXXX X ISO FORM CG00010413 PERSONAL&ADV INJURY $ 5,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY X !VT X LOC PRODUCTS-COMP/OP AGG $ 6,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y MMT H25290008 1/1/2020 1/1/2021 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX X OWNED ONLY _SCHEDULED BODILY INJURY(Per accident $ XXXXXXX_ X AUTOS ONLY X ATOS ONLY ((Perr acci entDAMAGE $ XXXXXXX X MCS-90 $ XXXXXXX D X UMBRELLA LIAB X OCCUR Y Y XOO G27929242 005 1/1/2020 1/1/2021 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 5,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION PER OTH- B AND EMPLOYERS'LIABILITY Y WLR C66043058(AOS) 1/1/2020 1/1/2021 X STATUTE ER AANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WLR 066043 0 1 0(AZ,OA&MA)1/1/2020 1/1/2021 C OFFICER/MEMBER EXCLUDED? N N/A SCF C66043095(WI) 1/1/2020 1/1/2021 EL EACH ACCIDENT $ 3,000,000 (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ 3,000,000 If yes,1s,she Linder DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 3,000,000 A EXCESS AUTO y y XSA H25289961 1/1/2020 1/1/2021 COMBINED SINGLE LIMIT LIABILITY $9,000,000 (EACH ACCIDENT) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS'COMP/EL)WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 15708436 AUTHORIZED REPRESENTATIVE CITY OF BREMERTON PUBLIC WORKS AND UTILITIES 100 OYSTER BAY AVE.N. BREMERTON WA 98312 C5,1— ACORD 25(2016/03) ©1988-2015 ACORD CORPORATI .All rights reserved The ACORD name and logo are registered marks of ACORD Attachment Code : D446557 Certificate ID : 15708436 POLICY NUMBER: HDO G71237345 Endorsement Number: 39 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS LESSEES OR CONTRACTORS - (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work"for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 Attachment Code : D540810 Certificate ID : 15708436 ADDITIONAL INSURED ENDORSEMENT Named Insured Waste Management, Inc. Endorsement Number 17 Policy Symbol Policy Number Policy Period Effective Date of Endorsement MMT MMT H25290008 1/1/2020 TO 1/1/2021 Issued By(Name of Insurance Company) ACE American Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: MOTOR CARRIER COVERAGE FORM Schedule Name of Person or Organization: any person or organization whom you have been required to include as an additional insured under contract or agreement, executed prior to the date of loss WHO IS AN INSURED (Section II) is amended to include as an additional insured the person or organization shown in the Schedule, but only with respect to their liability arising out of the ownership, maintenance or use of a covered"auto"being operated by or on behalf of the Named Insured. MS-11111 (01/17) ©Chubb. 2016.All rights reserved. Page 1 of 1 irAit 1 Lowey Monday,December 9,2019 RECEIVED JAN 0 8 2020 City of Bremerton Valued Certificate Holder Risk Management Re: Waste Management, Inc. - 1/1/2020 Certificate of Insurance Dear Waste Management Certificate Holder: Enclosed for your records you will find the 1/1/2020 renewal Certificate of Insurance for Waste Management, Inc. and its subsidiaries. Please note: • This will be the final hard copy of this certificate that is mailed out. We will no longer mail hard copies unless required. • Going forward we will send out all certificates electronically. • If you wish to receive renewal certificates going forward, please email the below information to Houston-ECertDelivery@lockton.com: 1. Do you wish to receive renewal certificates: Yes [ ] No [ ] 2. Certificate Holder Name and Address: 3. Email Address: 4. Certificate Number*: *Note:This information can be found at the bottom left hand corner of the certificate next to the certificate holder's information. PLEASE NOTE: If we do not receive a response from your company,we will assume that this certificate is no longer needed and the certificate will be inactivated in our system. i01 t-°) AN ) UMST 1 i;0 _