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HomeMy WebLinkAboutMt. St. Helens ReforestationR 03/26/® CERTIFICATE OF LIABILITY INSURANCE DATE(M/2021 Y) " 021 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 cercate holder is an If SUBROGATION IS WAIVED, subject to tl this certificate does not confer rights to th D, the policy(ies) must have ADDITIONAL INSURED provisions or be endorse is A the policy, certain policies may require an endorsement. A statement on lieu of such endorsement(s). PRODUCER NAME: NAME:t'' Joanne Hurley WCLA Insurance Agency MAR 3 0 2UZ PHONE (360) 352-5033 2 FAx (360) 352-1689 AIC No Ext : A/C No P O Box 2168 E-MAIL ) @gg oanne ID ers.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N Olympia City Of BremeApt j 8507-2168 INSURER A : American Forest Cas. Co., RRG INSURED INSURER B : Mt. St. Helens Reforestation, Inc. INSURER C : PO BOX 971 INSURER D : INSURER E : Chehalis WA 98532 INSURER F : COVERAGES CERTIFICATE NUMBER: 2021 REVISION NUMBER' 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Loggers BFPD Y AFC040404-21 03/23/2021 03/23/2022 EACH OCCURRENCE $ 11000,000 D E T RE T D PREMISES Ea occurrence 100,000 $ X MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 11000,000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY PRO LOC OTHER: GENERAL AGGREGATE $ 21000,000 2,0001000XJECT $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY AFC040404-21 03/23/2021 03/23/2022 COMBINED SINGLE LIMIT Ea accident $ 11000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A AFC040404-21 WA Stop Gap 03/23/2021 03/23/2022 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 110009000 E.L. DISEASE - EA EMPLOYEE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Pesticide coverage AFC040404-21 03/23/2021 03/23/2022 50,000limit DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is named additional insured with respect to the operation of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works & Utilities ACCORDANCE WITH THE POLICY PROVISIONS, 100 Oyster Bay Ave N AUTHORIZED REPRESENTATIVE Bremerton WA j v luj, 98312 ; ��, .q% ,tE p- , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD