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Home My WebLink About3 - Legal Review Submission_ 2021-22 COI City of BremertonHolder Identifier : 7777777707070700077763616065553330762707447315446607443036662517300072651566057221130763514013167111207162015732230552071662775324723300776205155245471207724011770276512077727252025773110777777707000707007 6666666606060600062606466204446200600222426226200206222004240060002062000060622420000622202624226002006222206040042022062220040420420200600200426224020006222024062022400066646062240664440666666606000606006Certificate No :570088890068CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/23/2021 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). 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. PRODUCER Aon Risk Services Central, Inc. MSC#17382 Aon PO Box 1447 Lincolnshire IL 60069 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (312) 381-1000 INSURED 22667ACE American Insurance CompanyINSURER A: 20702ACE Fire Underwriters Insurance Co.INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.): CONTACTNAME: Cues, Inc. SPX Corporation6325 Ardrey Kell Road, Suite 400Charlotte NC 28277 USA COVERAGES CERTIFICATE NUMBER:570088890068 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 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $5,000,000 $5,000,000 $5,000,000 $25,000,000 $10,000,000 A 01/01/2021 01/01/2022 SIR applies per policy terms & conditions General Liability - SPX XSLG71565075 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE(Per accident) X X X BODILY INJURY (Per accident) $2,000,000A01/01/2021 01/01/2022 COMBINED SINGLE LIMIT (Ea accident) ISAH25309406 EXCESS LIAB OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED UMBRELLA LIAB RETENTION E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH-ERPER STATUTEA01/01/2021 01/01/2022 Deductible - AOS SCFC67814563B 01/01/2021 01/01/2022 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN Retro - WI WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WLRC67814526 EL Each AccidentWCUC6781460501/01/2021 01/01/2022 Excess - MI & OH $1,000,000EL Disease - Policy EL Disease - Ea Empl $1,000,000 Excess WCA SIR applies per policy terms & conditions $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See following page for additional information. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Bremerton 100 Oyster Bay Ave N Bremerton WA 98312 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DocuSign Envelope ID: B648EBAF-8823-4CFA-8D11-2F16371B8B34 Certificate-holder is Additional Insured under the General Liability policy described hereon up to the limits of liability, required by written contract. This insurance applies only to the vicarious liability of the Additional Insured which occurs as a result of the Named Insured's performance of a written contract and not to liability arising out of the negligent, willful or tortuous misconduct of any person or organization included as an additional insured hereunder. The General Liability policy described hereon is primary and non-contributory only to the extent that Named Insured has assumed liability under the contract described hereon. Waiver of subrogation endorsement is included in the policies described hereon. Limits of Liability shown for General Liability policy #XSLG 71565075 are in excess of a Self Insured Retention of $250,000 per occurrence. Limits of Liability shown for Workers' Compensation policy #WCUC67814605, for Michigan & Ohio are in excess of a Self Insured Retention of $1,000,000 per occurrence. FORM TITLE:FORM NUMBER: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ADDITIONAL REMARKS EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER Aon Risk Services Central, Inc. NAMED INSUREDAGENCY LOC #: 570000011078AGENCY CUSTOMER ID: © 2008 ACORD CORPORATION. All rights reserved. See Certificate Number: See Certificate Number: The ACORD name and logo are registered marks of ACORD 570088890068 570088890068 ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles: ACORD 101 (2008/01) ADDITIONAL REMARKS SCHEDULE Page _ of _ Cues, Inc. DocuSign Envelope ID: B648EBAF-8823-4CFA-8D11-2F16371B8B34