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HomeMy WebLinkAboutCity-of-Bremerton_Performance-Sys_21-22_10-19-2021_193046219SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 10/19/2021 RBN &Associates,Inc.303 E Wacker Dr Ste 650ChicagoIL60601 312-856-9400 ckost@rbninsurance.com Scottsdale Insurance Company 41297 PERFSYS-01 Travelers Prop Cas Co of Amer 25674PerformanceSystemsIntegration,LLC;Carter’s Fire SprinklerMaintenanceandPiping,Inc.;PSI Fire&Wholesale,LLC dba Fire King of Seattle;7324 SW Durham RoadPortlandOR97224 The Travelers Indemnity Co.25658 Crum &Forster Specialty 44520 Indian Harbor Insurance Co.36940 193046219 D X 1,000,000 X 50,000 5,000 1,000,000 2,000,000 X Y Y GLO-082158 8/12/2021 8/12/2022 2,000,000 Prof.Liability 1,000,000 B 1,000,000 X 8101R80133A 8/12/2021 8/12/2022 A X 5,000,000 X XLS0120016 8/12/2021 8/12/2022 5,000,000 C X N UB1R820632 8/12/2021 8/12/2022 1,000,000 1,000,000 1,000,000 EDB Excess LiabilityExcessLiabilityCommercialProperty SXS0059632SEO-1147356309P749281 8/12/20218/12/20218/12/2021 8/12/20228/12/20228/12/2022 Each Occurrence/Agg.Each Occurrence/Agg.Rented Equipment 5,000,0002,000,00050,000 City of Bremerton,its officials,employees,agents,and volunteers is Additional Insured on a primary non-contributory basis with respect to General Liability asrequiredbywrittencontract.A Waiver of Subrogation applies in favor of the Additional Insured with respect to General Liability as required by written contract. City of Bremerton3456thStreet,Suite 100BremertonWA98337 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: PERFSYS-01 1 1 RBN &Associates,Inc.Performance Systems Integration,LLC;Carter’s Fire SprinklerMaintenanceandPiping,Inc.;PSI Fire&Wholesale,LLC dba Fire King of Seattle;7324 SW Durham RoadPortlandOR97224 25 CERTIFICATE OF LIABILITY INSURANCE Named Insured's Continued: PSI Fire Systems,LLCPSIGroupHoldingCompany,LLCPSIGroupAcquisitionCompany,LLCPSIAdvanceFire&Safety LLCBasicFire,LLC Policy# GLO-082158 Policy# GLO-082158 Policy# GLO-082158