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Home My WebLink About5495 - Olympic Ambulance Inc.DECLARATIONS FOR A BUSINESS AUTO AMENDED 07/15/21 ITEM ONE Named Insured and Address OLYMPIC AMBULANCE INC AND OR BREMERTON AMBULANCE IN 601 HENDRICKSON RD SEQUIM WA 98382 Producer Code: .100 Page 1 Policy No: CPW 6873977 1 Producer Name and Address FRYER INSURANCE AGENCY INC PO BOX 1347 PORT ANGELES WA 98362 Broker: Report Basis: ANNUAL Policy Period: From 07/15/21 t0 07/15/22 at 12:01 A.M. Standard Time at your mailing address shown above. Insurer Company and Code: NATIONAL CONTINENTAL INSURANCE COMPANY Named Insured's Business: 4 AMBULANCE SERVICE Form of Business: CORPORATION •RETURN PREMIUM $15,138- �This policy may be subject to final audit. IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY ITEM TWO Schedule Of Coverages And Covered Autos This policy provides only those coverages where a charge is shown in the premium column on the covered autos schedule. Each of these coverages will apply only to those "autos" shown as covered "autos"."Autos" are shown as covered "autos" fora particular coverage by the entry of one or more symbols from the Covered Autos section of the Business Auto Coverage Form next to the name of +tie �.,o Covera es Covered Autos Limit Covered Autos Liability 1,000,000 CSL 7 8 9 Personal Injury Protection Separately Stated In Each PIP Endorsement (Or Equivalent No—fault Coverage) Added Personal Injury Protection Separately Stated In Each Added PIP Endorsement (Or Equivalent Added No—fault Coverage Property Protection Insurance ��C 2 � 20�.� Separately Stated In The P.P.I. Endorsement (Michigan Only) Auto Medical Payments Each Insured Uninsured Motorists I y O reme Uri Risk Management Underinsured Motorists 7 100,000 PER PERSON (when Not Included In Uninsured 300,000 PER ACCIDENT Motorists Coverage) 50,000 PER ACCIDENT Physical Damage Actual Cash Value Or Cost Of Repair, Whichever Comprehensive Coverage Is Less Minus $ Ded. For Each Covered Auto. But No Deductible Applies To Loss Caused By Fire Or Lightning. See Item Four for Hired or Borrowed Autos. Physical Damage Specified Actual Cash Value Or Cost Of Repair, Whichever Causes Of Loss Coverage Is Less Minus $ Ded. For Each Covered Auto For Loss Caused By Mischief Or Vandalism. See Item Four for Hired or Borrowed Autos. Physical Damage Actual Cash Value Or Cost Of Repair, Whichever Collision Coverage Is Less Minus $ Ded. For Each Covered Auto. See Item Four for Hired or Borrowed Autos. Physical Damage $ For Each Disablement Of A Private Passenger Auto Towing And Labor (Not available in California) PER REVIEW AMEND LACEY TO TERRITORY 035 CA DS 03 10 13 Batch End Last Run Eff Date Pa es Yr PADDL.IN DEC 015 21335 07/15/21 3565 21 � Cur Date Run Seq FP5637 E G 21349 141 DECLARATIONS FOR A BUSINESS AUTO Page 2 Endorsements Attached To This Policy: SEE SCHEDULE ATTACHED FILINGS OTHER CHARGES INCLUDED WITH POLICY TOTAL PREMIUM COUNTERSIGNED 07/15/21 BY Copyright Insurance Services Office, Inc. 2011 CA DS 03 10 13 Batch End Last Run Eff Date Pa es Yr PADDLIN DEC 015 21335 07/15/21 3566 21 � Cur Date Run Seq FP5637 E G 21349 141 Policy No: CPW 6873977 1 Page 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AP 90 24 02 16 THIS ENDORSEMENT IDENTIFIES PERSONIS) OR ORGANIZATIONS WHO ARE ALREADY AN "INSURED" UNDER THE WHO IS AN INSURED PROVISION OF THE POLICY. THIS ENDORSEMENT DOES NOT ALTER COVERAGE PROVIDED IN THE POLICY. PERSONS) OR ORGANIZATIONS) IDENTIFIED AS "INSURED(S)" This endorsement is for use with the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM Each person or organization listed below is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision of Covered Autos Liability Coverage tlf no entry appears below, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Persons) or Organization(s): CITY OF BREMERTON C/0 CITY CLERK/CITY HALL 345 6TH ST SUITE 100 BREMERTON WA 98337 Page 1 of 1 Batch � Cur Date Run Seq End Last Run Eff Date Pa es Yr PADDLINS FP5637 E G 21349 140 015 21335 07/15/21 3557 21 PMD Policy No: CPW 6873977 7 Page 2 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. THIS PAGE IS BLANK Batch End Last Run Eff Date Pa es Yr PADDLINS 015 21335 07/15/21 3558 21 � Cur Date Run Seq FP5637 E G 21349 140