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HomeMy WebLinkAbout5990 - Con Serve Inc.THORN-1 OP ID DATE (MMIDD/YYYY) ,a►coizo CERTIFICATE OF LIABILITY INSURANCE 12/1712021 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 endorsements . PRODUCER 253456-2000 CONTACT Shawn McClain Pilkey-Hopping & Ekberg, Inc. 2102 N. Pearl St., Suite 102 Tacoma, WA 98406-2551 Andrew Imholt erve Inc dba Thornton Land Sury ix 249 NW DEC 2 0 2021 arbor, WA 98335 r�Tii�I � �7TN �1 Ciry of Bremertorl r:FRTIGIr`ATR NI IMRF 253-756-2000 nsurance.com Fnx „_ 253-756-5336 uRERA: Mutual of Enumclaw Insurance C DRI=R R . Beazley Insurance Company, Inc c: RFVIRInN NI IMRFR� si1LtL 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 1*0 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X X CPP0012724 01/01/2022 01/01/2023 IStop EACH OCCURRENCE $ 11000,000 TO TE PREASES(Ea oc/cure ce) $ 300,000 MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY � PRO-- LOC OTHER: GENERAL AGGREGATE $ 21000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 gap 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY CPP0012724 01/01/2022 01/01/2023 Ea accidentSINGLE LIMIT $ 11000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ A UMBRELLA LAB EXCESS LAB OCCUR CLAIMS -MADE UMC0002600 01/01/2022 01/01/2023 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 11000,000 X DED X RETENTION $ 10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER/ EXCLUDED? ECUTIVE ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A STATE MANDATED EMPLOYERS LIABILITY 01/01/2022 01/01/2023 X PER T T TE OTH- FIR E.L. EACH ACCIDENT 11000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,0001000 E.L. DISEASE - POLICY LIMIT 1/0002000 B PROFESSIONAL _ C191D9210701 07/25/2021 07/25/2022 E&O 12000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Holder shall be named as an additional insured per policy forms & conditions per written Agreement - cg 2404 0509 EG2018 1012 & cg2503 0509 ; 10 day cancellation provision SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WITH THE POLICY PROVISIONS. 6th St., Suite 100 Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE Andrew Imholt ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD