HomeMy WebLinkAboutCRT 22-00086CERTIFICATE OF LIABILITY INSURANCE Issue Date 8/31/2021
ISSUED BY: State of Washington Department of Enterprise Services Office of Risk Management PO Box 41466
Olympia, WA 98504-1466
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE LIABILITY PROGRAM.
COVERAGE AFFORDED BY
State of Washington Self Insurance Liability Program
INSURED: State of Washington
Western Washington University ATTN: Paul Mueller 516 High Street Bellingham, WA 98225
THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND DEPARTMENTS, IS SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY REQUIREMENTS.
COVERAGES
THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH PROGRAM.
TYPE OF COVERAGE POLICY NUMBER EFFECTIVE DATE
EXPIRATION DATE LIMITS
GENERAL LIABILITY GENERAL LIABILITY OCCURRENCE COVERAGE
Self-Insured Continuous Continuous BODILY INJURY, PROPERTY $5,000,000 DAMAGE & PERSONAL INJURY COMBINED EACH OCCURRENCE
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY & PROPERTY $5,000,000 DAMAGE COMBINED EACH ACCIDENT
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
L & I
Continuous
Continuous
WC – STATUTORY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS: Coverage applies as respects tort liability claims against the State of Washington as covered by the Tort Claims Act (RCW 4.92 et seq.) The Certificate Holder is named as
additional insured, but only as respects the negligence of the State of Washington.
CERTIFICATE HOLDER: CANCELLATION
CITY OF BREMERTON ATTN: ATTN: FINANCIAL SERVICES 345 6TH STREET, SUITE 100 BREMERTON, WA 98337
SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE STATE OF WASHINGTON WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY UPON THE STATE OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AGENTS
OR REPRESENTATIVES. CERTIFICATE NUMBER CRT 2022-00086
AUTHORIZED REPRESENTATIVE:
Jason Siems, State Risk Manager