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HomeMy WebLinkAboutCertificate (002) Kitsap ConcreteANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 3/28/2022 (206) 889-5248 24082 Kitsap Concrete Cutting, Inc. PO Box 247 Seabeck, WA 98380 24074 A 1,000,000 X X BKS60092959 8/11/2021 8/11/2022 1,000,000 15,000 1,000,000 2,000,000 2,000,000 1,000,000A X X BAS60092959 8/11/2021 8/11/2022 1,000,000B ESO60092959 8/11/2021 8/11/2022 1,000,000 A BKS60092959 8/11/2021 8/11/2022 1,000,000 1,000,000 1,000,000 Subject to policy conditions, endorsements & exclusions. The City of Bremerton, its officials, employees, agents and volunteers: See attached Additional insured ongoing, Primary/Non-Contributory, Waiver of Subrogation and completed operations from CG8810 & CG8583. Auto additional insured, Primary/Non-Contributory and Waiver of Subrogation from AC8501. City of Bremerton attn: Risk Management 345 6th Street Suite 100 Bremerton, WA 98337 KITSCON-01 CFINKELSON Fournier Insurance Solutions 115 Hall Brothers Loop NW #109 Bainbridge Island, WA 98110 Genia Kacey-McKnight geniam@fourniersolutions.com Ohio Security Insurance Company The Ohio Casualty Insurance Company X X X X X X X 5984of60092959002835235COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 6084of 6184of60092959002835235 6284of 6384of60092959002835235 6484of 6584of60092959002835235 6684of 7184of60092959002835235COMMERCIAL GENERAL LIABILITY CG 88 70 12 08 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S)-GENERAL AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Includes copyrighted material of ISO Properties,Inc.,with its permission.CG 88 70 12 08 Page 1 of 1 A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I -Coverage A -Bodily Injury And Property Damage Liability,and for all medical ex- penses caused by accidents under Section I -Coverage C Medical Payments,which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to you: 1.A separate Construction Project General Aggregate Limit applies to each construction project,and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations . 2.The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A,except damages because of "bodily injury"or "property damage" included in the "products-completed operations hazard",and for medical expenses under Cov- erage C regardless of the number of: a.Insureds; b.Claims made or "suits"brought;or c.Persons or organizations making claims or bringing "suits". 3.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project.Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4.The limits shown in the Declarations for Each Occurrence,Fire Damage and Medical Expense continue to apply.However,instead of being subject to the General Aggregate Limit shown in the Declarations,such limits will be subject to the applicable Construction Project General Aggregate Limit. B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I -Coverage A -Bodily Injury And Property Damage Liability,and for all medical ex- penses caused by accidents under Section I -Coverage C Medical Payments,which cannot be attrib- uted only to ongoing operations at a single construction project away from premises owned by or rented to you: 1.Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable;and 2.Such payments shall not reduce any Construction Project General Aggregate Limit. C.When coverage for liability arising out of the "products-completed operations hazard"is provided,any payments for damages because of "bodily injury"or "property damage"included in the "products- completed operations hazard"will reduce the Products-Completed Operations Aggregate Limit,and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D.If the applicable construction project has been abandoned,delayed,or abandoned and then restarted, or if the authorized contracting parties deviate from plans,blueprints,designs,specifications or timetables,the project will still be deemed to be the same construction project. E.The provisions of Section III -Limits Of Insurance not otherwise modified by this endorsement shall continue to apply. 2974of60092959002764235COMMERCIAL AUTO AC 85 01 06 18 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT 3074of 3174of60092959002764235 3274of 3374of60092959002764235 3474of 3574of60092959002764235 5984of60092959002835235COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 6084of 6184of60092959002835235 6284of 6384of60092959002835235 6484of 6584of60092959002835235 6684of 5784of60092959002835235COMMERCIAL GENERAL LIABILITY CG 85 83 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED CONTRACTORS -PRODUCTS/COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 5884of 2974of60092959002764235COMMERCIAL AUTO AC 85 01 06 18 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT 3074of 3174of60092959002764235 3274of 3374of60092959002764235 3474of 3574of60092959002764235