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HomeMy WebLinkAbout6299 - Double D Electrical Inc. -COIsDOUBDEL-01 TBREWSTER A� ORO CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 5/25/225/2022 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). PRODUCER CONTACT NAME: PLC Insurance LLC PHONE FAX 19401 40th Ave W, Suite 440 RECEIVED IE MA Lo, Ext): (425) 712-3664 (A/C, Ne):(425) 712-3786 Lynnwood, WA 98036 ADDRESS: plc@plcins.com INSURERS AFFORDING COVERAGE NAIC P MAY 31 2022 INSURERA:RLI Insurance Company 13056 INSURED INSURER B : Double D Electrical, Inc. City of Bremerton INSURER C : PO Box 957 Risk Manaaement INSURER D : Port Hadlock, WA 98339 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR RKA0400416 5/27/2022 5/27/2023 EACH OCCURRENCE $ 110005000 DAMAGE TO RENTED PREMISES Ea occurrence 3005000 $ MED EXP (Any oneperson) $ 51000 PERSONAL & ADV INJURY S 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a JECOT LOC RX GENERAL AGGREGATE $ 21000,000 PRODUCTS $ 29000'UOU OTHER: $19000 P.D. Ded, Applies WA STOP GAP $ 110009000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 110009000 S X BODILY INJURY Perperson)S ANY AUTO OWNED SCHEDULED CKA0400597 5/27/2022 5/27/2023 AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident)$ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 21000,000 Li N AGGREGATE $ 29000'000 EXCESS LIAB CLAIMS -MADE CKA0400598 5/27/2022 5/27/2023 DED I X I RETENTIONS 0 S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ (MandatoryOFFICER/Min ER EXCLUDED? (Mandatory in NH) NIADISEASE RKA0400416 5/27/2022 5/27/2023 PER TATUC OTH- ER E.L. EACH ACCIDENT 1,000,000 $ - EA EMPLOYEE 17000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Bremerton is included as Additional Insured as their interest may appear as required by written contract. Primary Non -Contributory provisions apply. Waiver of Subrogation applies as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CityTHEREOF, of Bremerton THE EXPIRATION DATE NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street, Suite 100 Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DOUBDEL-01 BGEORGE '4co/zo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `� 1 5/26/2023 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). PRODUCER CONTACT NAME: PLC Insurance Services PHONE FAX 19401 40th Ave W, Suite 440 (A/C, No, Ezt): (425) 712=3664 1 (A/C, No):(425) 712-3786 Lynnwood, WA 98036 E-MAIL Ic Icins.com ADDRESS: p @p INSURED Double D Electrical, Inc. PO Box 957 Port Hadlock, WA 98339 COVERAGES CERTIFICATE NUMBER: INSURER F REVISION NUMBER' 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS -MADE � OCCUR RKA0400416 5/27/2023 5/27/2024 DAMAGE TO RENTED PREMISES Ea occurrence 300,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 21000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,0001000 WA STOP GAP $ 1,0001000 X OTHER: $1,000 P.D. Ded. Applies B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 13000,000 $ X BODILY INJURY Perperson) $ ANY AUTO CKA0400597 5/27/2023 5/27/2024 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY r cciDAMAGE $ HIRED ONLY AUOTOS ONLY $ B X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,OOO AGGREGATE $ 21000,000 EXCESS LIAB CLAIMS -MADE CKA0400598 5/27/2023 5/27/2024 DED X RETENTION$ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFICER/MEMBOER EXCLUDED ECUTIVE ❑ (Mandatory in NH) N / A RKA0400416 5/27/2023 5/27/2024 STATUTE X ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Bremerton is included as Additional Insured as their interest may appear as required by written contract. Primary Non -Contributory provisions apply. Waiver of Subrogation applies as required by written contract. RECEIVED CERTIFICATE HOLDER ✓ v � � U J �U« CANCELLATIONTHE EXPIRATION DATE THEREOF City of Bremerton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Bremerton 345 6th Street, Suite 100 Disk Mana� eMPrt CE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD