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HomeMy WebLinkAbout6293 - Performance Systems Integration_COI 2023CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/04/2022 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 Rice Insurance LLC 1400 Broadway Bellingham INSURED Performance Systems Integration, LLC See page 2 for Additional Named Insureds 7324 SW Durham Rd WA 98227 Portland OR 97224 COVERAGES CERTIFICATE NUMBER: CL2.2839S887 Mallory Visser (360) 734-1161 malloryv@riceinsurance.com INSURERA; LIOydS Of London INSURER C D: INSURER E AFFORDING COVERAGE Scottsdale Insurance Company f 73�IF.ibTJiJIII�TiiT3-Z'' 734-1173 41297 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 ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR Y Y SPG22039 08/12/2022 08/12/2023 EACH OCCURRENCE $ 1,0001000 A TOR PREMMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 10,000 PERSONAL &ADV INJURY $ 11000*000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 21000,000 PRODUCTS-COMP/OPAGG $ 21000,000 Professional Liability $ 11000,000 AUTOMOBILE LIABILITY ANY AUTO OWNEDONLY AUTOS SCHEDULED AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X1 OCCUR CLAIMS -MADE Y Y SPG22039UMB 08/12/2022 08/12/2023 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,0001000 DED I X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ,ANY PROPRIFTOWPARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? In NH) IM ndabe under DESCRIPTION OF OPERATIONS below NIA PER STATUTE OTH- ER E1 EACH ACCIDENT _ $ E.L. DISEASE - EA EMPLOYEE —_ $ E.L. DISEASE - POLICY LIMIT $ B Excess over $5M Umbrella Y Y XLS2000264 08/12/2022 08/12/2023 Each Occurrence Aggregate 71000,000 71000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Bremerton, its officials, employees, agents, and volunteers is Additional Insured for General Liability for Ongoing Operations per form CG2010 0413 and CG2033 0413 and Completed Operations per form CG2037 0413. Coverage is Primary and Non -Contributory per form SARPG-CGL-PNC 0714. Waiver of Subrogation applies per form CG2404 1093. Per Project Aggregate applies per form CG2503 0397, CERTIFICATE HOLDER (:ANr:FI I ATInNI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES MCC ANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WITH THE POLICY PROVISIONS, 345 6th Street, Suite 100 AUTHORIZED REPRESENTATIVE Bremerton WA 98337 Y e '';A ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Basic Fire, LLC Additional Named Insured Carter's Fire Sprinkler Maintenance and Piping LLC Additional Named Insured Statcomm Inc Additional Named Insured PSI Evergreen Fire & Safety LLC Additional Named Insured PSI Advanced Fire & Safety LLC Additional Named Insured PSI Group Acquisition Company, LLC Additional Named Insured PSI Group Holding Company, LLC Additional Named Insured PSI Fire & Wholesale LLC Additional Named Insured PSI Fire Systems LLC Additional Named Insured PSI Group Holdco Inc Additional Named Insured PSI General Fire LLC Additional Named Insured Fire King of Seattle Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC I Policy No.: SPG220M COMMERCIAL GENERAL LIABILITY CG 20 30 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Declarations.A. Section II — Who Is an Insured is s ended to include a n additional insured the persons) or organizations) shownin the Schedule, but on with respect to liability for `bodily injury", "property damage" orm personal and advertising injury' caused, In whole or part, by. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the Performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However; 1. The insurance afforded to such additonal insured only applies to the extent permitted by law, and 2. If coverage provided to the additional insured is required by a contractor agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contractor agreement to Provide such additional Insured, B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply- CG 20 10 04 13 OISO Properties, Inc„ 2013-- Page 1 of 2 SCHEDULE Name of Additional Insured Person(s)or Organlxation s : Lowtion(s)of Covered Operations: As required by written contract or agreement As required by written contract or agreement Information required to complete this Schedule, if not shown above, will 6e shown in the Pol1ry No.; SPG22o39 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of AddRionai Insured Persons) or Organizations : Locatbn and Description of Completed O rations: As required by written contract or agreement As required by written contract or agreement Information required to complete this Schedule, if not shown above, will be shown In the Declarations. A. Section II - Who Is An Insured is amended to Include as an additional Insured the persons) or organlzatlon(s)shOwn In the Schedule, but only with respect to liability for "bodily Injury" or "property damage" caused, in whole or In part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional Insured and included in the "products -completed operations hazard". However: 1. The Insurance afforded to such additional Insured only applies to the extent permitted by Caw; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the Insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. B. With respect to the Insurance afforded to these additional Insureds, the following is added to Section Ill -limits Of Insurance: If coverage provided to the additional Insured is required by a contract or agreement, the most we will pay on behalf of the additional Insured Iz the amount of Insurance: I. Required by the contractor agreement; or 2. Available under the applicable limits of Insurance shown In the Declarations; whichever Is less. This endorsement shall not Increase the applRable Limits of Insurance shown In the Declarations. CG 20 370413 OISO Properties, Inc., 2004 Page 1 of 1 I i This insurance does not apply to `bodily injury' or "property damage" occurring after: 1. All work, Including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the Location of the covered operations has been completed; or i2. That portion of `your work" out of which the injury or damage arises has been put to its intended i use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following Is added to Section III —Limits of Insurance: If coverage provided to the additional insured is required by contract or agreement, the most wro will pay on behalf of the additional insured is the amount of Insurance: I 1. Required by tract the contractor agreemen L or 2. Available under the applicable Limits of Insurance stwsm in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown In We Declarations. CG 20 300413 OISO Properties, Inc., 2013 Page 2 of 2 Pdky No.: SPG22039 [oMMER[IAl GENERAL LIABILITY CG 24 04 30 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modlRes Insurance provided under the following: SCHEDULE " Name of Additional Insured Person(s)or Orga nizatlon(s): ' As required by written contractor agreement ' The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV —COMMERCIAL GENERAL LIABILITY CONDITIONS) Is amended by the addition of the following: We vroive any right of recovery we may have against the person or organization In the additional Insured endorsement Included in this policy because of payments we make (or In)ury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included In the "produ<tscompleted operations hazard". CG 24 04 30 93 OISO Properties, inc., 1992 Page 1 of 1 Policy No.: SPG22o39 COMMERCIAL GENERAL LIABILITY CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modlRes Insurance provided under the following: COMMERCIAL GENERAL LIAOILITY COVEflAGE PART SCHEDULE Designated Construction Projects: As required by written contract or agreement (I( no entry appears above, information required to complete tits endorsement will be shavn In the Declarations as applicable to this endorsement). A. For all sums which the Insured become legally obligated to pay as damages caused by rrences' under COVERAGE A (SECTION 1), and for all medical expense caused by accidents under COVERAGE C (SECTION 1), which urn be attributed only to ongoing operations at a single designated construction project shown in the Schedule above; 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit equal to the amount of the General Aggregate Limit shorn in the Declarations, 2, The Designated 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 hauW, and for medical expenses under COVERAGE C regardless of the number of: a.lnsureds; b.Claims made or'sulls" brought; or c. Persons w organizations making claims or bringing'suils 3, Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown In the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 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 Designated Construction Project General Aggregate Llmlt, B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I ), and for all medical expenses caused by accidents under COVERAGE C (SECTION I ), which cannot be attributed only to ongoing operations at a single designated constuction project shown In the Schedule above: [G 25 03 03 97 Page 1 of 2 Polcy No.: SPG22039 This endorsement modifes Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE '' Name of Additional Inaurod Pereon(s) or OrOani�llon(ej: ', As required by written contract w agreement A, Section IV —Commercial General Liability Conditions, 4. Other Insurance Is amended, only with respect to the above scheduled entity or operations by adding', o Notwithstanding any other provision to the contrary in this policy, or in a policy issued to the scheduled additional Insurad(s), the Insurance afforded by this endorsement shall be primary and non conbibuiwy wrlh respect to liability arising out o1 work performed by or for the Named Insured provided that', I) The additional insured is a Named Insured under such other Insurance; and 2) You have agreed In writing In a conbact or agreement Thal Ihls insurance would be primary and nnuld not seek contribution from any other insurance available to the additional Insured; and 3) The additional insured is not a subcontractor for you; and 4) The loss does not arise out of bodily Injury or personal injury to your employees, volunteers or subcontractors, 1. Any payments made under COVERAGE A for damages w under COVERAGE C (or 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 shalt not reduce any Designated 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 "properly damage" Included In the "products -completed operations hazard" will reduce the Producla-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. the applicable designated 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 Limits Of Insurance (SECTION III ) not otherwise modified by this endorsement shall continue to apply as stipulated, CG 25 03 03 97 Page 2 of 2 SARPG-CGL-PNC 07 14