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HomeMy WebLinkAbout5894 - COI - Anchor QEA_COIANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: 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 10/7/2020 License # 0C36861 25666 Anchor QEA, LLC 1201 3rd Ave., Suite 2600 Seattle, WA 98101 25658 25674 00000 A 1,000,000 X X 680-004R022572 10/10/2020 10/10/2021 1,000,000 5,000 1,000,000 2,000,000 2,000,000 X CA #680-4R022246 1,000,000B BA-0R118959 10/10/2020 10/10/2021 1,000,000C CUP-004R044287 10/10/2020 10/10/2021 1,000,000 10,000 B UB-4R041906 10/10/2020 10/10/2021 1,000,000 N 1,000,000 1,000,000 D Prof/Pollution Liab W11053201101 10/10/2020 Each Claim 5,000,000 D Prof Liab/Ded $250k W11053201101 10/10/2020 10/10/2021 Aggregate 5,000,000 Additional insured status extended for General Liability as required by written contract and subject to policy terms and conditions for the city. Coverage is provided on a primary and non-contributory basis where required by written contract and subject to policy terms and conditions, with respects to General Liability. Waiver of Subrogation applies to General Liability where required by written contract and subject to policy terms and conditions. City of Bremerton Attn: Risk Management 345 6th Street, Suite 100 Bremerton, WA 98337 ANCHQEA-01 WJOHNDROW Seattle-Alliant Insurance Services, Inc. 1420 Fifth Ave 15th Floor Seattle, WA 98101 Melanie Kelly Melanie.Kelly@alliant.com Travelers Indemnity Company of America Travelers Indemnity Company Travelers Property Casualty Company of America Lloyd's Syndicate 2623 (Beazley Furlonge Limited) X 10/10/2021 X X X X X X X X DocuSign Envelope ID: 68AC2C76-525B-427F-9854-AD8822B46ACE Page 1 of 2 CG D3 81 0915 © 2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II - WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury": and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization: or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section Ill - Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs: and (2) The "personal injury" for which coverage is sought arises out of an offense committed: after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. 10-10-2020 to 10-10-2021 DocuSign Envelope ID: 68AC2C76-525B-427F-9854-AD8822B46ACE Page 2 of 2 CG D3 81 0915 © 2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. DocuSign Envelope ID: 68AC2C76-525B-427F-9854-AD8822B46ACE ANCHQEA-01 KPHILLIP A�oRo CERTIFICATE OF LIABILITY INSURANCE F (MMIDDNY DATE 10/8/20221YY) 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 License # OC36861 CONTACT Melanie Kelly Seattle-Alliant Insurance Services, Inc. PHONE FAX 1420 Fifth Ave 15th Floor A/C, No, Ext : A/c, No): Seattle, WA 98101 RJ:L; J:1VE,U E-MA'L , Melanie.Kelly@alliant.com INSURER 3 AFFORDING COVERAGE NAIC # OCT INSURER A: Travelers Indemnity Company of America 25666 INSURED INSURER B: Travelers Indemnity Company 25658 Anchor QEA, LLC INSURER C : Travelers Property Casualty Company of America 25674 1201 3rd Ave., Suite 2600 Ciiy of Bremerton INSURER D: Lloyd's Syndicate 2623 (Beazley Furlongs Limited) 00000 Seattle, WA 98101 Risk Mce^dement 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L I SD /D /DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11000,000 CLAIMS -MADE X OCCUR L� X X 680-4R022572 10/10/2021 10/10/2022 DAMAGE TO RENTED PREMISES 1,0000000 X MED EXP (Any one arson 101000 All Other States PERSONAL & ADV INJURY $ 110001000 _ GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑X Mof a LOC GENERAL AGGREGATE 21000rOOO PRODUCTS - COMP/OP AGG $ UNION OTHER: CA #6804RO22246 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO BA-OR118959 10/10/2021 10/10/2022 BODILY INJURY Perperson) BODILY INJURY Per accident OWNED SCHEDULED AUTOS ONLY AUTOS DOPERTy AMAGE Per accident $ AUTOS ONLY AUTOS ONLY C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 11000,000 AGGREGATE 170001000 EXCESS LIAR CLAIMS -MADE CUP-4RO44287 10/10/2021 10/10/2022 DED X RETENTION$ 109000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N (Mandatory in NH) N / A UB-4R041906 10/10/2021 10/1012022 X SER U E ETW E.L. EACH ACCIDENT 110000000 $ E.L. DISEASE- EA EMPLOYE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 000 000 ' D Prof/Pollution Liab W11053211201 10/10/2021 10/10/2022 Each Claim 510009000 D Prof Liab/Ded $250k W11053211201 10/10/2021 10/10/2022 Aggregate 51000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insured status extended for General Liability as required by written contract and subject to policy terms and conditions for the city per forms attached. Coverage is provided on a primary and non-contributory basis where required by written contract and subject to policy terms and conditions, with respects to General Liability per forms attached. Waiver of Subrogation applies to General Liability where required by written contract and subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CityNOTICE of Bremerton THE EXPIRATION DATE THEREOF, WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Risk Management 345 6th Street, Suite 100 Bremerton, WA 98337 I AUTHORIZED REPRESENTATIVE J , IQ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Numbers: 6804R022572 & 6804R022246 Policy Term: 10-10-21 to 10-10-22 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury": and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization: or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III - Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs: and (2) The "personal injury" for which coverage is sought arises out of an offense committed: after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 0915 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 Of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission ANCHQEA-01 AGEOR DATE ( Y CERTIFICATE OF LIABILITY INSURANCE lo/6120/s/2o22 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). License # OC36861 coNTAcr Melanie Kelly PRODUCER^^I�,�� N ME: FAX Seattle-Alliant Insurance Services, Inc. Ik�1`.lr e 7 PHONE A/C. No): 1420 Fifth Ave 15th Floor (Alc, IL Ext): Seattle, WA 98101 ADD TES : MelanieXelly@alliant-com 0 C T 14 2022 INSURERS AFFORDING COVERAGE INSURED City Of Bremnrton INSURERB:TraV@Tars Indemnit Com an of Connecticut 25682 Anchor QEA, LLC Risk M>>tu ;C il8ilt INSURER C: Travelers Property Casualty Company of America 25674 1201 3rd Ave., Suite 2600 INSURERD:Travelers IndemnityCompany 25658 Seattle, WA 98101 INSURER E: Lloyd's Syndicate 2623 (Beazley Furlonge Limited) 00000 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, ADDL SUBR POLICY EFF POLICY EXP LIMITS ILT R TYPE OF INSURANCE I SD D POLICY NUMBER /Do MM/DD 120001000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE ❑X OCCUR X X 6BOAR022572 10/10/2022 10/10/2023 FIRDAMAItSE S (R occurrence)RENTED 1,010,000 X All Other States MED EXP An one person)0,000 PERSONAL & ADV INJURY 10000,000— GENERAL AGGREGATE 290009000 GEN'L AGGREGATE LIMIT APPLIES PER: 21000,000 POLICY ❑X PRO- JECT LOC PRODUCTS - COMP/OP AGG X OTHER: CA #6804R022246 COMBINED SINGLE LIMIT 11000,000 B AUTOMOBILE LIABILITY Ea accident X ANY AUTO BA-0R118959 10/10/2022 10/10/2023 BODILY INJURY Per person OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ROPER AMAGE HIRED NON -OWNED Per acci�t $ AUTOS ONLY AUTOS ONLY C X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 19000,000 EXCESS LIAB CLAIMS -MADE CUP-4R044287 10/10/2022 10/10/2023 AGGREGATE 1,000,000 DED X RETENTION $ 10,000 Gen Aggregate XER OTH- D WORKERS COMPENSATION S AND EMPLOYERS' LIABILITY Y / N U13 4R041906 10/10/2022 10/10/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A E.L. EACH ACCIDENT OFFICER/MEMBER Mend Rory iM NE) EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 130000000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below E Prof/Pollution Liab W11053221301 10/10/2022 10/10/2023 Each Claim cJ 000,000 E Prof Pollution Liab W11053221301 10/10/2022 10/10/2023 Aggregate 53000,000 $250DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insured status extended for General Liability as required by written contract and subject to policy terms and conditions for the city performs attached. Coverage is provided on a primary and non-contributory basis where required by written contract and subject to policy terms and conditions, with respects to General Liability per forms attached. Waiver of Subrogation applies to General Liability where required by written contract and subject to policy terms and conditions. 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. Attn: Risk Management 345 6th Street, Suite 100 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Numbers: 680=4RO22572 & 6804R022246 Policy Term: 10-10.22 to. 10-10-23 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II - WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- „ completed operations hazard" unless the "written contract requiring insurance to include as "written contract requiring insurance" an additional insured on this Coverage Part, but: specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or "personal injury": and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of 11 property damage that occurs before the end period of time for which the "written the you or your subcontractor in the performance of P of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.ae of additional insured: SECTION IV - COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization: or The insurance provided to the additional insured is excess over any valid and collectible other d. For bodily injury", property damage or insurance, whether primary, excess, contingent or "personal injury" for which such person or on any other basis, that is available to the organization has assumed liability in a additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part must apply on a primary basis or a primary and e. This insurance does not apply on any basis to any person or organization for which non-contributory basis, this insurance is primary to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this as a named insured for such loss, and we will not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs: and "professional services". (2) The "personal injury" for which coverage is g. In the event that the Limits of Insurance of the sought arises out of an offense committed: Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance"h excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III - person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 0915 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 ©2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 0915 Includes the copyrighted material of Insurance Services Office, Inc., with its permission ANCHQEA-01 AGEORGE ACORO CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) `--� 101912023 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 o, 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 LICenSe # OC36861 NAMEACT Melanie Kelly Seattle-Alliant Insurance Services, Inc. PHONE FAX 401 Union Street, 31st Floor RECEIVED(Alc, No, Exq: (A/c, No): R Seattle, WA 98101 RECEIVED LAo RIEss; Melanie.Kelly@alliant.com Anchor QEA, LLC Cityof Bremerton INsuRER c :Travelers Property Casualty Company of America 25674 1201 3rd Ave., Suite 2600ement INSURER D: Lloyd's Syndicate 2623 Beazle Furlonge Limited) 00000 Seattle, WA 98101 Risk Manag 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, ILSR TYPE OF INSURANCE ADS L POICYEFF POLICY EXP POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 100001000 CLAIMS -MADE OCCUR All Other States X X 680-4R022572 10/10/2023 10/10/2024 DAEMAGETOEREoNTIEDn PRESX 1,000,000 MED EXP (Any one person) 100000 PERSONAL & ADV INJURY 10000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I '� I JECT � LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X OTHER: CA #680-011022246 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ccident)$ 11000,000 X ANY AUTO BA-0R118959 10/10/2023 10/10/2024 BODILY INJURY Per arson $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY Per accident BODILY [per a�Ident AMAGE $ p HT OS ONLY — AU 03 ON LY C X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 1,000,000 AGGREGATE 1,000,000 EXCESS LIAB CLAIMS -MADE CUP411044287 10/10/2023 10/10/2024 DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/ N (MandaR/MtoryEn NH) EXCLUDED? [ N / A UBR041906 � 10/10/2023 10/10/2024 X PER ST TUTE OTW ER E.L. EACH ACCIDENT $ 11000,000 _ E.L. DISEASE - EA EMPLOYE 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 D Prof/Pollution Liab W11053231401 10/10/2023 10/10/2024 Each Claim 51000,000 D Prof Liab/Ded $250k W11053231401 10/10/2023 10/10/2024 Aggregate 51000)000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insured status extended for General Liability as required by written contract and subject to policy terms and conditions for the city per forms attached. Coverage is provided on a primary and non-contributory basis where required by written contract and subject to policy terms and conditions, with respects to General Liability per forms attached. Waiver of Subrogation applies to General Liability where required by written contract and subject to policy terms and conditions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Bremerton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Risk Management 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 Policy Numbers: 6804R022572 & 6804R022246 Policy Term: 10=10-23 to 10-10-24 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY 1. The following is added to SECTION II -WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products - "written contract requiring insurance" to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or "personal injury": and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you, policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV - COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization: or The insurance provided to the additional insured d. For "bodily injury", "property damage" or is excess over any valid and collectible other "personal injury" for which such person or insurance, whether primary, excess, contingent or organization has assumed liability in a on any other basis, that is available to the additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part e. This insurance does not apply on any basis to must apply on a primary basis or a primary and non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically insured which covers that person or organizations is added by another endorsement to this as a named insured for such loss, and we will not Coverage Part. share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs: and "professional services". g. In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage issought arises out of an offense committed: Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance", excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III - person or organization is an additional insured Limits Of Insurance, under any other insurance. CG D3 81 0915 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 Of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission