Loading...
HomeMy WebLinkAboutHasa Inc._City of Bremerton_21101122319217Holder Identifier : 7777777707070700077763616065553330762707447315446607443036662517300072651566057221130763514013167111207162011372630112075266335320363300776605151245471207724055730276552077727252025773110777777707000707007 6666666606060600062606466204446200600222606004222206220026042260020062002240422620020622220424006022006000006042262002062020062600420000622222426024002206022226242200622066646062240664440666666606000606006Certificate No :570089872465CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/13/2021 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). 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. PRODUCER Aon Risk Services Northeast, Inc. Stamford CT Office 1600 Summer Street Stamford CT 06907-4907 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 19410Commerce & Industry Ins CoINSURER A: 26883AIG Specialty Insurance CompanyINSURER B: 27847Insurance Company of the WestINSURER C: INSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: Hasa, Inc. 23119 Drayton StreetSaugus CA 91350 USA COVERAGES CERTIFICATE NUMBER:570089872465 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $1,000,000 $300,000 $25,000 $1,000,000 $2,000,000 $2,000,000 $1,000,000Pollution Liability B 05/08/2021 05/08/2022EG18260038 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $1,000,000A05/08/2021 05/08/2022 COMBINED SINGLE LIMIT (Ea accident) CA 7673934 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $10,000,000 $10,000,000 05/08/2021UMBRELLA LIABB 05/08/2022EGU18260039 RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH-ERPER STATUTEC05/08/2021 05/08/2022 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 WNJ503367005 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 in accordance with the policy provisions of the General Liability policy. General Liability and Automobile Liability policies evidenced herein are Primary and Non-Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Bremerton 345 6th Street, Suite 100 Bremerton WA 98337 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS - YOUR WORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY ANDPOLLUTION LEGAL LIABILITY POLICY SCHEDULE Name of Additional Insured Person(s) or Organization(s): Location(s) of Covered Operation(s): All other terms, conditions and exclusions shall remain the same. PAGE 1 OF 1103393 (10/09)CI4406 ENDORSEMENT NO. This endorsement, effective 12:01 AM, Forms a part of Policy No: Issued to: By: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTHORIZED REPRESENTATIVEor countersignature (in states where applicable) I.Solely as respects COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY, COVERAGE E-2 PRODUCTS POLLUTION AND EXPOSURE LIABILITY, and COVERAGE E-3 - CONTRACTORS POLLUTION LIABILITY, SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage or emergency response costs caused, in whole or in part, by: A.Your acts or omissions; or B.The acts or omissions of those acting on your behalf; in the performance of your work for the additional insured(s) at the location(s) designated above. II.As respects the coverage afforded the additional insured(s) scheduled above, this insurance is primary and non-contributory, and our obligations are not affected by any other insurance carried by such additional insured(s) whether primary, excess, contingent, or on any other basis. 12 0D\ EG 18260038 HASA, INC. AIG SPECIALTY INSURANCE COMPANY BLANKET WHERE REQUIRED BY WRITTEN CONTRACT PRIOR TO LOSS OR CLAIM BLANKET WHERE REQUIRED BY WRITTEN CONTRACT PRIOR TO LOSS OR CLAIM Archive Copy WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. All other terms, conditions, and exclusions shall remain the same. 94283 (3/07)CI3021 PAGE 1 OF 1 ENDORSEMENT NO. This endorsement, effective 12:01 AM, Forms a part of Policy No: Issued to: By: AUTHORIZED REPRESENTATIVEor countersignature (in states where applicable) It is hereby agreed as follows: SECTION IV - CONDITIONS, Paragraph 7. Transfer of Rights of Recovery Against Others to Us - Applicable to Coverages A, B, C and E is amended by the addition of the following at the end of such subparagraph: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make under Coverage A, B, C and E for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule below. BLANKET WHERE REQUIRED BY WRITTEN CONTRACT PRIOR TO CLAIM OR LOSS 5/8/2 EG18260038 Hasa, Inc. AIG Specialty Insurance Company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his endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement No. Premium $ Insurance Company Countersigned By INSURANCE COMPANY OF THE WEST INCL. WC 99 06 34 (Ed. 8-00) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be otherwise due. Schedule Person or Organization Job Description Included % of the total California Workers’ Compensation premium ANY PERSON OR ORGANIZATION FOR ALL OPERATIONS WHOM THIS WAIVER IS REQUIRED. Insured HASA INC Endorsement Effective05/08/202 Policy No.8/+