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HomeMy WebLinkAbout1 - Original Submission_ Insurance Cert 2021 DBA (2)ACORD® CERTIFICATE OF LIABILI TY INSURANCE I DATE (MM/DDNYYY) � 08/18/2021 THIS CERTIFICATE IS ISSUED ASA 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 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 NAME: Thompson Agency LLC ��gNJo Extl: I if,� Nol: 1703 SE Sedgwick Rd Suite #103 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Port Orchard WA 98366 INSURER A: Mount Vernon Fire Insurance Co. 26522 INSURED INSURERS: Downtown Bremerton Association INSURERC: PO Box 245 INSURER □: INSURER E: Bremerton WA 98337 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 A A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY I CLAIMS-MADE [&] OCCUR --GEN'LAGGREGATE LIMIT APPLIES PER� □PRO POLICY JECT OTHER AUTOMOBILE LIABILITY -ANY AUTO -ALL 0\/\INED --AUTOS ,__HIRED AUTOS - UMBRELLA LIAS - DLoc SCHEDULED AUTOS NON-0\/\INED AUTOS EXCESS LIAS H OCCUR CLAIMS-MADE OED I I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE [illOFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Directors & Officers Liability INS□ WVD POLICY NUMBER riSM%1���1 I r��Tb%1���1 LIMITS EACH OCCURRENCE $ 1.000.000DAMAGE TO RENTED 100.000PREMISES (Ea occurrence) $ MED EXP (Anv one oersonl $ 5.000 y y NBP2552331A 06/30/2021 06/30/2022 PERSONAL &ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2.000.000 PRODUCTS - COMP/OP AGG $ 2.000.000$ (§,���b�d��t?'NGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ rp����c�Je�t9AMAGE $ $ EACH OCCURRENCE $ AGGREGATE $ $ I �f:rnTE I I OTH-ER N/A EL EACH ACCIDENT $ EL DISEASE EA EMPLOYEE $ EL DISEASE POLICY LIMIT $ y y NBP2552331A 06/30/2021 06/30/2022 $1.000.000 I $1.000.000 -D&O DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Bremerton is named as Additional Insured per form BP04 48 01 06. Primary & Non-Contributory applies per form BP172 1 O 13. Waiver of Subrogation applies per form BP0497 01 06. -1 O day notice for non-payment of premium** CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WI TH THE POLICY PROVISIONS. 345 6th Street Suite 100 AUTHORIZED REPRESENTATIVE Bremerton WA 98337 UlU. I © 1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Victor Thompson 360-602-6999 360-519-3350 vthompson1@farmersagent.com DocuSign Envelope ID: 4BE60B0E-569E-464D-8183-361026B76908