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Home My WebLink About3 - Legal Review Submission_ Submittal 1-07 Contractor Performance Bond Certificate of InsuranceCITY OF BREMERTON SUBMITTAL FORM Submittal No.:1-07 Date:7/9/2021 Project:Marine Drive Watermain Replacement Resubmittal (Y/N): Contractor:Pape and Sons Construction Project No.20102 Previous Submittal No.-- To Be Completed by the Contractor To Be Completed by the City Specification No Make Amend Item P/C Para / Dwg Copies Exceptions Corrections and Rejected No.(*)Reference Description of Item Sub'm Taken Noted Resubmit Resubmit A9-A12 Performance Bond and Payment Bond Certificate of Insurance (*)P - Partial Submittal, C - Complete Submittal Contractor, initial by either (a) or (b), to certify the following: (a)We have verified that the material or equipment contained in this submittal meets all requirements specified or shown PS (no exceptions) (b)We have verified that the material or equipment contained in this submittal meets all requirements specified or shown, except for the following deviations (list deviations): Contractors Authorized Representative Phillip Sagen Review Remarks: Corrections or comments made relative to submittals during this review do not relieve the contractor from Very truly yours, compliance with the requirements of the drawings and specifications. This check is only for review of City of Bremerton general conformance with the design concept of the project and general compliance with the information Dept. of Public Works and Utilities given in the contract documents. The contractor is responsible for confirming and correlating all quantities and dimensions; selecting fabrication processes and techniques of construction; coordinating his work with that of other trades, and performing his work in a safe and satisfactory manner.Project Engineer DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 Bond No. 2321652 Pape & Sons Construction, Inc. North American Specialty Insurance Company $2,018,002.35 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 Pape & Sons Construction, Inc. North American Specialty Insurance Company Joanne Reinkensmeyer,Attorney-in-Fact 450 Alaskan Way South, Suite 200 Seattle, WA 98104 Swiss Re Corporate Hentschell & Associates, Inc. 1436 S. Union Ave. Tacoma, WA 98405 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 Bond No. 2321652 Pape & Sons Construction, Inc. North American Specialty Insurance Company $2,018,002.35 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 Pape & Sons Construction, Inc. North American Specialty Insurance Company Joanne Reinkensmeyer,Attorney-in-Fact Swiss Re Corporate 450 Alaskan Way South, Suite 200 Seattle, WA 98104 Hentschell & Associates, Inc. 1436 S. Union Ave. Tacoma, WA 98405 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 07/08/2021 HENTSCHELL & ASSOC INC 1436 S. Union Ave. Tacoma WA 98405-1925 Danielle Bryant (253) 272-1151 (253) 272-1225 danielleb@hentschell.com Pape & Sons Construction, Inc. 9401 Bujacich Road Suite 1A Gig Harbor WA 98332 Phoenix Insurance Company 25623 The Travelers Indemnity Co.25658 Travelers Prop Cas Co of Amer 25674 20/21 A Y Y DTCO0J154095PHX20 12/31/2020 12/31/2021 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 WA Stopgap/Empl Liab 1,000,000 B Y Y BA1L6589552026G 12/31/2020 12/31/2021 1,000,000 Incl. Hired&Non-Owned 1,000,000 C 10,000 Y Y CUP0J4039462026 12/31/2020 12/31/2021 5,000,000 5,000,000 WASHINGTON STATE FUND A Installation Floater DTCO0J154095PHX20 12/31/2020 12/31/2021 90,000 Limit 1,000, Deductible Project: Bremerton Marine Dr. Water Main Replacement Blanket Primary Non-Contributory Additional Insured, including completed operations and Blanket Waiver of Subrogation applies in favor of any person ororganization if called for by written contract or agreement, per policy forms and conditions; #CGD246 08/05, CGD316 11/11, CGD211 01/04, CAT353 02/15 - City of Bremerton, its officials, employees, agents and volunteers are all included as additional insured City of Bremerton 345 - 6th Street Suite 100 Bremerton WA 98337 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997 DocuSign Envelope ID: B89BF1F5-26D2-43D1-9B65-F807B281C997