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HomeMy WebLinkAbout6256 - Pape & Sons Construction_COIco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12I09I2021 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER HENTSCHELL &ASSOC INC 1436 S. Union Ave. Tacoma INSURED Pape &Sons Construction, Inc. 9401 Bujacich Road Suite 1A Gig Harbor rnvoonncc I�ECEI V MLJ City of Bremerton Risk Management WA 98332 FRTIPIr,CTF NI IMRFR• 21-22 U"" NAME: Danielle Bryant E: (253) 272-1151 s: danielleb@hentschell.com INSURERS) AFFORDING COVERAGE INsuRERA: The Charter Oak Fire Ins. Co INsuRER B : The Travelers Indemnity Co. of America INsuRER C : Travelers Prop Cas Cc of America INSURER D INSURER E : INSURER F : REVISION NUMBER: (253) 272-1225 NAIC # 25623 25658 25674 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEIJ ISSUED TO THE IIJSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTAN DING 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 LTR TYPE OF INSURANCE ADDLISUBIR INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y Y DTCOOJ 1 54095COF21 12/31/2021 12/31/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 3001000 $ MED EXP (Any one person) $ 101000 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑X PRO- ECT LOC OTHER. PRODUCTS - COMP/OPAGG $ 21000,000 WA StopGap/Empl Liab $ 11000,000 B AUTOMOBILE LIABILITY X ANYAUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY Y Y BA1 L6589552126G 12/31/2021 12/31/2022 COMBINED SINGLE LIMIT Ea accident $ 110003000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE Y Y CUPOJ4039462126 12/31/2021 12/31/2022 EACH OCCURRENCE $ 510003000 AGGREGATE $ 5,0001000 $ DED X RETENTION $ 101000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WASHINGTON STATE FUND 12/31/2021 12/31/2022 X STATUTE H ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C INSTALLATION FLOATER 630-9S118521-TIL-21 12/31/2021 12/31/2022 1,000,000 LIMIT- EACH 100,000 LIMIT - IN 100,000 LIMIT -TEMP. JOB SITE LOC. TRANSIT LOCATION DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 or organization if called for by written contract or agreement, per policy forms and conditions; #CGD316 02/19, CGD246 04/19, CGD211 01104, CGT100 0/193 CAT353 02/15- City of Bremerton, its officials, employees, agents and volunteers are all included as additional insured 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 WITH THE POLICY PROVISIONS. 345 - 6th Street AUTHORIZED REPRESENTATIVE Suite 100 Bremerton WA 98337 > ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD