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HomeMy WebLinkAbout6234 - Art Anderson Associates - COI - 2022ARTAND1 OP D: RB CERTIFICATE OF LIABILITY INSURANCE DATE 12/21/20041Y) 12/21/2021 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 endorsements . PRODUCER 360-7794448 CONTACT Rhonda Ausbun Ed ren Hecker & Lemmon Ins Inc NAME: P.O Box 986 (A/C,Nr o, Ext): 360-779-4448 (AA/C, No):360-697-4598 Poulsbo, WA 98370 E-MAIL rausbun@ehlinsurance.com Benjamin Rogers ADDRESS: INSURERS AFFORDING COVERAGE NAIC 4 INSURER A: General Casualty Co of WI 24414 INSURED INSURER B : Regent Insurance Co 24449 Art Anderson Associates Ben Anderson INSURER C:Alaska National Ins Co 38733 Bremerrtloin, WA98337200 Admiral Insurance Com INSURER D : pan Y INSURER E:BeaZley Insurance Company Inc. INSURER F : COVERAGES CERTIFICATE Nl)MRFRE RPvICIn AI NIIMRFR• 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 LTRTYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR X X BBP0014847 12/26/2021 12/26/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTEDence PREMMED $ 50,000 EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC LOC GENERAL AGGREGATE $ 21000,000 PRODUCTS -COMP/OP AGG $ 2'000'ODt) OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 00� ��� $ X ANY AUTO OWNED SCHEDULED BCA0005390 12/26/2021 12/26/2022 BODILY INJURY Per person)$ 1 AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident)$ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LABCLAIMS-MADE BUM0007388 12/26/2021 12/26/2022 DED I RETENTION $ C A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 21G WU 09082 USL&H BBP0014847 WA STOP GAP 07/30/2021 12/26/2021 07/30/2022 12/26/2022 PER STATUTE X OTH- ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,00� QOB $ D Professional Liab E0000018730.101 12/26/2021 12/26/2022 Prof Liab 2,000,000 E Cyber Liability V264AE210301 12/26/2021 12/26/2022 CyberLiab 10000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Bremerton is additional insured per attached AHBP8084. Waiver of RECEIVED subrogation applies per BP0497. RE: Project #4556; BPD Practice Range Classroom DEC 2 9 2021 Cky at 8 *WMrWn akv A t y's Offict CERTIFICATE HOLDER rAN('.FI I A - ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS AH BP 80 8410 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I MMILLUEV- R l This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM Paragraph C. Who is an insured in Section II — Jability A. Is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional in- sured only with respect to liability for "bodily injury', "property damage" or "personal and advertising in- jury" caused, in whole or in part, by your acts or omissions or the acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned or rented to you. B. The limits of insurance applicable to the additional Insured are those specified in the Declarations of this Policy or in the written contract, whichever is lower. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. C. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether that in- surance is primary, excess, contingent or on any other basis, unless you and the additional insured have specifically agreed in a written contract or written agreement that this insurance be primary. When coverage is provided on a primary basis we will not seek contribution from any other insurance available to the additional insured if a written con- tract or written agreement requires that this insur- ance be noncontributory. D. All other terms and conditions of this policy remain unchanged. Includes copyrighted material of Insurance Services Office, Inc., AH BP 80 8410 17 with its permission. Page 1 of 1 POLICY NUMBER: B0170014847-00 BUSINESSOWNERS BP 04 97 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Person Or Organization: As required by written contract 830 Pacific Ave Bremerton, WA 98337 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section 111 — Common Policy Conditions is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make 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 above. BP 04 97 01 06 ©ISO Properties, Inc., 2004 Page 1 of 2 ❑