HomeMy WebLinkAboutCOI-City of BremertonPacific Northwest Marine Company dba
Freedom Boat Club Tacoma
821 Dock Street #208
Tacoma, WA 98402
INSR
LTR
ADD'L
INSRD TYPE OF INSURANCE POLICY #
POLICY EXP
DATE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
GEN’L AGGREGATE LIMIT APPLIES PER:
POLICY [ ] PROJECT [ ] LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Each Occurrence)
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON‐OWNED AUTOS
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE
OCCUR CLAIMS MADE Excess MGL
A
DEDUCTIBLE
RETENTION $
OTH‐
ER
WORKERS COMPENSATION AND
EMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
345 Sixth St., Suite 100
Bremerton, WA 98337
AUTHORIZED REPRESENTATIVE
This document is issued as a matter of information only and confers no rights upon the document holder. This document does not amend, extend, or alter the coverage,
terms, exclusions, conditions, or other provisions afforded by the policies referenced herein.
DESCRIPTION OF OPERATIONS / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL
ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
City of Bremerton
As required by written contract, the City of Bremerton is named as an Additional Insured on a primary and non‐contributory basis with a Waiver of
Subrogation under the above referenced policy for space the Insured is leasing at 140 Washington Ave, Bremerton, WA 98337.
WC STATU‐
TORY LIMITS
E.L. EACH ACCIDENT
E.L. DISEASE ‐ EA EMPLOYEE
E.L. DISEASE ‐ POLICY LIMIT
1/0/1900 1/0/1900
AGGREGATE
$
$
$
0
$
BODILY INJURY $(Per person)
BODILY INJURY $(Per accident)
PROPERTY DAMAGE $(Per accident)
A N16854062
GENERAL AGGREGATE $2,000,000
PRODUCTS ‐ COMP/OP AGG $1,000,000
1/1/2020 1/1/2021
EACH OCCURENCE $2,000,000
DAMAGE TO RENTED $1,000,000PREMISES (Ea occurrence)
MED EXP (Any one person)$10,000
PERSONAL & ADV INJURY $1,000,000
INSURED INSURER A: Federal Insurance Company 20281
INSURER B:
DATE
CERTIFICATE OF LIABILITY INSURANCE 1/1/2020
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
TCA, Inc.
10188 Big Canoe
Jasper, GA 30143
INSURERS AFFORDING COVERAGE NAIC #
INSURER C:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFF
DATE LIMITS