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HomeMy WebLinkAbout6085 - COI - Cummins Inc._1SHOULD 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 below If 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 OCCURRENCE DAMAGE 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 HIRED AUTOS ONLY 11/23/2021 Aon Risk Services Central Inc. 200 E Randolph St. Chicago, IL 60601 317-841-6004 North American Elite Insurance Company 29700 Old Republic Insurance Company 24147 Allianz Global Risks US Insurance Co 35300 A 5,000,000CPG0000001-00 12/1/2021 8/1/2022 5,000,000 3 10,000 3 5,000,000 5,000,000 5,000,000 B MWTB314312-21 12/1/2021 12/1/2022 2,000,000 3 3 3 Phy Damage Self Insured A CGU0000001-00 12/1/2021 8/1/2022 10,000,00033 10,000,000 B MWC 314311-21 12/1/2021 12/1/2022 3 2,000,000N 2,000,000 2,000,000 B Excess Auto Liability MWZX 315881-21 12/1/2021 12/1/2022 Limit $13,000,000 C Excess Liability USL01543421 12/1/2021 12/1/2022 Limit $10,000,000 Richard Trakimas A. I. King Insurance Agency, Inc. cummins@aikinginsurance.com 3 Cummins Inc. 500 Jackson Street Mail Code 91676 Columbus IN 47201-6258 65159343 3 3 3 right-of-way where required by written contract. Should any of the above described policies be cancelled before the expiration date thereof, Thirty The City of Bremerton 345 6th St, Suite 100 Bremerton WA 98337 The City of Bremerton is named an additional insured with respect to work in the (30) day notice of cancellation will be delivered in accordance with the policy provisions. 65159343 | 21/22 GL AU UMB WC (Custom Merged) | Donna Howard | 11/23/2021 8:15:35 PM (EST) | Page 1 of 6 This certificate cancels and supersedes ALL previously issued certificates. Cummins Inc. 500 Jackson St. Columbus, IN 47201 Cummins Inc. 500 Jackson St. Columbus, IN 47201 11/19/2021 To Whom It May Concern, This is communication regarding the issuance of the Cummins Inc. Liability Certificates of Insurance effective 12/1/2021. Cummins Inc.’s insurance coverage remains unchanged for the 12/1/2021 insurance policies although you will note on the COI’s that the General Liability and Umbrella policies state a policy term from 12/1/2021 thru 8/1/2022. This is to align the GL and Umbrella policies to the same date as Cummins’ property coverage to fit our Company’s Risk Insurance strategy work. Both GL and Umbrella programs will be renewed again effective 8/1/2022, in which new COI’s will be reissued in advance of the 8/1/2022 effective date to evidence the new insurance programs, and to satisfy COI and contractual requirements with the same or similar insurance coverage terms & conditions. Hopefully this email provides clarification as to why the GL and Umbrella policies are not written as a 12-month term policy for this 12/1 renewal. Although rest assured that both insurance programs will be renewed effective 8/1/2022 with a new 12-month term at that time, with the same or similar coverage to comply with COI’s and contractual obligations. Sincerely, Seve South Global Risk Manager 65159343 | 21/22 GL AU UMB WC (Custom Merged) | Donna Howard | 11/23/2021 8:15:35 PM (EST) | Page 2 of 6 This certificate cancels and supersedes ALL previously issued certificates. CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY #CGP0000001-00 Cummins Inc. 12/01/2021 - 08/01/2022 Cummins Inc. Policy No. CGP0000001-00 12.1.2021 – 8.1.2022 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional in- sured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the in- surance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to pro- vide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Name Of Additional Insured Person(s) Or Organization(s): All persons or organizations as required by contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 65159343 | 21/22 GL AU UMB WC (Custom Merged) | Donna Howard | 11/23/2021 8:15:35 PM (EST) | Page 3 of 6 This certificate cancels and supersedes ALL previously issued certificates. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY #CGP0000001-00 Cummins Inc. 12/01/2021 - 08/01/2022 Policy No. CGP0000001-00 12.1.2021 – 8.1.2022 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQ- UOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Con- dition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek con- tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be pri- mary and would not seek contribution from any other insurance available to the addi- tional insured. 65159343 | 21/22 GL AU UMB WC (Custom Merged) | Donna Howard | 11/23/2021 8:15:35 PM (EST) | Page 4 of 6 This certificate cancels and supersedes ALL previously issued certificates. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY #CGP0000001-00 Cummins Inc. 12/01/2021 - 08/01/2022 Cummins Inc. Policy No. CGP0000001-00 12.1.2021 – 8.1.2022 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQ- UOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLU- TION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PROD- UCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAIL- ROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion IV – Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above be- cause of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organi- zation(s) shown in the Schedule above. Name Of Person(s) Or Organization(s): All persons or organizations as required by written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 65159343 | 21/22 GL AU UMB WC (Custom Merged) | Donna Howard | 11/23/2021 8:15:35 PM (EST) | Page 5 of 6 This certificate cancels and supersedes ALL previously issued certificates. WC 00 03 13 (Ed. 4-84)  1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) POLICY NUMBER: MWC 314311 21 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN CONTRACT. NOT APPLICABLE IN CA, TX AND UT DATE OF ISSUE: 10/15/21 65159343 | 21/22 GL AU UMB WC (Custom Merged) | Donna Howard | 11/23/2021 8:15:35 PM (EST) | Page 6 of 6 This certificate cancels and supersedes ALL previously issued certificates.