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Home My WebLink About6085 - COI - Cummins Inc._2SHOULD 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 11/18/2022 Aon Risk Services Central Inc. 200 E Randolph St. Chicago, IL 60601 317-841-6004 Swiss Re Corp Solutions Elite Ins Corp 29700 Old Republic Insurance Company 24147 North American Elite Ins Co/Swiss Re Corp Solution 29700 Allianz Global Risks US Insurance Co 35300 A 5,000,000CGP0000001-02 8/1/2022 8/1/2023 5,000,000 3 10,000 3 5,000,000 5,000,000 5,000,000 B MWTB 317015 22 8/1/2022 8/1/2023 2,000,000 3 C CGU0000001-02 8/1/2022 8/1/2023 10,000,00033 10,000,000 B MWC 314311-22 12/1/2022 8/1/2023 3 2,000,000N 2,000,000 2,000,000 B Excess Auto Liability MWZX 317016 22 8/1/2022 8/1/2023 Limit $13,000,000 D Excess Liability USL02306022 8/1/2022 8/1/2023 Limit $10,000,000 B Excess Workers' Comp/Employer's Liab MWNEX 308568 12/1/2022 8/1/2023 WC: STATUTORY / EL: 1,000,000 - NY Al King A. I. King Insurance Agency, Inc. cummins@aikinginsurance.com AOS 3 B Excess Workers' Comp/Employer's Liab MWNEX 308569 12/1/2022 8/1/2023 WC: STATUTORY / EL: 1,000,000 - WI Cummins Inc. 500 Jackson Street Mail Code 91676 Columbus IN 47201-6258 71343301 3 3 City of Bremerton Waste Water Treatment Plant 345 6th Street, Suite 100 Bremerton WA 98337 See addendum for additional insured verbiage. 3 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 1 of 7 This certificate cancels and supersedes ALL previously issued certificates. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: The City of Bremerton is listed Additional insured on the Commercial General Liability insurance policy and Cummins’ insurance shall be primary and non-contributory insurance as respects the City as per written contract. A Waiver of subrogation is in favor of the Additional Insured where required by written contract. Aon Risk Services Central Inc.Cummins Inc. 500 Jackson Street Mail Code 91676 Columbus IN 47201-6258 25 Certificate of Liability (03/16) ADDENDUM HOLDER: ADDRESS: City of Bremerton Waste Water Treatment Plant 345 6th Street, Suite 100 Bremerton WA 98337 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 2 of 7 This certificate cancels and supersedes ALL previously issued certificates. Cummins Inc. CGP0000001-02 08/01/2022 08/01/2023 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 3 of 7 This certificate cancels and supersedes ALL previously issued certificates. Cummins Inc. CGP0000001-02 08/01/2022 08/01/2023 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 4 of 7 This certificate cancels and supersedes ALL previously issued certificates. Cummins Inc. CGP0000001-02 08/01/2022 08/01/2023 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 5 of 7 This certificate cancels and supersedes ALL previously issued certificates. Cummins Inc. CGP0000001-02 08/01/2022 08/01/2023 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 6 of 7 This certificate cancels and supersedes ALL previously issued certificates. Cummins Inc. CGP0000001-02 08/01/2022 08/01/2023 71343301 | 22-8/1/23 GL AU UMB WC (Custom Merged) | Shelly Pence | 11/18/2022 8:11:51 PM (EST) | Page 7 of 7 This certificate cancels and supersedes ALL previously issued certificates.