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HomeMy WebLinkAboutInsurance update for Petrocard 5697Client#: 574333 BRISTBAY10 ACORD-, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/05/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Jamie ESquivel Marsh & McLennan Agency LLC PHONE - 907-276-5677 FAX ()UC, No, E4: INC, No): 1031 W 4th Avenue A oRl Suite 400 ess: Jamie.esquivel@marshmc.com INSURER(S) AFFORDING COVERAGE _ NAIC # Anchorage, AK 99501 INSURERA: Evanston Insurance Company 35378 INSURED INSURER B : Navigators Specialty Insurance Company 36056 PetroCardI Inc. — — 730 S Central Avenue Kent, WA 98032-0000 INSURER C : American Zurich Insurance Company 40142 INSURER D : Zurich American Insurance Company 16535 INSURER E : INSURER F : COVERAGES CFRTIFICOTF NIIMRFR• I'll 21.92 C:6FW Dcvrcinui ui merscD. 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 LTR TYPEOFINSURANCE ADDLSIJBF INSR,WVD POLICY NUMBER POLICY EFF I POLICY EXP JMMIDDNYYY).(MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR MKLV5ENV102958 04/01/2021 04/01/2022 EACH OCCURRENCE PREMISES Esoccurrrence $1 000,000 $3000OO MED EXP (Any one person) $1 O 000 PERSONAL & ADV INJURY GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY FX1 JECT _ LOC $2,000,000 PRODUCTS -COMP/OPAGG $2,000,000 $ _ OTHER: D AUTOMOBILE LIABILITY BAP927545020 4/01/2021 04/01/2022 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ is B UMBRELLA LIAB X OCCUR SF21 EXC7251671C 1410112021 0411112022., EACH OCCURRENCE $5 000 000 X EXCESS LIAB_ CLAIMS -MADE AGGREGATE $5 000 000 DED RETENTION $ N/A I WC588844816 04/01/2021 04/01/202 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? X IPER IOTH- I UIML E.L. EACH ACCIDENT $1 OOO,OOO (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ E.L. DISEASE - EA EMPLOYEE $1 000 000 E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Evidence of Insurance. Subject to said policy limits, terms, and exclusions. Where required by written contract, Certificate Holder is an Additional Insured on the General Liability and Auto Liability policies, subject to the terms, conditions and limitations of said policies and the additional insured endorsement. Where required by written contract, Waiver of Subrogation in favor of Certificate Holder applies to referenced policies subject to the terms, conditions and limitations of said policies and the Waiver of Subrogation endorsement. V CRrIr'II�AIC r1VLL/CR GANGtLLA 1 IVN City of Bremerton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Financial Services ACCORDANCE WITH THE POLICY PROVISIONS. 345 Sixth Street Suite 600 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337-1873 twit 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S8174375/M8143112 WAZAW ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED Marsh & McLennan Agency LLC PetroCard, Inc. CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance This is evidence of insurance procured and developed under the Alaska Surplus Lines Law, AS 21.34. It is not covered by the Alaska Insurance Guaranty Association Act, AS 21.80. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD