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HomeMy WebLinkAbout6359 - Petrocard Inc.Client#: 574333 BRISTBAY10 ACORDPA CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 3/31 /2022 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 Marsh & McLennan Agency LLC 1031 W 4th Avenue Suite 400 Anchorage, AK 99501 INSURED PetroCard, Inc. r30 S Central Avenue Kent, WA 980324000 COVERAGES H n 202 7_ City of Bremerton Risk Management NAMEA�� Jamie Esquivel �C NNo, Eat): 907-276-5617 FAX No): nDDRESS: jamie.esquivel@marshmma.com INSURERS) AFFORDING COVERAGE INsuRERA: Evanston Insurance Company INSURER B : Navigators Specialty Insurance Compar INsuRER C : American Zurich Insurance Company INsuRER D : Zurich American Insurance Company INSURER E ('.FRTIFIC:GTF NIIMRFR• 77_74 r,AF1A/.�.D.,1/Dr.,F 35378 36056 40142 16535 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 CONTRACTOR 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, LTR TYPE OF INSURANCE ADDL SUBR LIEFF POCY POLICY EXP INSR WVD POLICY NUMBER MMIDD/YYYY) (MM/DD/YYYY) LIMITS A D X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MKLV5ENV103524 BAP927545021 04/01/2022 04/01/2023 EACH OCCURRENCE $190001000 PRMMISETo aoccurrDence $300,000 MED EXP (Anyone person) $10,000 PERSONAL BADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- n POLICY FX JECTI LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 04/01/2022 04/01/2023 COMBINED tSINGLE LIMIT $1,0001000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ B C _ A ELLA LIAB S LIAB :E:S X OCCUR CLAIMS -MADE N/A LA22EXC7251671C WC588844817 � MKLV5ENV103539 04/01/2022 04/01/2022 04/01/2022 04/01/2023 � 04/01/2023 04/01/2023 EACH OCCURRENCE $5,000,000 X AGGREGATE $5,000,000 DED RETENTION $ AND EMPS YERS' LSA IONILIT AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Pollution Professional X STR UTE OTH- $ E.L. EACH ACCIDENT $1 ,000,000 E.L. DISEASE- EAEMPLOYEE1 $1 000,000 E.L. DISEASE - POLICY LIMIT $15000,000 _ Per Claim: $5,000,000 Aggregate: $5,000,000 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 (See Attached Descriptions) City of Bremerton Financial Services 345 Sixth Street Suite 600 TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Bremerton, WA 98337-1873 ©1988-2015 ACORD CORPORATION. uhts reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S10628037/M10628016 WAZAW DESCRIPTIONS (Continued from Page 1) Subrogation endorsement. It is further agreed that, where required by written contract, the General Liability and Auto Liability insurance as is afforded the Certificate Holder shall be primary and non contributory with any other insurance in force for or which may be purchased by the Certificate Holder. .]MVI I IM LJ.J �GV 1 V/VJ� L VT � #S10628037/M10628016 G AGENCY ADDITIONAL REMARKS SCHEDULE Marsh & McLennan Agency LLC CARRIER NAIC CODE NAMED INSURED PetroCard, Inc. EFFECTIVE DATE: Page 2 of ? ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD