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HomeMy WebLinkAboutcert_ATL_THE CITY OF BREMERTON_5274262_13SHOULD 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 THISCERTIFICATE 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 belowIf 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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY B 1,000,000 10/01/2024 RM3GL00010-231 RM3WC00007-231 (MA, WI) 20,000,000 ATL-005274262-13 1,000,000 10,000,000 RM3WC00008-231 (FL, ME, NJ) X 20699 10,000,000 N 10/01/2023 X SIR $250,000 10/01/2023 N/A 4 10/01/2024 01/01/2023 A 37540 10/01/2024 RM3CA00012-231 (AOS) Crime C 4,000,000 2,000,000 16045 ACE Property & Casualty Insurance Company 1,000,000 X D X 09/28/2023 10/01/2023 5,000,000 10/01/2023 RE: LOT 25-090-100, CITY OF BREMERTON PARKING ENFORCEMENT CITY OF BREMERTON IS INCLUDED AS ADDITIONAL INSURED (EXCEPT WORKERS’ COMPENSATION) WHERE REQUIRED BY WRITTEN CONTRACT. THIS INSURANCE IS PRIMARY AND NON- X 10/01/2023 GEN AGG PER LOC BREMERTON, WA 98337 THE CITY OF BREMERTON Beazley Insurance Company, Inc. 25,000 CONTRIBUTORY OVER ANY EXISTING INSURANCE AND LIMITED TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED SUBJECT TO POLICY TERMS AND CONDITIONS. X A A Everest Premier Insurance Company CN129383541-Globa-GAWU-23-24 Limit N/A 10/01/2024 2,000,000 XEUG72543117003 10/01/2024 A RM3CA00011-231 (MA) 4,000,000 10120 1,000,000 1,000,000 01/01/2024 RM3WC00009-231 AOS) 3031 N. Rocky Point Drive West, Suite 700 MARSH USA, LLC. X Tampa, FL 33607 1001 Brickell Bay Drive, Suite 2310 Imperial Parking (U.S.), LLC Miami, FL 33131 X X V1FFC1230601 10/01/2023 345 6TH STREET, SUITE 600 10/01/2023 A . 10/01/2024 N/A 10/01/2024 Everest National Insurance Co 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: GKLL Limit - $1,000,000 per location on an excess basis� 22 Auto Physical Damage and Garagekeepers (MA) -� � Tampa GKLL Limit - $1,000,000 per location on an excess basis� APD# - RM3CA00010-231 GKLL# - RM3CA00022-231� � APD - $50,000 deductible per unit GKLL - $150,000 SIR per unit� Auto Physical Damage and Garagekeepers (AOS) -� �� 10/01/2023 - 10/01/2024� Everest Indemnity Insurance Company� Certificate of Liability Insurance CN129383541 Everest Indemnity Insurance Company� APD# - RM3CA00009-231 GKLL# - RM3CA00023-231� APD - $50,000 deductible per unit GKLL - $150,000 SIR per unit� MARSH USA, LLC.� 1001 Brickell Bay Drive, Suite 2310� Imperial Parking (U.S.), LLC� Miami, FL 33131 25 10/01/2023 - 10/01/2024�