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Home My WebLink AboutHWA GEOSCIENCE 2023INSR ADDLSUBRLTRINSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Charter Oak Fire Insurance Company Travelers Property Cas. Co. of America Allied World Surplus Lines Insurance Co Travelers Indemnity Company of CT 12/06/2022 USI Insurance Services NW PR 601 Union Street, Suite 1000 Seattle, WA 98101 Please See Below 206 441-6300 610-362-8530 Seattle.PLCertRequest@usi.com HWA GeoSciences, Inc. 21312 30th Dr SE Bothell, WA 98021 25615 25674 24319 25682 A X X X X X 6802W3626492247 12/01/2022 12/01/2023 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 D X X X X X BA23626742247G 12/01/2022 12/01/2023 1,000,000 B X X X 10,000 X X CUP2W3627292247 (Follow Form) 12/01/2022 12/01/2023 5,000,000 5,000,000 A N X 6802W3626492247 (WA Stop Gap) 12/01/2022 12/01/2023 X 1,000,000 1,000,000 1,000,000 C Professional Liability Incl. Pollution X 03136265 12/01/2022 12/01/2023 $5,000,000 per claim $5,000,000 annl aggr. Full prior acts for 3m/3m limits. Excess Professional Liability limits of 2m/2m limits over primary professional liability policy - reto date 12/1/2020 through Navigators, Policy# CE21MPLZ07164IC. Project name: 2120 Phinney Bay Drive Geotechnical Site Investigation; Project No.: 2020-138-21 City of Bremerton is listed as additional insureds with primary non-contributory wording except with respect to professional liability and worker's compensation. 30-days notice of cancellation modification (See Attached Descriptions) City of Bremerton 345 6th Street Suite 100 Bremerton, WA 98337 1 of 2 #S38198219/M38186524 HWAGEOClient#: 1998559 DGSZP 1 of 2 #S38198219/M38186524 SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) applies to certificate holder. A blanket waiver of subrogation applies in favor of additional insureds for all policies, excluding professional and pollution. 2 of 2 #S38198219/M38186524