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HomeMy WebLinkAbout6343 - COI - Professional Service IndustriesPage 1 of 2 ATE Ace CERTIFICATE OF LIABILITY INSURANCE 009/30r/2022Y) 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(les) 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O, Box 305191 Nashville, TN 372305191 USA INSURED Professional Service 3011 S. Huson Street, Tacoma, WA 98409 COVERAGES Industries , Inp Suite A RECEIVED IN City of Bremerton City Attorney's Office CERTIFICATE NUMBER: Wz6199139 Willie Towers Watson Certificate Center 1-877-945-7378 certificates@willis.com 1-886-467-2378 IN REVISION NUMBER: 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. ILTR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER MMIDD/YYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILIYY CLAIMS -MADE %� OCCUR � EACHOCCURRENCE Is 1,0000000 DAMAGE TORE PREMISES occurrence) . $ 100, 000 A MED EXP (Any one person) $ 20,000 PERSONAL& ADV INJURY $ 11000,000 GLO 5415693-09 110/01/2022 10/01/2023 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000, 000 POLICY PRO• f I JECT LOG u PRODUCTS, COMP/OP AGG $ 2,000r()00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000, 000 X ANY AUTO $ BODILY INJURY (Per person) A OWNED AUTOS ONLY SCHEDULED AUTOS BAP 7296414-02 10/01/2022 10/01/2023 X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per aocide-nl), $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,0000000 EXCESS LIAB CLAIMS -MADE AUC5415694-09 10/01/2022 10/01/2023 AGGREGATE $ 11000,000 DED %� RETENTION$ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOFUPARTNER/EXECUTIVE Y / N OFFICERiMEMBEREXCLUOEI No (Mandatory in NH) NIA WC 7296412-02 (AOS) 10/01/2022 10/01/2023 x STATUTE ERH E.L. EACH ACCIDENT - --- - -- - - - E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000 $ 1,000,000 II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ $ 1, OOtl, 000 A Workers compensation a WC 7296413-02 (NA/WI) 10/01/2022 10/01/2023 EL Each Accident $11000,00o Employers Liability EL Disease - EA Empl.$1,000,000 Per Statute EL Disease - Pol Lmt.$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) See next page for additional information: SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULUM NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton AUTHORIZED REPRESENTATIVE 345 6th Street, Suite 100 Bremerton, WA 98337-1891 ", I\, ,,,\ © 19E38.2016 ACORD CORPORATION, All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sn ID: 23136485 BATCH: 2687771 2 of 2 6671 A � � 111i, MaNiVl AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Professional Service Industries, Inc. Soli S. Huson Street, Suite A Tacoma, WA 98409 POLICY NUMBER See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 err • � � �; ,�N � NUMBER:FORM _ of Liability insuranck� Named Insured Includes: Testing Holdings USA Inc. Professional Service Industries, Inc. dba Intertek-PSI aka PSI Professional Service Industries Holdings, Inc. Professional Service Industries Engineerings, PLLC Pittsburgh Testing Laboratory, Inc. PSI Acquisitions, Inc. Midwest Engineering Services, Inc. Wilson Inspection X-Ray Services, Inc. Clean Energy Associates LLC RE: Construction Materials Testing and Special Inspection Services Kitsap Way (SR310) and Warren Avenue/Wheaton Way (SR303) Bremerton, Washington / PSI Proposal Number o792-351929 City of Bremerton is included as additional insured (except as respects all coverage afforded by the Workers' Compensation and Professional Liability pelicies) as required by written contract. The General Liability coverage applies as primary and non-contributory where required by written contract. Umbrella Liability is Follow Form of General Liability, Automobile Liability and Employers Liability subject to policy terms, conditions and exclusions. INSURER AFL'ORDING COVERAGE; Steadfast Insurance Company POLLCY NUMBER: E00O206920-07 EFF DATE: 09/30/2022 TYPE OF INSURANCE: Professional Liability LIMIT DESCRIPTION: Each Claim/Aggregate SIR EXP DATE: 09/30/2023 LIMIT AMOUNT: $1,000,000 $1,000,000 NAZC�: 26387 ACORD 'IOi (2008I01) © 2008 ACORD CORPORATION. All rights reserved. The ACOR® name and logo are regis4ered marks of ACORD SR ID: 23136485 BATCH: 2687771 CERT: W26199139