Loading...
HomeMy WebLinkAbout5374 - COI - Public Utility District No. 1 - 2024CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/13/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRooucER Pacific Underwriters Corp. 12611 Des Moines Seattle, WA 98168 Memorial Drive RECEIVED Richard Rodruck 206-248-2254 urms.o PURMS Self -Insurance Fund INSURED Public Utility District No. 1 of '� �vv INsuRERB: Kitsap County, Washington INSURER C : P.O. Box 1989 City of Bremerton INSURER D : Poulsbo, WA 98370 Risk Management INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 206-248-0130 NAIC q 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR PURMS 2024L 01/01/2024 12/31/2024 EACH OCCURRENCE $ 11000,000 PREMISES SES (Ea occu ence $ 1,000,000 MED EXP (Any one person) $ 1,500 A PERSONAL & ADV INJURY $ 12000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ No Aggregate POLICY JEC LOC PRODUCTS - COMP/OPAGG $ No Aggregate OTHER: $ AUTOMOBILE LIABILITY PURMS 2024LA 01/01/2024 12/31/2024 SINGLE LIMIT et Ec aa accident) $ 1,000,000 A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ XPer PROPERTY DAMAGE accident)$ /� NON -OWNED HIRED AUTOS AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) N/A PURMS 2024WC 01/01/2024 12/31/2024 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 19000,000 E.L. DISEASE - EA EMPLOYE $ 11000,000 IF yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,0007000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Bremerton is listed as Additional Insured as required by written contract. This Certificate of Insurance is provided as required by the Interlocal Agreement between the parties. CERTIFICATE HOLDER CANCELLATION City of Bremerton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 345 6th St, Suite 100 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE - 4� �w P I - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD oizo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/13/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRooucER `'' DEC 18 INSURER A: PURMS Self -Insurance Fund INSURED Public Utility District No. 1 of INSURER B : Kitsap County, Washington City of Bremerton INSURER C : P.O. Box 1989 Risk Management INSURER D : POulsbo, WA 98370 INSURER E : INSURER F : r�n�roonr_oc r`CDTIrICATC nit IMRGD• REVISION NUMBER: T HIS 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 I LTR TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR ADDL SUER POLICY NUMBER PURMS2024L MMIDD/YYYY LICY EFF 01/01/2024 LICY EXP MMIDD/YYYY 12/31/2024 LIMITS EACH OCCURRENCE 00 $ 1100010DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 1000,000 A MED EXP (Any one person) $ 1,500 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE s No Aggregate GEN'L AGGREGATE LIMIT APPLIES PER: ❑PRO- LOG JECT PRODUCTS-COMP/OPAGG s No Aggregate S OTHER: OMOBILE LIABILITY PURMS2024LA 01/01/2024 12/31/2024 COMBINED Ea accident SINGLE LIMIT $ 110001000 AALL ANY AUTO OWNED SCHEDULED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED HIRED AUTOS x AUTOS P PROPERTY DAMAGE Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A PER OTH- STATUTE ER $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Bremerton is named as Additional Insured with respect to the work in the right-of-way. CERTIFICATE HOLDER 11111N7►1 City of Bremerton Financial Services THE SHOULD EXPIRATOI ONDATE H ABOVE THEREOFDESCRIBED NOTPOLICIES WIBL CANCELLED CVERED RN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th St STE 100 Bremerton, WA 98337-1873 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD