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HomeMy WebLinkAbout6385 - COI - Mason Bruce & Girard - 2025�C>RV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 /4/2024 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). PRODUCER NAME; "' Andrew Ferebee-S orko JD Fulwiler & Co., Insurance PHONE FAX 5727 S Macadam Ave. c No E • 503-977-5634 A/c No): 503-977-5634 Portland OR 97239 ADDRESS: aferebee-sporko@jdfulwiler.com INsuRERA: Federal Insurance Co 20281 INSURED MASOBRU-01 INSURER B : Travelers Casualty Insurance Company of America 19046 Mason Bruce & Girard, Inc. 707 SW Washington, Suite 1300 INSURER c :The Hartford Portland OR 97205 INSURER D : Underwriters at Lloyds of London 15642 INSURER E : Great Northern Insurance Co 20303 INSURER F : COVERAGES CERTIFICATE NUMBER: 1651002839 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, TYPE OF INSURANCE ADDL SU D POLICY NUMBER MMIDDmYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY Y Y 36061706 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000 rE CLAIMS -MADE FRI OCCUR DAMAGE TO RENED PREMISES Ea ocourrrence $11000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 X PRO POLICY ❑ PRO T ❑ LOC PRODUCTS -COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 73612935 1/1/2024 1/1/2025 COMBINED SINGLE LIMIT Ea accident $ I,000,000 _ X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NOWOWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ _ Hired Auto PD Deds $ 500/1,000 A X UMBRELLALIAB OCCUR 78195468 1/1/2024 1/1/2025 EACH OCCURRENCE $530000000 r EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 _ DED X RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 52WECP17230 1/1/2024 1/1/2025 X STATUTE ER E.L. EACH ACCIDENT $ 500,000 $ 500,000 E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 B D Professional Liability Cyber Liability 106620746 W34137723101 11/1/2023 4/16/2023 11/1/2024 4/16/2024 Aggregate Each Claim $2M Breach Response 59000,000 52000,000 $2M Policy Agg. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Excess Umbrella: 75119C221ALI 1/1/23-1/1/24 Aggregate: 5,000,000 Each Occurrence: $5,000,000 Crime/Fidelity $5,000,000 Limit; Fiduciary Liability $5,000,000 Travelers Insurance Company 107198509 1/1/2023 — 1/1/24 OR Work Comp policy # 487388 1/1/23 - 1/1/24 Each Occurrence:500,000 Other States WC covers CO, IL, CA VA, NC, TX, MO and VT Policy # 52WECP17230 1/1/24 to 1/1/25 1,000,000 coverage. The City of Bremerton, its officers, officials, employees, agents and volunteers are included as Additional Insureds as respects operations of the Named Insured subject to policy terms, conditions, and exclusions per attached form. Coverage is Primary/Non-Contributory and Waiver of Subrogation in favor of City of Bremerton applies per attached form. RFRTIFIRATF HAI 11FR Irir�0%lr�11k I1wPIi, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE JAN 1 I e09A THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton 345 6th Street, Suite 100 Bremerton WA 98339 City of Bremedw AUTHORIZED REPRESENTATIVE ,,,�� 0 04 © 19IIII-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CHUBB° Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies [o the following forms: GENERAL LIABILITY Who Is An Insured JANUARY 1, 2023 TO JANUARY 1, 2024 JANUARY 1, 2023 3606-17-06 PTL MASON BRUCE & GIRARD INC GREAT NORTHERN INSURANCE COMPANY JANUARY 19, 2023 Under Who Is An Insured, the following provision is added Addltlonal Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. Liability Insurance Additional Insured -Scheduled Person Or Organlzatlon continued Form 80.02-2367 (Rev. 5-07) Endorsement Page i Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance, Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization, Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Lfability Insurance Additional Insured -Scheduled Person Or Organization last page Form 80-02-2367 (Rev. 5-07) Endorsement Page 2 Conditions (continued) Transfer Or Waiver Of We will waive the right of recovery we would otherwise have had against another person or Rights Of Recovery organization, for loss to which this insurance applies, provided the insured has waived their rights Against Others of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured's rights to recover all or part of any payment made under this insurance have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. This condition does not apply to medical expenses. Liability Insurance Form 90-02-2000 (Rev. 4-01) Contract Page 24 of 32 A� ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 /4/2024 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). PRODUCER JD Fulwiler & Co., Insurance 5727 S Macadam Ave. Portland OR 97239 INSURED Mason Bruce & Girard, Inc. 707 SW Washington, Suite 1300 Portland OR 97205 .rrZiP/�:7�c7�� MASOBRU-01 CERTIFICATE NUMBER:879412704 Andrew Ferebee 503-977-5634 Iwiler.com AFFORDING COVERAGE Federal Insurance Co Travelers Casualty Insurance Cot The Hartford Underwriters at Llovds of London Insurance Co ;/c. Nol: 503-977-5634 NAIC # 20281 of America 19046 15642 20303 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, INSR LTR OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS E X COMMERCIAL GENERAL LIABILITY 36061706 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000 -1 CLAIMS -MADE OCCUR DAMAGE TO RENTE PREM IS (Ea occur ence) $ 1,000, 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,0002000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 73612935 1/1/2024 1/1/2025 COMBINED SINGLE LIMIT Ea accident $ 12000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED LNON-OWNED AUTOS ONLY AUTOS ONLY Hired Auto PD Deds $ 500/1,000 A X UMBRELLALIAB X OCCUR 78195468 1/1/2024 1/1/2025 EACH OCCURRENCE $520002000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED X RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AIJYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 52WECP17230 1/1/2024 1/1/2025 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 500,000 B D Professional Liability Cyber Liability 106620746 W34137723101 11/1/2023 4/16/2023 11/1/2024 4/16/2024 Aggregate Each Claim $2M Breach Response 51000,000 51000,000 $2M Policy Agg. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess Umbrella: 75119C221ALI 1/1/23-1/1/24 Aggregate: 5,000,000 Each Occurrence: $5,000,000 Crime/Fidelity $5,000,000 Limit; Fiduciary Liability $5,000,000 Travelers Insurance Company 107198509 1/1/2023 — 1/1/24 OR Work Comp policy # 487388 1/1/23 - 1/1/24 Each Occurrence: 5001000 Other States WC covers CO, IL, CA VA, NC, TX, MO and VT Policy # 52WECP17230 1/1/24 to 1/1/25 1,000,000 coverage. The City of Bremerton, its officers, officials, employees, agents and volunteers are added as additional insureds, Primary Non -Contributory applies but only as respects operations of the named insured in accordance with the policy terms, conditions & exclusions. CERTIFICATE HOLDER n l"v"i r `v CANCELLATION J � nI 1 1 ��� ;• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE r THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton City of Bremerton 345 6th Street Bremerton WA 98339 Risk Management AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CHUBB° Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABII.,ITY Who Is An Insured Additional Insured - Scheduled Person Or Organization JANUARY 1, 2022 TO JANUARY 1, 2023 JANUARY 1, 2022 781954C8 MASON BRUCE & GIRARD INC GREAT NORTHERN INSURANCE COMPANY JANUARY 22, 2022 Under Who Is An Insured, the following provision is added Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured onlys • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contractor agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies, No person or organization is an insured under this provision: that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured -Scheduled Person Or Organization continued Form 80-02-2367 (Rev. 5-07) Endorsement Page 1 Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance, Conditions Ofher Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Liability Insurance Schedule Persons or organizations that. you are obligated, pursuank to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged, Authorized Representative Additional Insured -Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement • last page