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HomeMy WebLinkAbout6312 - COI - Henden Electric - 2023®Allstate. You're in Good hands. CERTIFICATE OF INSURANCE CI CW A021011 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder: Named Insured: CITY OF BREMERTON HENDEN ELECTRIC, INC. DEC O i ZOZ1 345 6TH ST STE 600 26124 CALVARY LN NE BREMERTON, WA USA 983371873 KINGSTON WA 98346-9441 City of Bremerton City Attorneys Office Automobile Liabili Insurer Name: Allstate Insurance Company Polic Number: 648744039 X 1 --Any Auto 2 -Owned Autos Only 3 -Owned Priv. Pass. Autos Only 4 -- Owned Autos Other Than Priv. Pass. Autos Onl 5 -Owned Autos Subject to No Fault 6 -Owned Autos Subject to a Compulsory UM Law 7 -- S ecificall Described Autos 8 -Hired Autos Onl 9 - Nonowned Autos Onl Policy Effective Qate : O 1-18 - 2 0 2 2 Policy Expiration Date: 01-18 - 2 0 2 3 Limits of $1, 000, 000 Combined Single Limit (each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Pa T Additional Insured - All Other THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUS"f EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: CHISHOLM INSURANCE Authorized Representative: Date:ll-23-21 Includes copyrighted material of Insurance Services Office, Inc., with its permission �311I'I � CI CW A021011 Allstate Insurance Company Pddilional Insured Copy Page 1 of 1 POLICY NUMBER: 648744039 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies persons) or organizations) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. y _e y 1 8-2022 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. t�un�.: CA204$iQ13 ©Insurance Services Office, Inc., 2011 hdditional Insured Copy ®Allstate. You m in good hands. CERTIFICATE OF INSURANCE CI CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any parry nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF BREMERTON HENDEN ELECTRIC, INC. RECEIVED 345 6TH ST STE 600 26124 CALVARY LN NE BREMERTON, WA USA 983371873 KINGSTON WA 98346-9441 DEC 0 7 2021 City of Bremerton City Attorney's Offi. c Automobile Liabilit Insurer Name: Allstate Insurance Company Polic Number: 648744039 X 1 Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass, Autos Only 4 Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law 7 -- Specifically Described Autos 8 - Hired Autos Only 9 - Nonowned Autos Only Policy Effective Date : 01-18 - 2 0 21 Policy Expiration Date: 01-18 - 2 0 2 2 Limits of $1, 000, 000 Combined Single Limit (each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - All Other THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS, THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: CHISHOLM INSURANCE Authorized Representative: Date:ll-23-21 Includes copyrighted material of Insurance Services Office, Inc., with its permission `r � CI CW A021011 Allstate Insurance Company Pddilional Insured Copy Page 1 of 1 POLICY NUMBER: 648744039 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage I=orm apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. IVarr� �t Pers®n(a) ®r ®rgani�ation(s): CITY OF BREMERTON 345 6TH ST STE 600 BREMERTON, WA USA 983371873 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. 1 IJI1�i.3 ©Insurance Services Office, Inc., 2011 ALidilional Insured Copy l ;o L 86ed 6do0 pamsul luuogippd �tuedwoo aoueansul aleislly GG O! 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