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HomeMy WebLinkAbout6312 - COI - Henden Electric 2023_1AWN a 144 s subject F the provisionspolicies,g any exclusionsor i i regardless of the provisions of b x contract - between ". certificate holder and Named - e shown belowx. the .x provide ► i - the i..inception,Sub sequent i.these Certificate Flolder: Named Insured: CITY OF BREMERTON HENDEN ELECTRIC, INC. 345 6TH ST STE 600 26124 CALVARY LN NE BREMERTON, WA USA 983371873 ICINGSTON WA 98346-9441 Automobile Liabilit 0nsurer Name: Allstate Insurance Compan 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 5 -Hired Autos Onl 9 — Nonowned Autos Onl Policy Effective Date t 01-18 - 2 0 2 2 Policy Expiration [?ate: 01-18 - 2 02 3 Limits of $1, 000, 000 Combined Single Limit (each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Lacations/Vehicles/Endorsements/special Provisions Interested Pariyl-yam: Additional Insured - A11 Other THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE NOLDER 15 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 Authorised Representative: Date:ll-30-21 Includes copyrighted material of Insurance Services Office, Inc., with its permission Pdditional Insured Copy . �.. � M e i � � � a r ,. w �..� =3' ....� � � s. 'y.'x ' � � l r. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Endorsement Effective: 01-18 - 2 0 2 2 Countersigned By: Named Insured: xEND>;N ELECTRzc, zrrc. (Authorized Representative) �ECiI®N IV � BUSINESS AIJi� C®N®ITI®NS,B.�neral Conditions, 5. ®der Insurane� is modified by this endorse nt, only as it applies to any coverage provided to the person or organization designated in the schedule of this endorsement and only to the extent that such person or organization qualifies as an "insured" under this policy. If the named insured has entered into an agreement with the person or organization designated in the Schedule of this endorsement, which requires that the insurance available to them under this policy be applied on a primary and non-contributory basis, the following provision applies: Any coverage provided under this policy to the person or organization designated in the Schedule of this endorsement is primary, and we will not seek contribution from any other Automobile Liability insurance otherwise available to the designated person or organization. ;�„���: �•: �a Includes copyrighted material of Insurance Services Office, Inc., with its permission 3�i�,i� CW23091A Additional Insured Copy POLICY NUMBER: 648744039 � �� �. � � 1 �i "� �i;IF"'���t�7� � f _� 1 � i � , . � �. � �7�C+3'�7���T�'�T���f1�T#��11� 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. IVa ®f Person(s) ®r �rganization(a): CITY OF' BREMERTON 345 6T�I ST STE 600 BREMERTON, WA USA 983371873 Information reauired to complete this Schedule, if not shown 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. will be shown in the Declarations. ���'� 3 CA204�1©13 O Insurance Services Office, Inc., 2011 Pddilional Insured Copy