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HomeMy WebLinkAbout6312 - COI - Potelco Inc. - 2024ACQR%J® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 164.� 5/1/2024 1 04/25/2023 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). PRODUCER LCOMPANIES EM�UrmI` 3657 57 BRIRIARPARK DRIVE, SUIT V t:Lj HOUSTON TX 77042 866-260-3538 MAY 4 2023 3 INSURERA: Old INSURED pOTELCO, INC. 1373129 A QUANTA SERVICES COMPANYCIty Of Bremerton 14103 STEWART RD, SUMNER WA 98390 Risk Management Insurance 147 COVERAGES CERTIFICATE NUMBER: 17610048 REVISION NUMBER: XXXXXXX 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 INSD SUB WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N MWZY 313093 23 05/01/202 05/01/2024 EACH OCCURRENCE $ 1 000 000 DA ES (R TED a occurrence) $ 14000,000 MED EXP An one person)$ Excluded PERSONAL $ ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑ PRO ❑ LOC OTHER: GENERAL AGGREGATE $ 1 000000 PRODUCTS - COMP/OP AGG $ 1 000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY NOT APPLICABLE COEa acccideDt51NGLE LIMIT $ XXXXXXX BODILY INJURY (Per person) $ XXXJ ) accident Per BODILY INJURY ) ( $ XXXXX XX ROPERTY AMAGE Per accident $XXXXXXX UMBRELLA LIAB EXCESS LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX HCLAIMS-MADE AGGREGATE $ XXXXXXX DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERWEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS belorr NIA NOT APPLICABLE S UTE R E.L. EACH ACCIDENT $ XXXXXXX E.L. DISEASE - EA EMPLOYEE $ XXXXXXX E.L. DISEASE - POLICY L IMIT $ XXXXXXX DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: All Operations. Additional Insured in favor of The City of Bremerton on the General Liability where and to the extent required by written contract. 30 Day Notice of Cancellation is included on all policies. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 17610048 AUTHORIZED REPRESENTATIVE The City of Bremerton 345 6th St. Suite 100 Bremerton, WA 98337 ACORD 25 (2016/03) U 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Attachment Code : D488205 Certificate ID : 17610048 �1lC�l'��1�1�13�i1•�U��r�Yt7f � • yet? COMMERCIAL GENERAL LIABILITY CG 20 1212 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. �.- WSJ gia NON& • - This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: The City of Bremerton A. Section II —Who Is An Insured is amended to include as an additional insured any state or 2. governmental agency or subdivision or political This insurance does not apply to: subdivision shown in the Schedule, subject to the a. "Bodily injury", "property damage" or following provisions: "personal and advertising injury" arising out 1. This insurance applies only with respect to of operations performed for the federal operations performed by you or on your behalf government, state or municipality; or for which the state or governmental agency or b. "Bodily injury" or "property damage" included subdivision or political subdivision has issued a within the "products -completed operations permit or authorization. hazard". However: Be With respect to the insurance afforded to these a. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted Section III — Limits Of Insurance: by law; and If coverage provided to the additional insured is b. If coverage provided to the additional insured required by a contract or agreement, the most we is required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured amount of insurance: will not be broader than that which you are 1. Required by the contract or agreement; or required by the contract or agreement to 2. Available under the applicable limits of provide for such additional insured. insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 12 12 19 ©Insurance Services Otfice, Inc., 2018 Page 1 of 1 MWZY31309323 Quanfa Services Inc. 05/01/2023-05/01/2024