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Home My WebLink About6213 - COI - Pape & Sons ConstructionCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/09/2021 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 CONTACT Danielle Bryant HENTSCHELL&ASSOC INC PHONE (253) 272-1151 rHx (253) 272-1225 (A/C. No Ext : IAIC No i 1436 S. Union Ave. )li r) ADDARESS: danielleb@hentschell.com INSURER(S) AFFORDING COVERAGE NAIC # Tacoma ffV5.1925 INSURERA: The Charter Oak Fire his. Co 25623 INSURED utu INSURER B: The Travelers Indemnity Co. of America 25658 Pape & Sons Construction, Inc. INSURER C : Travelers Prop Cas Cc of America 25674 9401 Bujacich Road (✓ity of Bremelton INSURER D : Suite 1A Risk Management INSURER E Gig Harbor WA 98332 INSURER F : COVERAGES CERTIFICATE NUMBER: 21-22 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAIJCE 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD YYYY MMIDD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y Y DTCOOJ154095COF21 12/31/2021 12/31/2022 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED PREM SES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ 110001000 GENERAL AGGREGATE $ 21000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑X PRO LOC JECT OTHER: PRODUCTS-COMP/OPAGG $ 23000,000 WAStopGap/Empl Liab $ 11000,000 B AUTOMOBILE LIABILITY X ANYAUTO OWNED M SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y Y BA1L6589552126G 12/31/2021 12/31/2022 COMBINED SINGLE LIMIT Ea accident $ 13000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y Y CUPOJ4039462126 12/31/2021 12/31/2022 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,0003000 $ DED I X1 RETENTION $ 103000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WASHINGTON STATE FUND 12/31/2021 12/31/2022 X1 PER STATUTE ORH E.L. EACHACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C INSTALLATION FLOATER 630-9S118521-TIL-21 12/31/2021 12/31/2022 110001000 LIMIT - EACH 1007000 LIMIT - IN 100,000 LIMIT -TEMP. JOB SITE LOC. TRANSIT LOCATION DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 6TH Street Sewer Replacement Blanket Primary Non -Contributory Additional Insured, including completed operations and Blanket Waiver of Subrogation applies in favor of any person or organization if called for by written contract or agreement, per policy forms and conditions; #CGD316 02/19, CGD246 04/19, CGD211 01/04, CGT100 0/192 CAT353 02/15 - City of Bremerton, its officials, employees, agents and volunteers are all included as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WITH THE POLICY PROVISIONS. 345 - 6th Street AUTHORIZED REPRESENTATIVE Suite 100 Bremerton WA 98337 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD