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HomeMy WebLinkAbout1 - Original Submission_ 20210709_4555_Updated Professional Certificate of InsuranceSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 7/9/2021 (WC) Heffernan Insurance Brokers1350 Carlback AvenueWalnut Creek CA 94596 Shelaine Gonsalves 925-934-8500 925-934-8278 ShelaineG@heffins.com Travelers Property Casualty Company of America 25674 KRAZ&AS-01 Krazan & Associates, Inc.215 West Dakota AvenueClovis CA 93612 796675037 A X 1,000,000 X 100,000 5,000 X Deductible $0 1,000,000 2,000,000 X X Stop Gap Y Y 6600F55445ATIL20 10/1/2020 10/1/2021 2,000,000 WA Stop Gap ELL 1,000,000 A 1,000,000 X X X 8106N8697512043G 10/1/2020 10/1/2021 A X X 1,000,000CUP9J292435204310/1/2020 10/1/2021 1,000,000 X 0 A XUB9H9483652143G1/1/2021 1/1/2022 1,000,000 1,000,000 1,000,000 A WA STOP GAPEMPLOYERS LIABILITY UB9H9483652143G 1/1/2021 1/1/2022 LIMIT $1,000,000 Re: KA Project #106-21154, Marine Drive Water Main Replacement, Bremerton, WA. City of Bremerton is included as an additional insured (primary andnon-contributory) on General Liability policy per the attached endorsements, if required. Waiver of Subrogation is included on General Liability policy per theattached endorsement, if required. This certificate replaces and supersedes all previously issued certificates. City of BremertonAttn: Robert Endsley345 6th Street, Suite 100Bremerton, WA 98337 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 POLICY NUMBER:6600F55445ATIL20 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 16 POLICY NUMBER:6600F55445ATIL20 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 POLICY NUMBER:6600F55445ATIL20 DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4 6600F55445ATIL20 City of Bremerton DocuSign Envelope ID: 2FF72CC3-DCD1-4361-A788-457AC5F80DF4