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HomeMy WebLinkAboutCity of Bremerton Project No 876 [193070] [LIAB]1 of 9 (JLD02) CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSR ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10/13/2021 Parker, Smith & Feek, Inc. 16201 E Indiana Ave, Suite 1000 Spokane Valley, WA 99216 509-789-8350 509-931-0794 Liberty Mutual Fire Insurance Company SCI Infrastructure, LLC 2821 South 154th Street SeaTac, WA 98188 Liberty Mutual Insurance Co. Liberty Insurance Corporation A X 1,000,000 8 X 8 8 8 TB2Z91470317011 04/01/2021 04/01/2022 500,000 15,000 1,000,000 2,000,000 2,000,000 B 1,000,000 8 8 8 AS2Z91470317021 04/01/2021 04/01/2022 C 8 6,000,000 8 X X 6,000,000 8 0 TH7Z91470317041 04/01/2021 04/01/2022 A 804/01/2021 04/01/2022 1,000,000 WC2Z91470317031 Stop Gap 1,000,000 1,000,000 Project No: 876 Ostrich Bay Creek Stormwater Treatment City of Bremerton is an additional insured on the general liability and excess liability policies per the attached endorsements/forms... (See Attached Description) City of Bremerton City Clerks Office 345 6th St, Ste 600 Bremerton, WA 98337-1873 2 of 9 (JLD02) DESCRIPTIONS (Continued from Page ) 1 . Coverage is primary and non-contributory on the general liability and excess liability policies per the attached endorsements/forms. Waiver of subrogation applies on the general liability and excess liability policies per the attached endorsements/forms. CANCELS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE. 3 of 9 (JLD02) (b) To the spouse, child, parent, brother or sister of that co-employee or volunteer worker as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (1)(b) above; or (d) Ansing out of his or her providing or failing to provide professional health care services. However, Paragraphs (1){a), (1)(b) and (1)(c) do not apply to the extent underlying insurance provides coverage for such person(s). Coverage under this policy will be no broader than that provided by underlying insurance. Insurance provided by this policy for bodily injury to a co-employee or volunteer worker will not apply if the injured co-employee's or volunteer worker's sole remedy for such injury is provided under a workers' compensation law or any similar law. (2) Property damage to property: (a) Owned, occupied, used by; (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your employees, volunteer workers, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company), b. Any person (other than your employee) or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability ansing out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative, if you die, but only with respect to duties as such. That representative will have all your rights and duties under this policy. e. Any person or organization included as an additional insured in underlying insurance. Coverage under this policy will be no broader than that provided by underlying insurance. However: (1) The insurance afforded to such additional insured only applies to the extent permitted by law; and (2) If coverage provided to the additional insured is required by a contract or agreement, this insurance will be no broader than that which you are required by the contract or agreement to provide for such additional insured. The Limits of Insurance applicable to the additional insured are included within, and are not in addition to, the Limits of Insurance shown in the Declarations. f. Any person while using with your permission a covered auto and any person or organization legally responsible for its use, but only if that person is an insured with respect to liability arising out of the ownership, maintenance, use or entrustment to others of covered autos. 5. Any organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority interest, will qualify as an insured under this policy if there is no other similar insurance available to that organization and that organization qualifies as an insured in underlying insurance. However: LCU 00 01 01 18 © 2017 Liberty Mutual Insurance Page 3 of 24 Includes copyrighted material of Insurance Services Office, Inc, with its permission. 4 of 9 (JLD02) LCU 00 01 01 18 © 2017 Liberty Mutual Insurance Page 17 of 24 Includes copyrighted material of Insurance Services Office, Inc., with its permission. d. The total applicable limits of all underlying insurance do not decrease, except for any reduction or exhaustion of aggregate limits by payment of judgments or settlements; and e. You notify us in writing, as soon as practicable, if any underlying insurance is cancelled, not renewed, replaced or otherwise terminated, or if the limits or scope of coverage of any underlying insurance is changed. Failure to comply with these requirements will not invalidate this insurance. However, in the event of such failure, we will only be liable to the same extent that we would have been, had you fully complied with these requirements. 10. Named Insureds a. The first named insured is authorized to act and agrees to act on behalf of all persons or organizations insured under this policy with respect to all matters pertaining to the insurance afforded by the policy. b. Each Named Insured is jointly and severally liable for: (1) All premiums due under this policy; and (2) Any other financial obligations of any Named Insured to us arising out of any agreements contained in this policy. 11. Other Insurance This insurance is excess over, and will not share or contribute with any other insurance whether primary, excess, contingent or on any other basis. However, this insurance will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured on such other insurance; b. You have agreed in a written contract or agreement with the additional insured that this insurance would not seek contribution from any other insurance available; c. Underlying insurance includes the person or organization as an additional insured; and d. Underlying insurance provides coverage to the person or organization on a primary and noncontributory basis. 12. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate, complete and based on information and representations you provided or made to us; b. We have issued this policy in reliance upon your information and representations. 13. Separation of Insureds Except with respect to the Limits of Insurance of this policy and any rights or duties specifically assigned to the first named insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or suit is brought. 5 of 9 (JLD02) LCU 00 01 01 18 © 2017 Liberty Mutual Insurance Page 18 of 24 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 14. Terms Conformed to Statute The terms of this policy which are in conflict with the statutes, laws, ordinances or regulations of the state or jurisdiction where this policy is issued are amended to conform to such statutes, laws, ordinances or regulations. 15. Trade or Economic Sanctions This insurance applies except to the extent coverage is in violation of any trade or economic sanction, embargo or similar regulation imposed by the United States of America. 16. Transfer of Rights of Recovery Against Others to Us a. If any insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The insured will do all that is necessary to secure such rights and must help us enforce them. The insured will do nothing after loss to prejudice such rights. We have the right to recover our payments from anyone liable for injury or damage covered by this policy. We waive any right of recovery we may have against a person or organization, if you waive any right of recovery against such a person or organization in a written contract, but only if such contract was executed prior to injury or damage. b. Any recoveries shall be applied as follows: (1) Any person or organization, including the insured, that has paid an amount in excess of the applicable Limits of Insurance of this policy will be reimbursed first; (2) We then will be reimbursed up to the amount we have paid; and (3) Lastly, any person or organization, including the insured, that has paid an amount over which this policy is excess is entitled to claim the remainder. Expenses incurred by us in the exercise of the rights of recovery shall be apportioned among the persons or organizations, including the insured, in the ratio of their respective recoveries as finally settled. 17. Transfer of Your Rights and Duties Your rights and duties under this policy may not be transferred without our written consent. If you die or are legally declared bankrupt, your rights and duties will be transferred to your legal representative, but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. However, in such event, notice of cancellation of this policy sent to the first named insured and mailed to the last mailing address known to us will be sufficient notice to effect cancellation of this policy. 18. Unintentional Failure to Disclose There will be no coverage under this policy for hazards you fail to disclose at the inception of the policy period, except that unintentional failure of the Named Insured to disclose all hazards existing at the inception of this policy shall not be a basis for denial of any coverage afforded by this policy. However, you must report the hazard to us as soon as practical after discovering the failure to disclose. 19. When Loss is Payable Coverage under this policy will not apply unless and until the insured or the underlying insurer has paid or is obligated to pay the full amount of the retained limit. However, when an agreed settlement or final judgment has been determined, we will promptly pay on behalf of the insured those sums falling within the terms of this policy. 6 of 9 (JLD02) 7 of 9 (JLD02) TB2-Z91-470317-011 8 of 9 (JLD02) 9 of 9 (JLD02) POLCYNUMBER: TB2-Z91-470317-011 COMMERCIAL GENERAL LIABILITY CG 24 0412 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under tiie following: COMMERCIAL GENERAL LIABILITYCOVERAGE PART ELECTRONIC DATA LlABlLfTY COVERAGE PART LIQUOR LlABlLfTY COVERAGE PART POLLUTION LlABlLfTY'COVERAGE PART DESIGNATED SfTES POLLUTION LIABILITY LlMfTED COVERAGE PART DESIGNATED SfTES PRODUCTS/COMPLETED OPERATIONS LlABlLfTY COVERAGE PART RAILROAD PROTECTIVE LlABlLfTY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under tiiis Coverage Part. Such waiver by us appHes only to the extent tiiat tiie insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organizafion(s) shown in ttie Schedule above. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization for whom you perfonm work under a written contract if tiie contract requires you to obtain ttiis agreement from us, but only if the confi-act is executed prior to ttie injury or damage occurring. Informafion required to complete this Schedule, if not shown above, will be shown in ttie Declarations. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1