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HomeMy WebLinkAboutSPKC COI - City of Bremerton.SHOULD 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 3/9/2022 Affinity Insurance Services, Inc. SERVPRO Franchisee Insurance Center 1100 Virginia Drive, Suite 250 Fort Washington, PA 19034 866-231-2006 800-567-4028 LIC#: CA 0795465 - PA 14210 Restoration Risk Retention Group 12209 ALLIED P & C Ins Co 42579 Farmers Mutual Insurance Co of Michigan 33448 A 2,000,000RGL1922346/23/2021 6/23/2022 100,000 3 5,000 3 2,000,000 5,000,000 5,000,000 C 607211096 6/23/2021 6/23/2022 1,000,000 3 3 3 0 A RGL192234 6/23/2021 6/23/2022 Stop Gap Coverage A CPL ($1,500 Deductible)RPU151487 6/23/2021 6/23/2022 PER OCC: $2,000,000 AGG: $5,000,000 A Limited Service & Repair RLS081118 6/23/2021 6/23/2022 PER OCC: $250,000 AGG: $250,000 Mark Nunes SERVPRO Franchisee Insurance Center RRRGInsurance@aon.com $100,000 3 B Bailees CIM 3029250915 6/23/2021 6/23/2022 $250,000 BTD Holdings, LLC P.O. Box 4957 Bremerton WA 98312 67121365 3 3 dba Servpro of Kitsap County applies. City of Bremerton 345 6th Street Bremerton WA 98337-0000 ** Supplemental Name ** BTD Holdings, LLC Certificate holder is included as additional insured under general liability policy with regard to operations of insured to which this insurance 3 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 1 of 8 This certificate cancels and supersedes ALL previously issued certificates. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: City of Bremerton is hereby named as additional insured with regards to the general liability. This insurance is primary and non-contributory insurance as respects the City and a waiver of subrogation applies in favor of the City of Bremerton for claims arising out of any operations, liabilities and obligations to which coverage applies. 9623 Affinity Insurance Services, Inc.BTD Holdings, LLCP.O. Box 4957Bremerton WA 98312 25 Certificate of Liability (03/16) ADDENDUM HOLDER: ADDRESS: City of Bremerton 345 6th Street Bremerton WA 98337-0000 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 2 of 8 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY RGL 2021 (07/20) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – ONGOING OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Or Organizations(s): Location And Description of Ongoing Operations: Where required by written contract Any site where work is performed by the named insured or on behalf of the named insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1.Only applies to the extent permitted by law; and 2.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1."Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. RGL 2021 (07/20) Includes copyrighted material of Insurance Services Office, Inc., with permission Page 1 of 2 RGL192234 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 3 of 8 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY RGL 2021 (07/18) 1. "Bodily injury" or "property damage" occurring after: c. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or d. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. D. COMMERCIAL GENERAL LIABILITY CONDITIONS – Duties In The Event of Occurrence, Offense, Claim or Suit (Section IV.2) is amended to add the following: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to us for a loss we cover under this Coverage Part; (3) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (4) Agree to make available any other insurance, which the additional insured has for a loss we cover under this Coverage Part. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. E. COMMERCIAL GENERAL LIABILITY CONDITIONS – Other Insurance (Section IV.4) are deleted and replaced with the following: a. This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance is excess over any other insurance to which the additional insured has been added as an additional insured by endorsement. b. When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit" If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. RGL 2021 (07/20) Includes copyrighted material of Insurance Services Office, Inc., with permission Page 2 of 2 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 4 of 8 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Or Organizations(s): Location And Description of Completed Operations: Where required by written contract Any site where work is performed by the named insured or on behalf of the named insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". 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, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 RGL192234 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 5 of 8 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY CG 24 53 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 24 53 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) – AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY 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 any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. RGL192234 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 6 of 8 This certificate cancels and supersedes ALL previously issued certificates. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY RGL 2018 05/14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – AUTOMATIC STATUS WHEN REQUIRED IN DISASTER, WATER OR FIRE REMEDIATION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any site where work is performed by the named insured or on behalf of the named insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who is An Insured is amended to include as an additional insured any person or organization for whom you are performing disaster, water or fire remediation operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person’s or organization’s status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. “Bodily injury”, “property damage” or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. RGL 2018 05/14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 RGL192234 City of Bremerton345 6th StreetBremerton WA 98337-0000 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 7 of 8 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY RGL 2018 05/14 2. “Bodily injury” or “property damage” occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. COMMERCIAL GENERAL LIABILITY CONDITIONS – Duties In The Event of Occurrence, Offense, Claim or Suit (Section IV.2) is amended to add the following: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to us for a loss we cover under this Coverage Part; (3) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (4) Agree to make available any other insurance, which the additional insured has for a loss we cover under this Coverage Part. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. D. COMMERCIAL GENERAL LIABILITY CONDITIONS – Other Insurance (Section IV.4) are deleted and replaced with the following: a. This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance is excess over any other insurance to which the additional insured has been added as an additional insured by endorsement. b. When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit" If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part RGL 2018 05/14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 67121365 | 9623 | 21/22 GL POLL LSRL | JoAnne Miller | 3/9/2022 8:16:21 AM (EST) | Page 8 of 8 This certificate cancels and supersedes ALL previously issued certificates.