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HomeMy WebLinkAbout6435 ACCDATE(MM/DD/YYYY) �..,....--- CERTIFICATE OF LIABILITY INSURANCE 04/11/2024 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 NAME:CONTACT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE HOME OFFICE:P.O.BOX 328 (A/C,No,Extl:888-333-4949 (AA/C,No):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 423-900-0 INSURER B: AIR MANAGEMENT SOLUTIONS,LLC INSURER C: 5822 W WERNER RD — BREMERTON,WA 98312-3245 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1237 REVISION NUMBER:0 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 TYPE OF INSURANCE IN6RL UB POLICY NUMBER (MM/LDD/YVYYI (MM/DD/YYVV) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES $100,000 (Ea occurrence) MED EXP(Any one person) $5,000 A Y Y 1859839 04/28/2024 04/28/2025 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PERT- LOC PRODUCTS&COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY AUTESULED N N 1859839 04/28/2024 04/28/2025 BODILY INJURY(Per Accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE —AUTOS ONLY (Per Accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 A EXCESS LIAB CLAIMS-MADE N N 1859841 04/28/2024 04/28/2025 AGGREGATE $10,000,000 DED RETENTION WORKERS-COMPENSATION PER STATUTE OTHER AND-EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N 1859839 04/28/2024 04/28/2025 (Mandatory in NH) E.L DISEASE EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) STOP-GAP (EMPLOYER'S LIABILITY) COVERED STATE(S) WA INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT CERTIFICATE HOLDER CANCELLATION 423-900-0 1237 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED CITY OF BREMERTON 345 6TH ST STE 100 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BREMERTON,WA 98337-1891 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /I ae © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (21 You have agreed in writing in a contract Condition and supersedes any provision to the or agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 1859839 Transaction Effective Date: 04/28/2024 POLICY NUMBER: 1859839 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS 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 345 6th St Ste 100 Bremerton, WA 98337-1891 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 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury," "property damage" or governmental agency or subdivision or political "personal and advertising injury" arising subdivision shown in the Schedule, subject to the out of operations performed for the federal following provisions: government, state or municipality; or 1. This insurance applies only with respect to b. "Bodily injury" or "property damage" operations performed by you or on your behalf included within the "products-completed for which the state or governmental agency or operations hazard". subdivision or political subdivision has issued B. With respect to the insurance afforded to these a permit or authorization. additional insureds, the following is added to However. Section III - Limits Of Insurance: a. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent required by a contract or agreement, the most we permitted by law; and will pay on behalf of the additional insured is the b. If coverage provided to the additional amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such 2. Available under the applicable limits of additional insured will not be broader than that which you are required by the insurance; contract or agreement to provide for such whichever is less. additional insured. This endorsement shall not increase the applicable limits of insurance. Insured: GS Seer Group Purchaser Corp PO Box 1528 Bothell, WA 98041-1528 © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 12 12 19 Policy Number 1859839 Transaction Effective Date: 04/28/2024 COMMERCIAL GENERAL LIABILITY CG24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 1859839 Transaction Effective Date: 04/28/2024