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HomeMy WebLinkAbout6474A�� � DATE IMM/DD/VYYV) - CERTIFICATE OF LIABILITY INSURANCE 03/29/2023 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 INSURED PUGET FENCE INC 1598 SE OREGON ST PORT ORCHARD, WA 98367-9345 888-333-4949 Nol: 507-446-4664 INsuRER A:FEDERATED MUTUAL INSURANCE COMPANY 175-434-0 � INSURER e: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 13 REVISION NUMBER: 0 13935 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 8Y PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUER PODGY NUMBER POLICY EFF POLICY E%P LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR BUSINESS OWNER'S LIABILITY Y Y 6092558 04/12/2022 04/12/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO ELATED PREMISES $100,000 X MED E%P (My one person) pERSONALB PDVINJURV 1 000 000 GEN L AGGREGATE LIMIT APPLIES PER: POLICY X IE�T ❑ LOC OTHER: GENERAL AGGREGATE 2 OOO OOO PRODUCTS 6 COMP/OP ACC $2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED AUTOS ONLY AUTOSULED HIRED AUTOS OWNLY AUOTOS ONLD Y Y 6092559 04/12/2022 04/12/2023 COMBINED SINGLE LIMIT Ea acaden $1,000,000 BODILY INJURY (Per Person) _ BODILY INJURY (Per AccidenQ PRPe ARCS TdY�DAMAGE A X UMBRELLA LU\B EXCESS LIAR X OCCUR CLAIMS -MADE Y Y 6092560 04/12/2022 04/12/2023 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED RETENTION A WOR1fERS-COMPENSATIAN AN&EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/ EXECUTIVE OFFlCERIMEMBER EXCWDEDP IMandetory in NH) If yes, descrlEe under DESCRIPTION OF OPERATIONS below ri//.\ N 6092558 04/12/2022 04/12/2023 PER STATUTE THER E.L EACH ACCIDENT $1,000,000 E.L DISEASE fA EMPLOYEE '— $1,000,000 E.L DISEASE � POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER 175-434-0 CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON, WA 98337-1891 CANCELLATION 13 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 198B•2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2076/03) The ACORD name and logo are registered marks of ACORD A� �° AGENCY CUSTOMER ID: 175-434-0 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY PUGET FENCE INC 1598 SE OREGON ST POLICY NUMBER PORT ORCHARD, WA 98367-9345 SEE CERTIFICATE �# 13.0 CARRIER NAiC CODE EFFECTIVE DATE: SEE CERTIFICATE # 13.0 SEE CERTIFICATE # 13.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE STOP -GAP (EMPLOYER'S LIABILITY) COVERED STATE(S> WA RE: BREMERTON WASTE WATER - HWY 3, BREMERTON WA NO SPECIFIC BUSINESSOWNERS LIABILITY EXCLUSIONS FOR: CROSS LIABILITY/JOINT SEVERABILITY & X, G, U (EXPLOSION, COLLAPSE, UNDERGROUND) CONTRACTUAL LIABILITY COVERAGE FOR LIABILITY FOR DAMAGES ASSUMED IN A CONTRACT OR AGREEMENT THAT IS AN "INSURED CONTRACT" IS PROVIDED PER THE BP-F-102, BUSINESSOWNERS LIABILITY COVERAGE FORM. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED 8Y CONTRACT ENDORSEMENT FOR BUSINESSOWNERS LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON BUSINESSOWNERS LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - COMPLETED OPERATIONS ENDORSEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE BUSINESSOWNERS LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. BUSINESSOWNERS LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. BUSINESS AUTO LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. BUSINESSOWNERS COVERAGE CONTAINS BP-F-47 AMENDMENT - AGGREGATE LIMITS OF INSURANCE (PER PROJECT). COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT MODIFIES THE POLICY. PLEASE READ IT CAREFULLY. � 1 1 • � 1 • � 1 •' _ ll _l This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A. Paragraph C. Who Is An Insured is amended to include as an additional insured any person or organization, other than a joint venture, 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 forthe 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. This additional insurance does not apply to: 1. An employee, association of employees or labor union, except with respect to work performed by or for you for such employee, association of employees or labor union under direct contract between you as contractor and such employee, association of employees or labor union as owners; 2. Any railroad company except with respect to work performed by or for you for such railroad company under direct contract or agreement between you and such railroad company; 3. Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer �a�ith respect to liability arising out of the preparation or approval of or the failure in preparation or approval of maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs, drawings, specifications or the performance of any other professional services by such person or organization; or 4. Any of your Subcontractors, or any partner, officer, agent or employee of such Subcontractor. B. The Coverage extended to any additional insured by this endorsement is limited to, and subject to, all terms, conditions, and exclusions of the coverage form to which this endorsement is attached. In addition, Coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. In the event that the Limits of Insurance shown in the Declarations exceeds the limits of liability required in a written contract or written agreement for an additional insured, the insurance provided to the additional insured shall be limited to the limits of liability required by that written contract or written agreement. D. Additional Exclusions The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "bodily injury", "property damage" or "personal and advertising injury" which occurs prior to the date of your contract with such person or organization; 2. To "bodily injury" or "property damage" included within the "products -completed operations hazard"; or 3. To "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-115 (07-09) Policy Number: 6092558 Transaction Effective Date: 04-12-2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM It is agreed that the insurance provided by any additional insured endorsement is primary. We will not seek contribution from any other insurer when insurance on anon -contributing basis is required by contract. Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-119 (07-04) Policy Number: 6092558 Transaction Effective Date: 04-12-2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM In the event of any payment for a loss under this Businessowners Liability Coverage Form arising out of your ongoing operations, the company agrees to waive its rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Businessowners Common Policy Conditions against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees. Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-215 (01-03) Policy Number: 6092558 Transaction Effective Date: 04-12-2022 FEDERATED INSURANCE COMPANIES 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: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE Name of Additional insured Persons) Or Organization: THE CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON WA 98337 Location and Description Of Completed Operations: ANY COVERAGE PROVIDED BY THIS ENDORSEMENT APPLIES ONLY TO FENCING WORK ALONG HWY 3, BREMERTON WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is An Insured: Any persons) or organizations) shown in the Schedule is also an additional insured, 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. PUGET FENCE INC 1598 SE OREGON ST PORT ORCHARD WA 98367 B. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. FEDERATED MUTUAL INSURANCE COMPANY Home Office 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-256 (01-13) Policy Number: 6092558 Transaction Effective Date: 03-29-2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 6092559 Transaction Effective Date:04/12/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. In the event of any payment for a loss under this Business Auto Coverage Part arising out of your ongoing operations, we agree to waive our rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US condition against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-128 (03-03) Policy Number: 6092559 Transaction Effective Date:04/12/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT -AGGREGATE LIMITS OF INSURANCE (PER PROJECT) This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Under Paragraph D.4.b. Liability Limits Of Insurance, the aggregate limit for all "bodily injury" and "property damage" other than "bodily injury" or "property damage" included in the "products - completed operations hazard" applies separately to each of your projects away from premises owned by or rented to you. A separate aggregate will apply for projects at premises owned by or rented to you. Includes copyrighted material of Insurance Services Office, Inc., with its permission. BP-F-47 (07-02) Policy Number:6092558 Transaction Effective Date: 04-12-2022 Additional Insured Copy FEDERATED INSURANCE COMPANIES 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: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE Name of Additional Insured Persons) Or Organization: Location and Description Of Completed Operations: City of Bremerton Any coverage provided by this endorsement 345 6th St Ste 100 applies only to fencing work along Hwy 3, Bremerton, WA 98337-1891 Bremerton WA. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is An Insured: Any persons) or organizations) shown in the Schedule is also an additional insured, 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. Puget Fence INC 1598 SE Oregon St Port Orchard, WA 98367-9345 B. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. Federated Mutual Insurance Company Home Office 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-256 (01-13) Policy Number: 6092558 Transaction Effective Date: 04/12/2023 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/VYYV) 02/16/2024 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 RECEIVED INSURED PUGET FENCE INC 1598 SE OREGON ST PORT ORCHARD, WA COVERAGES F LB 2 7 2024 CNY of Bremerton itY Attorney FIF ATE NUMBER: 13 CLIENT CONTACT CENTER 888-333-4949 INSURERS AFFORDING COVERAGE INsuRER A:FEDERATED MUTUAL INSURANCE COMPANY INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: REVISION NUMBER: 0 13935 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 ADDL SUBRI POLICY NUMBER POLICY EFMMIODIYYYF POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR BUSINESS OWNER'S LIABILITY Y Y 6092558 04/12/2024 04/12/2025 EACH OCCURRENCE $1,000,000 DAMAGE TO ENTED PREMISES Ira occurrent $100,000 MED EXP (Any one person) X PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,0004000 GENT AGGREGATE LIMIT APPLIES PER: POLICY I •• uECOT LOC OTHER: PRODUCTS & COMPIOP AGO $21000,000 AOWNED AUTOMOBILE LIABILITY JANYAUTO AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OV^ED AUTOS ONLY Y Y 6092559 04/12/2024 04/12/2025 EOMBcIjJdeeD SINGLE LIMIT $1,000,000 BODILY INJURY (Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE A X_ UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE Y Y 6092560 04/12/2024 04/12/2025 EACH OCCURRENCE _ $110001000 AGGREGATE _ $1,000,000 DED I RETENTION A WORKERS-COMPENSATiON AND -EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/ EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N 6092558 04/12/2024 04/12/2025 PER STATUTE OTHER E.L EACH ACCIDENT $1,0005000 E.L DISEASE EA EMPLOYEE $110001000 E.I. 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) SEE ATTACHED PAGE CERTIFICATE HOLDER 175-434-0 CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON, WA 98337-1891 CANCELLATION 130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT MODIFIES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A. Paragraph C. Who Is An Insured is amended to include as an additional insured any person or organization, other than a joint venture, 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. This additional insurance does not apply to: 1. An employee, association of employees or labor union, except with respect to work performed by or for you for such employee, association of employees or labor union under direct contract between you as contractor and such employee, association of employees or labor union as owners; 2. Any railroad company except with respect to work performed by or for you for such railroad company under direct contract or agreement between you and such railroad company; 3. Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the preparation or approval of or the failure in preparation or approval of maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs, drawings, specifications or the performance of any other professional services by such person or organization; or 4. Any of your Subcontractors, or any partner, officer, agent or employee of such Subcontractor. B. The Coverage extended to any additional insured by this endorsement is limited to, and subject to, all terms, conditions, and exclusions of the coverage form to which this endorsement is attached. In addition, Coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. In the event that the Limits of Insurance shown in the Declarations exceeds the limits of liability required in a written contract or written agreement for an additional insured, the insurance provided to the additional insured shall be limited to the limits of liability required by that written contract or written agreement. D. Additional Exclusions The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "bodily injury", "property damage" or "personal and advertising injury" which occurs prior to the date of your contract with such person or organization; 2. To "bodily injury" or "property damage" included within the "products - completed operations hazard"; or 3. To "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-115 (07-09) Policy Number: 6092558 Transaction Effective Date: 04/12/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON=CONTRIBUTORY CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM It is agreed that the insurance provided by any additional insured endorsement is primary. We will not seek contribution from any other insurer when insurance on a non-contributing basis is required by contract. Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-119 (07-04) Policy Number: 6092558 Transaction Effective Date: 04/12/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM In the event of any payment for a loss under this Businessowners Liability Coverage Form arising out of your ongoing operations, the company agrees to waive its rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Businessowners Common Policy Conditions against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees. Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-215 (01-03) Policy Number: 60g2558 Transaction Effective Date: 04/12/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - AGGREGATE LIMITS OF INSURANCE (PER PROJECT) This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Under Paragraph D.4.b. Liability Limits Of Insurance, the aggregate limit for all "bodily injury" and "property damage" other than "bodily injury" or "property damage" included in the "products - completed operations hazard" applies separately to each of your projects away from premises owned by or rented to you. A separate aggregate will apply for projects at premises owned by or rented to you. Includes copyrighted material of Insurance Services Office, Inc., with its permission. BP-F-47 (07-02) Policy Number: 6092558 Transaction Effective Date: 04/12/2024 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 6092559 Transaction Effective Date: 04/12/2024 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. In the event of any payment for a loss under this Business Auto Coverage Part arising out of your ongoing operations, we agree to waive our rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US condition against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-128 (03-03) Policy Number: 6092559 Transaction Effective Date: 04/12/2024 Additional Insured Copy FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAlltrULLTM ADDITIONAL INSURED - OWNERS, LESSEES OR KLIL&I V&D CONTRACTORS - COMPLETED OPERATIONS FEB 2 7 2024 This endorsement modifies insurance provided under the following: City of Bremerton BUSINESSOWNERS LIABILITY COVERAGE FORM Risk Management SCHEDULE Name of Additional Insured Persons) Or Organization: Location and Description Of Completed Operations: City of Bremerton Any coverage provided by this endorsement 345 6th St Ste 100 applies only to fencing work along Hwy 3, Bremerton, WA 98337-1891 Bremerton WA. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is B. With respect to the insurance afforded to these An Insured: additional insureds, the following is added to Any person(s) or organization(s) shown in the Paragraph D. Liability Limits of Insurance: Schedule is also an additional insured, but only If coverage provided to the additional insured is with respect to liability for "bodily injury" or required by a contract or agreement, the most "property damage" caused, in whole or in part, we will pay on behalf of the additional insured is by "your work" at the location designated and the amount of insurance: described in the Schedule of this endorsement 1. Required by the contract or agreement; or performed for that additional insured and 2. Available under the applicable Limits of included in the "products -completed operations Insurance shown in the Declarations; hazard". However: whichever is less. 1. The insurance afforded to such additional This endorsement shall not increase the insured only applies to the extent permitted applicable Limits Of Insurance shown in the by law; and Declarations. 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. Puget Fence INC Federated Mutual Insurance Company 1598 SE Oregon St Home Office Port Orchard, WA 98367-9345 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office, Inc. with its permission. BP-F-256 (01-13) Policy Number: 6092558 Transaction Effective Date: 04/12/2024 CANCELLATIONMON RENEWAL NOTICE Page 1 of 1 �+� Third Part Copy I;�a �' ADDITIONAL INSURED MAY 0 8 7' 1 City of Bremerton Risk Management Insured: PUGET FENCE INC 1598 SE OREGON ST PORT ORCHARD, WA 98367-9345 Account Number: 175-434-0 Date: 04/30/2024 Place of Issue: FEDERATED INSURANCE 121 East Park Square PO Box 328 Owatonna, MN 55060 Cancel lation/Nonrenewal of each policy listed below was requested by the insured. According to contract language in the policies listed below, we will continue to protect your interest as a mortgagee, additional insured, or a loss payee through the date and time of day shown below. Policy Policy Cancellation/Nonrenewal Number Policy Type Date 6092558 Business Owners Package 04/12/2024 6092559 Commercial Package Policy 04/12/2024 6092561 Employment Related Pract 04/12/2024 6092560 Umbrella 04/12/2024 * Standard time at the designated business premises. CITY OF BREMERTON 345 6TH ST STE 100 BREMERTON, WA 98337-1891 Loss Payee/ Mortgagee/ Additional Insured/ Certificate Holder Time of Policy Cancel lation/Nonrenewal' 12:01 a.m. 12:01 a.m. 12:01 a.m. 12:01 a.m. FEDERATED MUTUAL INSURANCE COMPANY • FEDERATED SERVICE INSURANCE COMPANY*0 FEDERATED RESERVE INSURANCE COMPANY* MFO-40 (08-17) federatedinsurance.com I *Not licensed in all states. 11-888-333-4949