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Home My WebLink AboutCity of BremertonAttn Director of Financial Services 49725 LIAB1 of 13 (RJS00) 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 PERIODINDICATED. 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. 10/03/2023 Parker, Smith & Feek Insurance, LLC. 2233 112th Avenue NE Bellevue, WA 98004 425-709-3600 425-709-7460 Hanover American Insurance Company Columbia Hospitality, Inc. Attn: Finance Department 2200 Alaskan Way, Suite 200 Seattle, WA 98121-3608 Allmerica Financial Benefit Insurance Ace Property & Casualty Ins. Co. Allied World Surplus Lines Insurance A X 1,000,000 8 X 8 8 ZZ2A39143610 10/01/2023 10/01/2024 1,000,000 10,000 1,000,000 2,000,000 2,000,000 Liquor-Ea Common Cause 1,000,000 B 1,000,000 8 X 8 8 AW2A90458710 10/01/2023 10/01/2024 C 8 10,000,000 8 X X 10,000,000 8 NIL PUMB23AG27675797 10/01/2023 10/01/2024 A 810/01/2023 10/01/2024 1,000,000 ZZ2A39143610 ** WA Stop Gap 1,000,000 1,000,000 D Professional Liability Misc Professional 03047668 10/01/2023 10/01/2024 1,000,000 INSR: Markel American Insurance Company | INS TYPE: Umbrella / Excess Liability Occur; Retention: NIL; | | POLICY NUMBER: SHELLPUMB23AG27675797 (10/01/2023 - 10/01/2024)SHELLPUMB23AG27675797 | LIMITS: Each Occurrence: 5,000,000;Aggregate: 5,000,000; INSR: Admiral Insurance Co. | INS TYPE: Employment Practices Liability | | POLICY NUMBER: DCP1058358P13 (10/01/2023 - 10/01/2024)DCP1058358P13 | LIMITS: 2MM Each Claim/35k Retention... (See Attached Description) City of Bremerton Attn: Director of Financial Services 345 6th St, Ste 100 Bremerton, WA 98337 2 of 13 (RJS00) DESCRIPTIONS (Continued from Page ) 1 ; INSR: Federal Insurance Company | INS TYPE: Employee Theft/ERISA | | POLICY NUMBER: 82075839 (10/01/2023 - 10/01/2024)82075839 | LIMITS: 2MM/2,500 Ded/$500k ERISA or 10% up to $1M no retention; Kitsap County Conference Center - 100 Washington Avenue, Bremerton, WA 98337. The City of Bremerton is an additional insured and coverage is primary and non-contributory on the General Liability, Auto, and Excess Liability policies per the attached endorsements/forms. The General Liability policy includes Liquor Liability of $1,000,000 Occurrence; $2,000,000 Aggregate. Waiver of Subrogation applies on the general liability and excess liability policies per the attached endorsements/forms. 3 of 13 (RJS00) ,QFOXGHVFRS\ULJKWHGPDWHULDORI,QVXUDQFH6HUYLFHV2IILFH,QFZLWKLWVSHUPLVVLRQ3DJHRI 7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< &200(5&,$/*(1(5$//,$%,/,7<%52$'(1,1*(1'256(0(17 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 6800$5<2)&29(5$*(6 $GGLWLRQDO,QVXUHGE\&RQWUDFW$JUHHPHQWRU3HUPLW ,QFOXGHG $GGLWLRQDO,QVXUHG–3ULPDU\DQG1RQ&RQWULEXWRU\ ,QFOXGHG %ODQNHW:DLYHURI6XEURJDWLRQ ,QFOXGHG %RGLO\,QMXU\5HGHILQHG,QFOXGHG %URDG)RUP3URSHUW\'DPDJH–%RUURZHG(TXLSPHQW&XVWRPHUV*RRGV 8VHRI(OHYDWRUV ,QFOXGHG .QRZOHGJHRI2FFXUUHQFH ,QFOXGHG /LEHUDOL]DWLRQ&ODXVHOQFOXGHG 0HGLFDO3D\PHQWV–([WHQGHG5HSRUWLQJ3HULRG ,QFOXGHG 1HZO\$FTXLUHGRU)RUPHG2UJDQL]DWLRQV&RYHUHGXQWLOHQGRISROLF\SHULRG ,QFOXGHG 1RQRZQHG:DWHUFUDIWIW 6XSSOHPHQWDU\3D\PHQWV,QFUHDVHG/LPLWV %DLO%RQGV /RVVRI(DUQLQJV 8QLQWHQWLRQDO)DLOXUHWR'LVFORVH+D]DUGV ,QFOXGHG 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&200(5&,$/ *(1(5$/ /,$%,/,7< &21',7,2163DUDJUDSK7UDQVIHU2I5LJKWV 2I 5HFRYHU\$JDLQVW2WKHUV7R8V :HZDLYHDQ\ULJKWRIUHFRYHU\ZHPD\KDYH DJDLQVWDQ\SHUVRQRURUJDQL]DWLRQZLWKZKRP\RX KDYHDZULWWHQFRQWUDFWWKDWUHTXLUHVVXFKZDLYHU EHFDXVHRISD\PHQWVZHPDNHIRUGDPDJHXQGHU WKLVFRYHUDJHIRUP7KHGDPDJHPXVWDULVHRXWRI \RXU DFWLYLWLHV XQGHU D ZULWWHQ FRQWUDFW ZLWK WKDW SHUVRQRURUJDQL]DWLRQ7KLVZDLYHUDSSOLHVRQO\WR WKH H[WHQW WKDW VXEURJDWLRQ LV ZDLYHG XQGHU D ZULWWHQFRQWUDFt executed prior to the “occurrence” RURIIHQVHJLYLQJULVHWRVXFKSD\PHQWV %RGLO\,QMXU\5HGHILQHG 6(&7,219–'(),1,7,216'HILQLWLRQ“bodily injury” is replaced E\WKHIROORZLQJ “Bodily injury” means ERGLO\LQMXU\VLFNQHVVRU GLVHDVHVXVWDLQHGE\DSHUVRQLQFOXGLQJGHDWK UHVXOWLQJIURPDQ\RIWKHVHDWDQ\WLPH“Bodily injury” LQFOXGHV PHQWDO DQJXLVK RU RWKHU PHQWDOLQMXU\UHVXOWLQJIURP“bodily injury”. %URDG )RUP 3URSHUW\ 'DPDJH–%RUURZHG (TXLSPHQW &XVWRPHUV *RRGV 8VH RI (OHYDWRUV D 6(&7,21,–&29(5$*(6&29(5$*($– %2',/,< ,1-85< $1' 3523(57< '$0$*( /,$%,/,7< 3DUDJUDSK ([FOXVLRQVVXESDUDJUDSKM LV DPHQGHG DV IROORZV 3DUDJUDSKGRHVQRWDSSO\WRSURSHUW\ GDPDJH WR ERUURZHG HTXLSPHQW ZKLOH DW D MREVLWH DQG QRW EHLQJ XVHG WR SHUIRUP RSHUDWLRQV 3DUDJUDSKV DQG GR QRW DSSO\ WR SURSHUW\GDPDJHWRFXVWRPHUVJRRGVZKLOH RQ\RXUSUHPLVHVQRUGRWKH\DSSO\WRWKHXVH RIHOHYDWRUVDWSUHPLVHV\RXRZQUHQWOHDVH RURFFXS\ E 7KH IROORZLQJ LV DGGHG WR6(&7,21 9– '(),17,216 &XVWRPHUV JRRGV PHDQV SURSHUW\ RI \RXU FXVWRPHU RQ \RXU SUHPLVHV IRU WKH SXUSRVHRIEHLQJ 6 of 13 (RJS00)2 of 4 (SZ000) THIS PAGE INTENTIONALLY LEFT BLANK 7 of 13 (RJS00)2 of 4 (SZ000) THIS PAGE INTENTIONALLY LEFT BLANK 8 of 13 (RJS00)2 of 4 (SZ000) THIS PAGE INTENTIONALLY LEFT BLANK 9 of 13 (RJS00) Mobile Equip- ment Subject To Compulsory Or Financial Responsibility Or Other Motor Vehicle Insur- ance Law Only Only those "autos" thai are land vehicles and that would qualify under the definition of "mobile equipment" under this policy if they were not subject lo a compulsory or financial responsibility law or other motor vehicle insurance law where they are licensed or principally garaged. B. Owned Autos You Acquire After The Policy Begins 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered next to a coverage in Item Two of the Decla- rations, then you have coverage for "autos" that you acquire of the type described for the remainder of the policy period. 2. But, if Symbol 7 Is entered next to a cover- age in Item Two of the Declarations, an "auto" you acquire will be a covered "auto" for that coverage only if: a. We already cover all "autos" that you own for that coverage or it replaces an "auto" you previously owned that had that cov- erage; and b. You tell us within 30 days after you ac- quire it that you want us lo cover it for that coverage. C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos If Liability Coverage is provided by this Cover- age Form, the following types of vehicles are also covered "autos" for Liability Coverage: 1. "Trailers" with a load capacity of 2,000 pounds or less designed primarily for travel on public roads. 2. "Mobile equipment" while being carried or towed by a covered "auto". 3. Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or e. Destruction. SECTION 11 - LIABILITY COVERAGE A. Coverage We will pay all sums an "Insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance ap- plies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto". We will also pay all sums an "insured" legally must pay as a "covered pollution cost or ex- pense" to which this insurance applies, caused by an "accident" and resulting from the owner- ship, maintenance or use of covered "autos". However, we will only pay for the "covered pol- lution cost or expense" if there is either "bodily Injury" or "property damage" to which this in- surance applies that Is caused by the same "accident". We have the right and duty lo defend any "in- sured" against a "suit" asking for such damages or a "covered pollution cost or expense". How- ever, we have no duty to defend any "insured" against a "suit" seeking damages for "bodily injury" or "property damage" or a "covered pollution cost or expense" to which this insur- ance does not apply. We may Investigate and settle any claim or "suit" as we consider appro- priate. Our duty to defend or settle ends when the Liability Coverage Limit of Insurance has been exhausted by payment of judgments or settlements. 1. Who Is An Insured The following are "Insureds": a. You for any covered "auto". b. Anyone else while using with your per- mission a covered "auto" you own, hire or borrow except: (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. Page 2 of 12 4,812 Copyright ISO Properties, Inc., 2005 CA 00 01 03 06 10 of 13 (RJS00) (#\) Hanover In.surance Group . AW2A904587 0901121 (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 busi- ness 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 mov- ing property to or from a covered "aulo". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "aulo" owned by him or her or a member of his or her household. c. Anyone liable for the conduct of an "in- sured" described above but only to the extent of that liability. 2. Coverage Extensions a. Supplementary Payments We will pay for the "insured": (1) All expenses we incur. (2) Up to $2,000 for cost of bail bonds (in- cluding bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (3) The cost of bonds to release attach- ments in any "suit" against the "In- sured" we defend, but only for bond amounts within our Limit of Insurance. (4) All reasonable expenses incurred by the "insured" at our request Including actual loss of earnings up to $250 a day because of time off from work. (5) All costs taxed againsl the "insured" In any "suit" against the "insured" we defend. (6) All interest on the full amount of any judgment that accrues after enlry of the judgment in any "suit" againsl the "insured" we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. These payments will not reduce the Limit of Insurance. b. Out-Of-State Coverage Extensions While a covered "auto" is away from the state where il is licensed we will: (1) Increase the Limit of Insurance for Li- ability Coverage to meet the limits specified by a compulsory or financial responsibility law of the jurisdiction where the covered "auto" Is being used. This extension does not apply to the limit or limits specified by any law governing motor carriers of passen- gers or property. (2) Provide the minimum amounts and types of other coverages, such as no- fault, required of out-of-state vehicles by the jurisdiction where the covered "auto" is being used. We will not pay anyone more than once for the same elements of loss because of these extensions. B. Exclusions This Insurance does not apply to any of the fol- lowing: 1. Expected Or Intended Injury "Bodily injury" or "property damage" ex- pected or Intended from the standpoint of the "Insured". 2. Contractual Liability assumed under any contract or agreemenL But this exclusion does not apply to liability for damages: a. Assumed in a contract or agreement that is an "insured contract" provided the "bodily Injury" or "property damage" oc- curs subsequent to the execution of the contract or agreement or b. That the "insured" would have in the ab- sence of the contract or agreement. 3. Workers' Compensation Any obligation for which the "insured" or the "insured's" insurer may be held liable under any workers' compensation, disability bene- fits or unemployment compensalion law or any similar law. 4. Employee Indemnification And Employer's Liability "Bodily injury" to: a. An "employee" of the "insured" arising out of and in the course of: (1) Employment by the "insured"; or CA 00 01 03 06 4.813 Copyright ISO Properties, Inc., 2005 Page 3 of 12 11 of 13 (RJS00) ADDITIONAL INSURED WHERE REQUIRED BY AGREEMENT ENDORSEMENT ORAL AGREEMENT PERMITTED Named Insured Endorsement Number Premier Hospitality Insurance Group,Inc.007 Policy Symbol Poticy Number Policy Period Effective Date of Endorsement XO0O G28970249 001 03/01/2021 to 03/01/2023 03/01/2021 Issued By (Name of Insurance Company)ACE Property and Casualty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY POLICY The policy is amended as follows: Section Il.WHO IS AN INSURED is amended to add the following: Any person or organization to whom you become obligated to include as an additional “insured”under this policy,as a result of an agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy.It is not necessary that such agreement be in writing but it must be legally binding on you and in effect prior to the “occurrence”for which coverage is claimed. Such person or organization is an “insured”subject to the following limitations: 1.The person or organization in an “insured”only with respect to liability arising out of your operations,“products completed operations hazard”or premises owned by or rented to you;and 2.The insurance provided will not exceed the lesser of: a.The limits of this policy,or b.The limits required by the contract. All other terms and conditions of this policy remain unchanged. Authorized Representative XS-41442 (01/14)©2014 Page 1 of 1 12 of 13 (RJS00) OTHER INSURANCE AMENDMENT PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY CONTRACT Named Insured Endorsement Number Columbia Hospitality, Inc. 006 Policy Symbol I Policy Number I Policy Penod xoo PUMB22AG27671834 10/1/2022 to 10/1/2023 Effective Date of Endorsement 10/1/2022 Issued By (Name of Insurance Company) ACE Property and Casualty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: ACE UMBRELLA PLUSsM COMMERCIAL UMBRELLA LIABILITY POLICY SECTION VI. CONDITIONS, Part J. Other Insurance is deleted and replaced by the following: If valid and collectible "other insurance" applies to damages that are also covered by this policy, this policy will apply excess of the "other insurance" and will not contribute with such "other insurance" unless the insured is required by contract to provide insurance on a primary and non-contributory basis. This provision will not apply if the "other insurance" is written to be excess of this policy. All other terms and conditions of this policy remain unchanged. Authorized Representative XS-38039 (05/13) ©2012C Page 1 of 1 13 of 13 (RJS00) TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured Endorsement Number Premier Hospitality Insurance Group,Inc.037 Policy Symbol Policy Number Policy Period Effective Date of EndorsementX00G2897024900103/01/2021 to 03/01/2023 03/01/2021 tssued By (Name of Insurance Company)ACE Property and Casualty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY POLICY It is agreed that the policy is amended at SECTION VI.CONDITIONS by deleting Condition N.Transfer of Rights of Recovery Against Others to Us in its entirety and replacing it with the following: N.Transfer of Rights of Recovery Against Others to Us 1.If the “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”must do nothing after “loss”to impair them.At our request,the “insured”wilt bring “suit”or transfer those rights to us and help us enforce them. 2.Any amount recovered will be apportioned in the inverse order of payment of “loss”to the extent of actual payment.The expenses of all such recovery proceedings will be apportioned in the ratio of respective recoveries. 3.If you and the insurer of “underlying insurance”waive any right of recovery against a specific person or organization for damages as required under an “insured contract’,we will also waive any such rights we mayhaveagainstsuchpersonororganizationprovidedthatthe“bodily injury”or “property damage”occurs subsequent to the execution of the “insured contract”. All other terms and conditions of this policy remain unchanged. Authorized Representative XS-48916 (03/17)Page 1 of 1