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HomeMy WebLinkAboutCity of Bremerton - COI 2024-25ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Lockton Companies, LLC 3280 Peachtree Rd. NE, Ste. 1000 Atlanta GA 30305 (404) 460-3600 Imperial Parking (U.S.), LLC 307 7th Avenue, Suite 607 New York NY 10001 ACE Property and Casualty Insurance Company 20699 Everest National Insurance Company 10120 Beazley Insurance Company, Inc.37540 Endurance American Specialty Insurance Co.41718 Everest Premier Insurance Company 16045 X X X SIR $250K 2,000,000 1,000,000 XXXXXXX 1,000,000 4,000,000 4,000,000 X 5,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X 10,000,000 10,000,000 XXXXXXX N X 1,000,000 1,000,000 1,000,000 Crime $5,000,000 A RM3CA00011-241 (MA)10/1/2024 10/1/2025ARM3CA00012-241 (AOS)10/1/2024 10/1/2025EEXT3006836790010/1/2024 10/1/2025 A RM3GL00011-241 10/1/2024 10/1/2025 D V1FFC1240701 5/19/2024 5/19/2025 B XEUG72543117004 10/1/2024 10/1/2025 C RM3WC00007-241 (MA, WI)10/1/2024 10/1/2025CRM3WC00008-241 (FL, ME, NJ)10/1/2024 10/1/2025CRM3WC00009-241 (AOS)10/1/2024 10/1/2025 5/19/2025 1542829 Y N Y N Y N N 9/17/2024 N N 20706650 20706650 XXXXXXX THE CITY OF BREMERTON 345 6TH STREET, SUITE 600 Anaheim CA 92808 See Attached. X X See Attachment CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required) ACORD 25 (2016/03) RE: LOT 25-090-100, CITY OF BREMERTON PARKING ENFORCEMENT CITY OF BREMERTON IS INCLUDED AS ADDITIONAL INSURED (EXCEPT WORKERS’ COMPENSATION) WHERE REQUIRED BY WRITTEN CONTRACT. THIS INSURANCE IS PRIMARY AND NON-CONTRIBUTORY OVER ANY EXISTING INSURANCE AND LIMITED TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED SUBJECT TO POLICY TERMS AND CONDITIONS. Certificate Holder ID: 20706650 Auto Physical Damage and Garagekeepers (AOS) - Everest Indemnity Insurance Company 10/01/2024 - 10/01/2025 APD# - RM3CA00010-241 GKLL# - RM3CA00022-241 GKLL Limit - $1,000,000 per location on an excess basis APD - $50,000 deductible per unit GKLL - $250,000 SIR per unit Auto Physical Damage and Garagekeepers (MA) – Everest Indemnity Insurance Company 10/01/2024 - 10/01/2025 APD# - RM3CA00009-241 GKLL# - RM3CA00023-241 GKLL Limit - $1,000,000 per location on an excess basis APD - $50,000 deductible per unit GKLL - $250,000 SIR per unit Attachment Code: D648186 Master ID: 1542829, Certificate ID: 20706650