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HomeMy WebLinkAboutCOI 2019-2021DATE (MM/DD/YYYY) AGENCY PHONE A/C, No, Ext): COMPANY E-MAIL ADDRESS: FAX A/C, No): CODE:SUB CODE: AGENCY CUSTOMER ID #: INSURED LOAN NUMBER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE THIS REPLACES PRIOR EVIDENCE DATED: LOCATION/DESCRIPTION COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE NAME AND ADDRESS AUTHORIZED REPRESENTATIVE CONTINUED UNTIL TERMINATED IF CHECKED MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN # THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PROPERTY INFORMATION COVERAGE INFORMATION REMARKS (Including Special Conditions) CANCELLATION ADDITIONALINTEREST ACORD 27 (2009/12) 1 of © 1993-2009 ACORD CORPORATION. All rightsreserved. The ACORD name andlogo are registered marks of ACORD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONSOF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ACORDTM EVIDENCE OF PROPERTY INSURANCE YMCAPIE 11/18/2020 USI Insurance Services NW 601 Union St. Suite 1000 Seattle, WA 98101 206 441-6300 1617813 kevin.swiryn@usi.com Great American Insurance Company YMCA of Pierce and Kitsap Counties 4717 S 19th St Ste 201 Tacoma, WA 98405-1167 PAC327464100 12/31/19 12/31/20 Location #1 REFER TO SOV Tacoma, WA 98465-2122 Blanket Building Limit $246,416,560 $10,000 Blanket Business Personal Property $30,596,750 $10,000 Blanket Business Income $62,351,719 24 Hours 100% Coinsurance, Agreed Value Special Form, Replacement Cost Earthquake Limits Everest Indemnity #8400007695-191 $10,000,000 $50,000/5% City of Bremerton 345 6th St., Ste 100 Bremerton, WA 98337 X 1 S 1105202 TOEJU Client#: 1617813 YMCAPIE ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/24/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services NW 601 Union St. Suite 1000 Seattle, WA 98101 206 441-6300 INSURED a 206 731-1200 INSURERS) AFFORDING COVERAGE JAN 0 4 2020 IINSURER A: Great American Insurance Company YMCA of Pierce and Kitsap Counties City of Bremerton acoma, WA 98405=1167 4Risk Management T 717 S 19th St Ste 201 COVERAGES CERTIFICATE Nl1MRFR• INSURER B : Ohio CaSUalty Insurance Company D: E: NAIC # 16691 24074 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 CONTRACTOR 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 ADDL SU8 POLICY EFF POLICY EXP LTRTYPEOFINSURANCEINSRWVDPOLICYNUMBERMMIDDMM/DD LIMITS A A X COMMERCIAL GENERAL LIABILITY CLAIMS - MADE OCCUR WA STOPGAP* X X X X PAC327464101 CAP327464201 12/ 31/2020 12/ 31/2020 07/ 01/2021 07/ 01/2021 EACH OCCURRENCE 1,0009000 PREMISES EaRENTED100,000 X MED EXP (Anyone person) 5,000 PERSONAL & ADV INJURY 110001000 GEN' L AGGREGATE LIMIT APPLIES PER: POLICY ECOT Fx] LOC OTHER: AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED XXAUTOSONLYAUTOSONLYGENERAL AGGREGATE 3,000,000 PRODUCTS - COMP/OP AGG 3,000,000 STOPGAP* COMBINED tSINGLELIMIT 11000, 000 1, 0001000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident A B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS - MADE X X NIA X X UMB327464301 ECO215935894 12/ 31/2020 12/ 31/2020 07/ 01/2021 07/ 01/2021 EACH OCCURRENCE 10OOO OOO AGGREGATE 1 O 00O 000 DED X RETENTION $1U 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/ PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 5M x $ 10M PER OTH- S UTE I JER 5 000 000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is named as Additional Insured as it relates to General Liability in accordance with the terms and conditions of the policy. City of Bremerton 345 6th St., Suite 100 BremertonWA 98337 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 1988- 2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/ 03) 1 of 1 The ACORD name and logo are registered marks of ACORD S30741601/M30740345 pp p