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HomeMy WebLinkAboutCityofBremerton_W28733353SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY Willis Towers Watson Northeast, Inc.c/o 26 Century BlvdP.O. Box 305191Nashville, TN 372305191 USA Ferguson Enterprises, LLC and Subsidiaries(See Attached Named Insured Schedule)751 Lakefront CommonsNewport News, VA 23606 Store #3653 Workers Compensation Policy WLR C70312165 provides coverage for AK, AL, AR, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL,IN, KS, KY, LA, MD, ME, MI, MN, MO, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WVSEE ATTACHED City of BremertonAttn: Melinda Monroe345 6th St., Suite 100Bremerton, WA 98337 04/18/2023 1-877-945-7378 1-888-467-2378 certificates@willis.com ACE American Insurance Company 22667 ACE Property & Casualty Insurance Company Indemnity Insurance Company of North Ameri 20699 43575 ACE Fire Underwriters Insurance Company 20702 W28733353 A 5,000,000 5,000,000 5,000 5,000,000 10,000,000 10,000,000 Y HDO G47312097 05/01/2023 05/01/2024 A 5,000,000 05/01/202405/01/2023 Self-Insured Physical Damage Y ISA H10707377 B 1,000,000 XOOG72519802 003 05/01/2023 05/01/2024 1,000,000 WLR C70312165C 2,000,000No05/01/2023 05/01/2024 2,000,000 2,000,000 A Workers' Compensation & Employers Liability - AZ/CA/MA/ E.L. Each AccidentWLR C70312128 05/01/2023 05/01/2024 E.L. Disease -Pol Lmt OR, Per Statute E.L. Disease-Each Emp 293899424022795SR ID:BATCH: $2,000,000 $2,000,000 $2,000,000 Willis Towers Watson Certificate Center Page 1 of 2 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Ferguson Enterprises, LLC and Subsidiaries(See Attached Named Insured Schedule)751 Lakefront CommonsNewport News, VA 23606 City of Bremerton is included as Additional Insured under General Liability as required by written contract but onlywith respect to liability arising out of Named Insured's operations. City of Bremerton is included as Additional Insured as respects to Auto Liability. INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIC#: 20702POLICY NUMBER: RWC C70312244 EFF DATE: 05/01/2023 EXP DATE: 05/01/2024 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:Workers' Compensation & E.L. Each Accident $2,000,000Employers Liability - WI E.L. Disease -Pol Lmt $2,000,000Per Statute E.L. Disease-Each Emp $2,000,000 2 2 Willis Towers Watson Northeast, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W28733353CERT:2938994BATCH:24022795SR ID: As of 1/19/2023 Entity Name Entity Name Aaron and Company, Inc. (effective 5/23/2022)Ferguson Enterprises LLC dba Plumbers Supply Company of St. Louis (eff 2/16/2022) AC Wholesalers Ferguson Enterprises of Virginia, LLC ACF Environmental (effective 11/16/2020)Ferguson Facilities Supply (FEI) Action Automation, a Wolseley Industrial Group company (eff 8/20/2018)Ferguson Facilities Supply (for Matera Paper -TX only) Action Plumbing Supply (effective 7/15/2019)Ferguson Facilities Supply, Dogwood Building Supply Division (eff 10/22/18) Adirondack Piping Solutions (effective 2/7/2022)Ferguson Fire & Fabrication, Inc. ADL (effective 7/16/2018)Ferguson Fire & Fabrication International Airefco (effective 11/16/2022)Ferguson Fire Design, LLC (effective 10/7/2022) Alaska Pipe & Supply Ferguson Heating & Cooling Amerock, LLC (effective 1/11/2021)Ferguson Hospitality Sales Amerock Holdings, Inc. (effective 1/11/2021)Ferguson HVAC – Air Cold AMS Steam Products (effective 12/13/2021)Ferguson HVAC – EastWest Air Andrews Lighting & Hardware Gallery Ferguson HVAC – Lyon Conklin The Ar-Jay Center Ferguson Industrial (effective 3/15/2022) Atlantic American Fire Equipment Company Ferguson Integrated Services Avallon Global Ferguson International BAC Appliance Center Ferguson Panama, S.A. Bath + Beyond Ferguson Parts & Packaging Bayport Partners, LLC Ferguson Valve & Automation Blackman Plumbing Supply, LLC (effective 12/11/2018)Ferguson Waterworks Brock-McVey (effective 7/30/2018)Ferguson Waterworks - Municipal Pipe Bruce-Rogers Company Ferguson Waterworks - Red Hed Build.com, Inc. (fka Improvement Direct, Inc.)Ferguson Waterworks EPPCO Cal-Steam Ferguson Waterworks International Canyon Pipe & Supply (effective 7/26/2021)Founders Kitchen & Bath, Inc. (effective 4/25/2022) Capital Distributing (effective 10/29/2018)Galleria Bath & Kitchen Showplace City Lights Design Showroom Grand Junction Pipe (effective 9/24/2018) CFP HM Wallace, Inc. Clawfoot Supply, LLC Hot Water Products (effective 12/13/2021) Cline Contract Sales Hot Water Sales and Associates (effective 12/13/2021) Columbia Pipe & Supply LLC (eff 3/13/2020)H.P. Products Corporation Custom Lighting & Hardware HP Logistic, Inc. D2 Land & Water Resource (effective 7/18/2022)Improvement Brands Holdings, Inc. Davies Water Industrial Hub of the Carolinas DBS Holdings, Inc. Innovative Soil Solutions LLC (effective 7/29/2019) Dealernet James Martin Signature Vanities, LLC (effective 1/28/2019) Duhig Stainless (effective 3/12/2018)J&G Products Energy & Process Corporation Jones Stephens Corp. (effective 8/13/2018) Equarius Waterworks, Meter & Automation Group Jones Stephens Global Sourcing (Wuxi) Ltd. (effective 8/13/2018) Factory Direct Appliance J.D. Daddario Company Ferguson Bath & Kitchen Gallery Joseph G. Pollard Co. Ferguson Bath, Kitchen & Lighting Gallery JWIT Hydrotherapy Bath Solutions (effective 3/16/2020) Ferguson.com Karl’s Appliances Ferguson CESCO, Inc.Kitchen Art (effective 2/4/2019) Ferguson Direct Lakeland Plumbing Supply, LLC Ferguson CeSCO, Inc.Lighting Design Center Ferguson Enterprises, Inc. Lighting Unlimited Ferguson Enterprises, LLC Lincoln Products Ferguson Enterprises LLC dba Henry Plumbing Kitchen & Bath Galleries (eff 2/9/2022)Linwood Pipe and Supply Ferguson Enterprises LLC dba Henry Plumbing Supply (effective 2/9/2022)Living Direct, Inc. Ferguson Enterprises LLC dba Henry Kitchen & Bath (effective 2/16/2022)Louisiana Utilities Supply Company FERGUSON ENTERPRISES, LLC ACTIVE DBA SUBSIDIARY LIST As of 1/19/2023 FERGUSON ENTERPRISES, LLC ACTIVE DBA SUBSIDIARY LIST PAGE 2 - DBA & SUBSIDIARY LIST Entity Name Entity Name LUSCO Rybak Engineering (effective 7/26/2022) Mahwah Realty, LLC S.W. Anderson Sales Corporation (effective 11/11/2019) Maskir Properties Inc.Safe Step Walk in Tub (effective 11/1/2021) Matera Paper Company, Inc.Safe Step Walk in Tub, LLC (effective 7/31/2018) Max Industries, Ltd. (effective 1/28/2019)SG Supply Co. McFarland Supply Ship-Pac Meyer Appliance (effective 9/20/2021)Signature Hardware MFP Design (effective 3/25/2020)SimplyPlumbing, LLC Michigan Meter SOS Sales Millennium Lighting, Inc. (effective 8/27/2018)Southhampton Realty Corp. Minka Lighting, LLC (effective 7/25/2022)Stock Loan Services, LLC Mission Valley Pipe (effective 6/3/2019)Sunstate Meter & Supply, Inc. (effective 10/25/2021) Mississippi Utility Supply Co. (MUSCO)Supply.com Moore Industrial Supply (effective 7/12/2021)Tarpon Wholesale Supplies Myers HVAC Supply The Davidson Group National Fire Products The Kitchen Showcase (effective 6/21/2021) New Jersey Plumbing Group, LLC The Plumbing Source New York Plumbing Designs, LLC The Stock Market North Point Plumbing Supply, LLC Tinkar Realty, LLC Old Dominion Supply, Inc. (effective 10/26/2020)TotalFab, LLC Orange County Plumbing Group, LLC TPW Kitchen & Bath Palm Designs LLC Triton Environmental (effective 6/27/2022) PCS Industries Uncle Sam Piping Solutions (effective 2/7/2022) PL Sourcing Wallwork (effective 12/10/2018) Plumb Source Wanlyn Realty Corp. Plumbers Supply Company (effective 1/24/2022)Waterworks Industries Plumbing Décor Webb Distributors Plumbing Holdings Corp.Western Air Supply Pollardwater Westfield Lighting Powell Pipe & Supply Co.Wholesale Group Power Equipment Direct Inc.Wholesale Group Operations, Inc. Power Process Equipment (effective 12/5/2022)Wolseley (Barbados) Ltd Process Instruments & Controls, LLC (effective 9/9/2019)Wolseley de Puerto Rico, Inc. Professional's Bath Source Wolseley Financial Services PV Sullivan Supply Wolseley Industrial Group Ramapo Wholesalers Wolseley Integrated de Mexico S.A. de C.V. RB Huntington Realty, LLC Wolseley Investments North America, Inc. Rencor Controls (effective 3/16/2020 Wolseley Investments, Inc. Robertson Supply (effective 11/19/2018)Wolseley NA Construction Services, LLC Rocky Hollow Realty, LLC Wolseley NA Finance, Inc. Renwes Sales Wolseley Staffing de Mexico S.A. de C.V. Redlon & Johnson WPCC Forwarding Reese Kitchen, Bath & Lighting Gallery Wright Plumbing Supply