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HomeMy WebLinkAbout6195 - L2 Systems LLC - COI_2Humble Insurance Group r ACC " CERTIFICATE OF LIABILITY INSURANCE DATE 4MMlDD1YYYY) 1012812022 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 CONTACT Kathy Kane NAME: Humble Insurance Group, Inc. A Na : (425) 255 9342 At Na Ext : (425) 226 8221 FA 3500 Maple Valley Hwy E-MAIL kathy@humbleinsurancegroup.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Western National Mutual Insurance Company 15377 Renton WA 98058 INSURED INSURERS: INSURER C : L2 Systems LLC INSURER D : 3925 88th St NE, Ste F INSURER E : INSURER F : Marysville WA 98270 COVERAGES CERTIFICATE NUMBER: 22/23 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIT1 iOTANDING ANY REQUIREMENT, TERM OR CONDITION or Aw.' OONTRAOT OR OT3 IER DOCUMENT WITI I REDPEOT TO WI 11011 TI 110 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 LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO PREM SE5 Ea occurrence $ 100,000 _7RETED MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 A Y CPP 1032664 11115/2022 11/15/2023 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JPERCTO LOC PRODUCTS -COMPIOPACG $ 2,000,000 $ OTHER: AUTOMOBILE LABILITY COMBINED S#NGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS CPP 1032260 1111512022 /1/1512023 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE g 1,000,000 A EXCESStIAB CLAIMS -MADE UMS 1005317 11/15/2022 11/15/2023 DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETO£t(PARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory in NH) N/A CPP1032664 11115/2022 1111512023 PER OTH- STATUTE X ER WA STOP GAP E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ PROFESSIONAL LIABILITY A CPP 1032664 11/15/2022 11115/2023 LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES tACORD 101, Additional Remarks Schedute, may be attached if more space is required) The Certificate holder is named as additional insured with respects to the operations of the named insured. Coverage is primary and non-contributory per form WNGL49. Waiver of subrogation applies per farm WNGL39. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Bremerton ACCORDANCE WITH THE POLICY PROVISIONS. Public Works & Utililities AUTHORIZED REPRESENTATIVE 100 Oyster Bay Ave N Bremerton WA 98312 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD