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HomeMy WebLinkAbout1 - Original Submission_ CONEL07-City of Bremerton-18512984ANY 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 Insurance Brokers, LLC 777 S. Figueroa Street, 52nd Fl. CA License #0F15767 Los Angeles CA 90017 (213) 689-0065 Consolidated Electrical Distributors, Inc. PC 0936 4503 Auto Center Way Bremerton WA 98310 CONEL07 The Travelers Indemnity Company 25658 Travelers Property Casualty Co of America 25674 X X X Contractual Liab. 2,000,000 1,000,000 Excluded 2,000,000 8,000,000 4,000,000 X X X 3,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X 15,000,000 15,000,000 XXXXXXX N X 1,000,000 1,000,000 1,000,000 A TC2J-CAP-4252B443-TIL-21 11/1/2021 11/1/2022 A TC2JGLSA-4252B431-21 11/1/2021 11/1/2022 A ZUP-51N21568-21-NF 11/1/2021 11/1/2022 A UB-0R372280-21-51-K 11/1/2021 11/1/2022BUB-0R294586-21-51-R 11/1/2021 11/1/2022B(AZ/MA/WI) 11/1/2022 1327136 Y Y N N N N N 5/10/2022 18512984 18512984 XXXXXXX City of Bremerton 345 6th Street, Suite 100 Bremerton WA 98337 Evidence of Insurance as respects operations of the Named Insured. RE: City of Bremerton is/are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. Waiver of Subrogation applies per attached endorsement(s) or policy language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached endorsements or policy language. X See Attachments DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 City of Bremerton 345 6th Street, Suite 100 Bremerton, WA 98337 To whom it may concern: In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance, thus, this is your final hard-copy delivery. To ensure electronic delivery for future renewals of this certificate, we need your email address. Please contact us via one of the methods below, referencing Certificate ID 18512984. Email: PacificeDelivery@lockton.com Phone: (213) 689-2300 If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. In the event your mailing address has changed, will change in the future, or you no longer require this certificate, please let us know using one of the methods above. The above inbox and phone number below are for automating electronic delivery of certificates only. Please do NOT send future certificate requests to the above inbox or call into the number below. Thank you for your cooperation and willingness in reducing our environmental footprint. Lockton Insurance Brokers, LLC - Pacific Series Lockton Insurance Brokers, LLC License #0F15767 777 S Figueroa Street, 52nd Fl / Los Angeles, CA 90017-5524 213-689-0065 / FAX: 213-689-0550 lockton.com Attachment Code: D567517 Master ID: 1327136, Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 services, including:The following is added to SECTION II – WHO IS AN INSURED:(a) The preparing, approving, or failing to Any person or organization that you agree in a written prepare or approve,maps,shop contract or agreement to include as an additional drawings, opinions, reports, surveys, field insured on this Coverage Part is an insured, but only:orders or changeorders, or the preparing, approving,or failing to prepare ora.With respect to liability for "bodily injury"or approve,drawings and specifications;"property damage"that occurs,or for "personal andinjury" caused by an offense that is committed, subsequent to the signing of that contract or (b) Supervisory, inspection, architectural or agreement and while that part of the contract or engineering activities. agreement is in effect; and (2)Any "bodily injury"or "property damage"b.If,and only to the extent that,the injury or caused by "your work"and included in thedamage is caused by acts or omissions of you or "products-completed operations hazard".your subcontractor in the performance of "your work" to which the written contract or agreement c.The additional insured must comply with the applies. Such person or organization does not following duties:qualify as an additional insured with respect to the independent acts or omissions of such person or (1) Give us written notice as soon as practicable organization.of an "occurrence" or an offense which may result in a claim. To the extent possible, suchThe insurance provided to such additional insured is notice should include:subject to the following provisions: (a)How,when and where the "a.If the Limits of Insurance of this Coverage Partshown in the exceed the minimum or offense took place; limits required by the written contract or (b)The names and addresses of any injuredagreement,the insurance provided to the persons and witnesses; andadditional insured will be limited to such minimum required limits. For the purposes of determining (c) The nature and location of any injury or whether this limitation applies, the minimum limits damage arising out of the "occurrence" or required by the written contract or agreement will offense. be considered to include the minimum limits of (2)If a claim is made or "suit" is brought againstanyUmbrellaorExcessliabilitycoveragethe additional insured:required for the additional insured by that written contract or agreement. This provision will not (a) Immediately record the of the increase the limits of insurance described in claim or "suit" and the date received; and Section III – Limits Of Insurance.(b)Notify us as soon as practicable and seeb.The insurance provided to such insured to it that we receive written notice of thedoes not apply to:claim or "suit" as soon as(1)Any "bodily injury","property damage"or"personal injury" arising out of the providing,(3) Immediately send us copies of all legal occurrence" Declarations specifics additional practicable. or failure to provide,any professional papers received in connection with the claim or "suit",cooperate with us in the CG D2 48 04 19 © 2018 The Travelers Indemnity Company. All rights reserved.Page 1 of 2 COMMERCIAL GENERAL LIABILITY TC2JGLSA-4252B431-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Excludes Products-Completed Operations) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITYCOVERAGE PART PROVISIONS architectural,engineering or surveying Attachment Code: D469209 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 TC2JGLSA-4252B431-21 COMMERCIAL GENERAL LIABILITY investigation or settlement of the claim or condition does not affect whether the defense against the "suit", and otherwise insurance provided to such additional insured comply with all policy conditions.is primary to other insurance available to such additional insured which covers that person or(4)Tender the defense and indemnity of any organization as a named insured asclaimor"suit"to any provider of other described in Paragraph 4.,Other Insurance,insurance which would cover such additional of Section IV – Commercial General Liabilityinsuredforalosswecover.However,this Conditions. Page 2 of 2 © 2018 The Travelers Indemnity Company. All rights reserved.CG D2 48 04 19 Attachment Code: D469209 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 a.The statements in the Declarations are accurate and complete; b.Those statements are based upon representations you made to us; and c.We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a.As if each Named Insured were the only Named Insured; and b.Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1."Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a.Notices that are published include material placed on the Internet or on similar electronic means of communication; and b.Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved.CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY Policy #TC2JGLSA-4252B431-21 c.Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d.Primary And Non-Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury' or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5.Premium Audit a.We will compute all premiums for this Coverage Part in accordance with our rules and rates. b.Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6.Representations By accepting this policy, you agree: Attachment Code: D541709 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 TC2JGLSA-4252B431-21 Travelers Property Casualty Co of America (b.)if coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: (1) This insurance does not apply to "bodily injury" or "property damage" occurring after: (a.) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations has been completed; or (b.) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. (2) The insurance provided to any additional insured does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: (a.) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions,reports,surveys,field orders,change orders,or drawings and specifications; or (b.) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that Insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering or the failure to render any professional services by or for you. c. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: (1)Required by the contract or agreement; or (2)Available under the applicable Limits of Insurance shown in the Declarations; Whichever is less. 2. Vendors a. SECTION II - WHO IS AN INSURED, is amended to include as an additional insured: (1.) Any person or organization (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. However: ESG 3206 (Ed. 01/16)(Page 6 of 10) Attachment Code: D600604 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 TC2JGLSA-4252B431-21 Travelers Property Casualty Co of America (a.) the insurance afforded to such vendor only applies to the extent permitted by law; and (b.) if coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. b. With respect to the insurance afforded to these vendors, the following additional exclusions apply: (1.) The insurance afforded the vendor does not apply to: (a.) "bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b.) any express warranty unauthorized by you; (c.) any physical or chemical change in the product made intentionally by the vendor; (d.) repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e.) any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f.) demonstration, installation, servicing or repair operations, except such operations performed by the vendor in full compliance with the manufacturer's written instructions at the vendor's premises in connection with the sale of the product; (g.) products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; (h.) "bodily injury" or "property damage" arising out of the sole negligence of the vendors for its own acts or omission of those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i)the exceptions contained in subparagraphs (d.) or (f.); or (ii) such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2.) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. c. With respect to the insurance afforded to these vendors, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the most amount of insurance: (1.) Required by the contract or agreement; or ESG 3206 (Ed. 01/16)(Page 7 of 10) Attachment Code: D600604 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 TC2JGLSA-4252B431-21 Travelers Property Casualty Co of America (2.) Available under the applicable Limits of Insurance shown in the Declarations; Whichever is less. 3.Primary and Non-Contributory Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1.) The Additional Insured is a Named Insured under such other insurance; and (2.) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an Additional Insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an Additional Insured on other policies. L. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1.Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, or "explosion," to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. 2.Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced by the following: 6. Subject to paragraph 5. Above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, or "explosion," while rented to you or temporarily ESG 3206 (Ed. 01/16)(Page 8 of 10) Attachment Code: D600604 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7 TC2JGLSA-4252B431-21 Travelers Property Casualty Co of America occupied by you with the permission of the owner, for all such damage caused by fire, lightning, or "explosion," proximately caused by the same event, whether such damage results from fire, lightning, or "explosion," or any combination of the three, is the higher of $500,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3.Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance item (ii) of the Occurrence Form and item (iii) of the Claims-Made Form where the words, fire insurance, appear they are changed to, insurance for fire, lightning, or "explosion." 4.As regards coverage provided by this provision L. Damage to Premises Rented to You, SECTION V - DEFINITIONS, paragraph 9. Insured Contract, subparagraph a. is replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, or "explosion," to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract." 5.As regards coverage provided by this provision L. Damage to Premises Rented to You, SECTION V - DEFINITIONS is amended by the addition of the following definition: "Explosion" means a sudden release of expanding pressure accompanied by a noise, a bursting forth of material and evidence of the scattering of debris to locations further than would have resulted by gravity alone. "Explosion" does not include any of the following: (a)artificially generated electrical current including electrical arcing, that disturbs electrical devices, appliances or wires; (b)rupture or bursting of water pipes; (c)explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your control; or (d)rupture or bursting caused by centrifugal force. M.Waiver of Subrogation Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 8. Transfer or Rights of Recovery Against Others to Us, the following paragraph is added: b. If required by a written "insured contract" executed prior to the occurrence or offense, we waive our right of recovery we have against any person or organization named in such "insured contract," because of payments we make for injury or damage arising out of your ongoing operations or "your work" for that person or organization. N.Property Damage - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), and (4) of exclusion j. Damage to Property do not apply if such "property damage" results from the use of elevators. ESG 3206 (Ed. 01/16)(Page 9 of 10) Attachment Code: D600604 Certificate ID: 18512984 DocuSign Envelope ID: D90CA156-5160-4AAB-9549-CDE2E4783BF7