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HomeMy WebLinkAbout6583At ORS® �..�� CERTIFICATE OF LIABILITY INSURANCE oAT02/10/2025 vv1 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(les) 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 FEDERATED MUTUAL INSURANCE COMPANY AND ITS AFFILIATES INCLUDING PRIMARY SOURCE INSURANCE AGENCY NAME: CLIENT CONTACT CENTER PHONE (A/C, No, Ext):888-333-4949 (A/C, 110): 507-446-4664 E-MAIL ADORESs: CLIENTCONTACTCENTER@FEDINS.COM 121 E. PARK SQUARE OWATONNA, MN 55060 INSURERS AFFORDING COVERAGE NAIC N INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED I btt&�VAVIGATORS SPECIALTY INSURANCE 36056 NEW LINE SERVICES INC, AGATE ASPHALT INSURER C: 16330 STATE HIGHWAY 305 NE STE 200 INSURER D: POULSBO, WA 98370-7892 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 88 REVISION NUMBER: U 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YVYV POLICY EXP MM/DD/YYYV LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y Y 1853153 03/06/2025 03/06/2026 EACH OCCURRENCE $1,()00,000 TO ENTED PREMISES AMo (Ea DAGEcarrence $100,000 MED EXP (Any one person) EXCLUDED PERSONAL& ADV INJURY $1,000,000 OENL MP0LICY AGGREGATE LIMIT APPLIES PER: ECT LOC L_POTHER: GENERAL AGGREGATE $2 ODD 000 PRODUCTS & COMPIOP ACC $2,000,000 A AUTOMOBILE LIABILITY X ANYAUTO OWNED AUTOS ONLY AUTOSSCHEDULED HIRED AUTOS ONLY O OoED N N N 1853153 03/06/2025 03/06/2026 O C MBINED SINGLE LIMIT CO accident) $1,000,000 BODILY INJURY (Per Person) BODILY INJURY (Per Accident) RORTYDAMAGEA PROPERTY r A A X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE N N 1853155 03/06/2025 03/06/2026 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED RETENTION A WORK-ERS-LOMPENSATION AND -EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERI EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N 1853153 03/06/2025 03/06/2026 PER STATUTE OTHER E.L EACH ACCIDENT $1,000,000 E.L DISEASE EA EMPLOYEE $1,000,000 E.L DISEASE - POLICY LIMIT $1,000,000 B CONTRACTORS POLLUTION LIABILITY Y Y SF25ECP000158NC 03/06/2025 03/06/2026 EACH LIMIT $1,000,000 GGREG4TE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) SEE ATTACHED PAGE CFRTIFICATF HOLDER CANCELLATION CITY OF BREMERTON 345 6TH ST STE 100 RECEIVED 88 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BREMERTON, WA 98337-1891 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FEB19 2025 AUTHORIZED REPRESENTATIVE --.y Q, -remefZon _ Risk Management O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACC t�+� �0 k__1 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY AND ITS AFFILIATES NEW LINE SERVICES INC, AGATE ASPHALT 16330 STATE HIGHWAY 305 NE STE 200 INCLUDING PRIMARY SOURCE INSURANCE AGENCY POULSBO, WA 98370-7892 POLICY NUMBER SEE CERTIFICATE # 88.0 CARRIER NAIC CODE EFFECTIVE DATE: SEE CERTIFICATE # 88.0 SEE CERTIFICATE # 88.0 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE STOP -GAP (EMPLOYER'S LIABILITY) COVERED STATE(S) WA PROJECT-1314 SHOREWOOD DRIVEWAY IMPROVEMENTS. THE CITY, ITS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS SHALL BE NAMED AS AN ADDITIONAL INSURED. WAIVER OF SUBROGATION ALSO INCLUDES THE CITY, ITS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTDRY CLAUSE- OTHER INSURANCE CONDITIDN. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT ACORD 101 (2008701) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. we -non 14-Rill-Ink� • • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory 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. © Insurance Services Office, Inc., 2018 Page 1of1 CG 20 01 12 19 Policy Number: 1853153 Transaction Effective Date: 03/06/2025 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying 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 of or the failure to render any professional architectural, engineering or surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 1853153 Transaction Effective Date: 03/06/2025 2. '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(s) 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 a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 1853153 Transaction Effective Date: 03/06/2025 COMMERCIAL GENERAL LIABILITY CG 24 53 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 1853153 Transaction Effective Date: 03/06/2025 ��56-188 #BVVNOHBG oBOoO-O*'m,r #XVVXVVO021>0XO0<XX5# CITY DFBREK8ERTON 3458thGtSte 1OO Bremerton, VVA98337'1881