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HomeMy WebLinkAbout6499 CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 03/12/202/2024 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 NAME:Progressive Commercial Lines Customer and Agent Servicing Omega Financial PHONE FAX 10827 NE 68TH STE B,KIRKLAND,WA 98033 (A/C,No,Ext):1-800-444-4487 (A/C,No): E-MAIL ADDRESS: ro ressivecommercial email. ro ressive.com ADDRESS:p 9 @ p 9 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United Financial Casualty Company 11770 INSURED INSURER B: CONFLUENCE ENGINEERING GROUP,LLC 517 NORTH EAST 92ND INSURER C: SEATTLE,WA 98115 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 536654417883547207D031224T200912 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. 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 TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER D/POLICY EFF POLICY EXP LIMITS LTR INSD VD (MM/DYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE I I OCCUR DAMAGE O(Ea RENTED $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- PRODUCTS-COMP/OP AGG $ POLICY I I JECT I I LOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED _AUTOS ONLY X AUTOS Y Y 063546327 03/28/2023 03/28/2024 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER W- AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If Es,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below See ACORD 101 for additional coverage details. $ A Y Y 063546327 03/28/2023 03/28/2024 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. 345 6TH STREET BREMERTON,WA 98337 AUTHORIZED REPRESENTATIVE TTTT illat4lje ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: A D ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Omega Financial CONFLUENCE ENGINEERING GROUP,LLC POLICY NUMBER 517 NORTH EAST 92ND SEATTLE,WA 98115 063546327 CARRIER NAIC CODE United Financial Casualty Company 11770 EFFECTIVE DATE:03/28/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Additional Coverages Insurance coverage(s) Limits Personal Injury Protection $10,000 Underinsured Motorist Bodily Injury $2,000,000 Combined Single Limit Underinsured Motorist Property Damage $100,000 w/$100 Ded($300 if Hit&Run) Broad Form Matching Limits All Coverages Description of Location/Vehicles/Special Items Scheduled autos only 2021 TESLA MODEL Y 5YJYGDEE7MF146090 Comprehensive $500 Ded Collision $500 Ded Liability coverage may not apply to all scheduled vehicles. Additional Information City Of Bremerton is listed as an Additional Insured on this commercial auto policy. This policy is primary and non-contributory as to City of Bremerton regardless of whether Holder is a named insured of any other policy. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Form 2367 (06/10)M_CL Blanket Waiver of Subrogation Endorsement This endorsement modifies insurance provided by the Commercial Auto Policy, Motor Truck Cargo Legal Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement, as appears on the declarations page. All terms and conditions of the policy apply unless modified by this endorsement. If you pay the fee for this Blanket Waiver of Subrogation Endorsement, we agree to waive any and all subrogation claims against any person or organization with whom a written waiver agreement has been executed by the named insured, as required by written contract, prior to the occurrence of any loss. ALL OTHER TERMS, LIMITS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED. ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ih.------ 03/12/2024 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 CONTNAME: Chris Chris Kelly-Storbeck Omega Financial Investments & Insurance (C,"NO,Ext): (425)822-5722 FAX (A/C,No): (425)827-0889 10829 NE 68th St Suite 201 E-MAIL ADDRESS: chrisks@omega-financial.com KIRKLAND, WA 98033 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Crum Forster Specialty Insurance Company INSURED INSURERB: Progressive Insurance Co 11770 CONFLUENCE ENGINEERING GROUP LLC INSURERC: 517 North East 92nd INSURER D: Seattle, WA 98115 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00001113-815509 REVISION NUMBER: 343 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y EPK-146947 03/19/2024 03/19/2025 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 06354632-8 03/28/2023 03/28/2024 COMBINED SINGLE LIMIT $ (Ea accident) 2,000,000 x 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) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION EPK-146947 03/19/2024 03/19/2025 STATUTE X OERTH Stop Gap AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Professional Liab EPK-146947 03/19/2024 03/19/2025 Per Occ/Agg $2M/$3M A Pollution Liab EPK-146947 03/19/2024 03/19/2025 Occ/AGg $2M/$2M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: City of Bremerton Technical Assistance Water Quality 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. 345 6th Street Suite 100 Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE 42 ' A / ���21%1� �=iti (CKS) ©1988 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CKS on 03/12/2024 at 01:07PM AGENCY CUSTOMER ID: 00001113 LOC#: A`oRo ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED Omega Financial Investments&Insurance CONFLUENCE ENGINEERING GROUP LLC POLICY NUMBER N/A CARRIER NAIC CODE Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The City of Bremerton is an Additional Insured per EN0111-0211 and Completed Operaitons per EN0320-0211. Insurance is Primary and Noncontributory per EN0118-0211 and Waiver of Subrogation applies per EN0109-0211 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by CKS on March 12,2024 at 01:07PM CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 03/12/202/2024 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 NAME:Progressive Commercial Lines Customer and Agent Servicing Omega Financial PHONE FAX 10827 NE 68TH STE B,KIRKLAND,WA 98033 (A/C,No,Ext):1-800-444-4487 (A/C,No): E-MAIL ADDRESS: ro ressivecommercial email. ro ressive.com ADDRESS:p 9 @ p 9 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United Financial Casualty Company 11770 INSURED INSURER B: CONFLUENCE ENGINEERING GROUP,LLC 517 NORTH EAST 92ND INSURER C: SEATTLE,WA 98115 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 536654417883547207D031224T200912 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. 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 TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER D/POLICY EFF POLICY EXP LIMITS LTR INSD VD (MM/DYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE I I OCCUR DAMAGE O(Ea RENTED $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- PRODUCTS-COMP/OP AGG $ POLICY I I JECT I I LOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED _AUTOS ONLY X AUTOS Y Y 063546327 03/28/2023 03/28/2024 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER W- AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If Es,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below See ACORD 101 for additional coverage details. $ A Y Y 063546327 03/28/2023 03/28/2024 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. 345 6TH STREET BREMERTON,WA 98337 AUTHORIZED REPRESENTATIVE TTTT illat4lje ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: A D ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Omega Financial CONFLUENCE ENGINEERING GROUP,LLC POLICY NUMBER 517 NORTH EAST 92ND SEATTLE,WA 98115 063546327 CARRIER NAIC CODE United Financial Casualty Company 11770 EFFECTIVE DATE:03/28/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Additional Coverages Insurance coverage(s) Limits Personal Injury Protection $10,000 Underinsured Motorist Bodily Injury $2,000,000 Combined Single Limit Underinsured Motorist Property Damage $100,000 w/$100 Ded($300 if Hit&Run) Broad Form Matching Limits All Coverages Description of Location/Vehicles/Special Items Scheduled autos only 2021 TESLA MODEL Y 5YJYGDEE7MF146090 Comprehensive $500 Ded Collision $500 Ded Liability coverage may not apply to all scheduled vehicles. Additional Information City Of Bremerton is listed as an Additional Insured on this commercial auto policy. This policy is primary and non-contributory as to City of Bremerton regardless of whether Holder is a named insured of any other policy. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Form 2367 (06/10)M_CL Blanket Waiver of Subrogation Endorsement This endorsement modifies insurance provided by the Commercial Auto Policy, Motor Truck Cargo Legal Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement, as appears on the declarations page. All terms and conditions of the policy apply unless modified by this endorsement. If you pay the fee for this Blanket Waiver of Subrogation Endorsement, we agree to waive any and all subrogation claims against any person or organization with whom a written waiver agreement has been executed by the named insured, as required by written contract, prior to the occurrence of any loss. ALL OTHER TERMS, LIMITS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED. ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ih.------ 03/12/2024 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 CONTNAME: Chris Chris Kelly-Storbeck Omega Financial Investments & Insurance (C,"NO,Ext): (425)822-5722 FAX (A/C,No): (425)827-0889 10829 NE 68th St Suite 201 E-MAIL ADDRESS: chrisks@omega-financial.com KIRKLAND, WA 98033 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Crum Forster Specialty Insurance Company INSURED INSURERB: Progressive Insurance Co 11770 CONFLUENCE ENGINEERING GROUP LLC INSURERC: 517 North East 92nd INSURER D: Seattle, WA 98115 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00001113-815509 REVISION NUMBER: 343 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y EPK-146947 03/19/2024 03/19/2025 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 06354632-8 03/28/2023 03/28/2024 COMBINED SINGLE LIMIT $ (Ea accident) 2,000,000 x 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) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION EPK-146947 03/19/2024 03/19/2025 STATUTE X OERTH Stop Gap AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Professional Liab EPK-146947 03/19/2024 03/19/2025 Per Occ/Agg $2M/$3M A Pollution Liab EPK-146947 03/19/2024 03/19/2025 Occ/AGg $2M/$2M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: City of Bremerton Technical Assistance Water Quality 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. 345 6th Street Suite 100 Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE 42 ' A / ���21%1� �=iti (CKS) ©1988 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CKS on 03/12/2024 at 01:07PM AGENCY CUSTOMER ID: 00001113 LOC#: A`oRo ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED Omega Financial Investments&Insurance CONFLUENCE ENGINEERING GROUP LLC POLICY NUMBER N/A CARRIER NAIC CODE Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The City of Bremerton is an Additional Insured per EN0111-0211 and Completed Operaitons per EN0320-0211. Insurance is Primary and Noncontributory per EN0118-0211 and Waiver of Subrogation applies per EN0109-0211 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by CKS on March 12,2024 at 01:07PM OMEGA financial investments & insurance 10827 NE 68*StSuite 200; Kirkland WA 98033-4000 T 425/822/5722 F 425/827/0889 Omega Financial Investments & Insurance, will issue certificates of insurance in accordance with statutory laws.We will only issue the most current edition of the ACORD certificates of insurance - a revised edition of the Acord 25 was published in October 2009. The issuance or modification of a certificate of insurance that in any way misrepresents any material term, condition, coverage or other provision as set forth in the policy, or deliberately or falsely amends or alters the insurance policy or assists in such issuance or modification violated the state law and subjects the violator to civil and criminal penalties. The only information allowed to be entered in the Description of Operations area of the ACORD certificates of insurance is the description of operations, the locations and/or vehicles covered by the in-force policy. Wording referencing forms or status must be added in the Remarks section. The certificate holder is not owed a duty to be notified in the event the insurance policy is cancelled. There is no longer a "30 day notice" provision in the certificate and it cannot be added. Only a policy can obligate an insurer to provide notice of cancellation. Unless a policy's provisions explicitly provide for notice to a party also listed as the certificate holder on the certificate of insurance, the insurer is not obliged to notify that party. Please note a certificate of insurance is simply a summary of the designated insurance policy and does not!cannot modify or amend the reference insurance policy or confer any right upon the certificate holder. For purposes of this notice, "certificate" or"certificate of insurance"means any ACORD certificate of insurance, which is prepared or issued by an insurer or insurance agent as evidence of property or casualty insurance coverage but does not include an actual copy of the insurance policy or insurance binder. Please contact the Washington State Office of the Insurance Commissioner for further explanation. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART ONSITE CLEANUP COVERAGE PART SCHEDULE Name of Person(s)or Organization(s) Blanket when specifically required in a written contract with the named insured. SECTION VI — COMMON CONDITIONS, item 17. Transfer Of Rights of Recovery Against Others To Us within the Common Provisions is amended by the addition of the following: Solely as respects the person(s) or organization(s) indicated in the Schedule shown above, we waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of your ongoing operations or "your work" performed under a written contract with that person(s) or organization(s) and included in the "products- completed operations hazard". However, this waiver shall not apply to "damages" resulting from the sole negligence of the person(s) or organization(s) indicated in the Schedule shown above. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0109-0211 Page 1 of 1 El CRUM &FORSTER A FAIRFAX COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) or Organization(s) Blanket when specifically required in a written contract with the named insured. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability caused, in whole or in part, by "your work" for that insured which is performed by you or by those acting on your behalf. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0111-0211 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) or Organization(s) Blanket when specifically required in a written contract with the named insured. A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely with respect to "claims" caused in whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This insurance shall be primary and non-contributory, but only in the event of a named insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of"your work" performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0118-0211 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Person(s) or Organization(s): Location And Description Of Completed Operations Blanket when specifically required in a written contract with the Blanket when specifically required in a written named insured. contract with the named insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section III — Who Is An Insured within the Common Provisions is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". EN0320-0211 Page 1 of 1