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HomeMy WebLinkAbout5999 - Pape & Sons ConstructionCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/09I2021 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 endorse 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 HENTSCHELL &ASSOC INC 1436 S. Union Ave. Tacoma INSURED Pape &Sons Construction, Inc. 9401 Bujacich Road Suite 1A Gig Harbor COVERAGES DEC 2 0 202I Ciry of Bremeltot: Risk Man)"/ -mom CERTIFICATE NUMBER: 21-22 Danielle Bryant (253) 272-1151 danielleb@hentschell.com INSURERS) AFFORDING COVERAGE INSURERA: The Charter Oak Fire Ins. Co INSURER B : The Travelers Indemnity Co. of America INsuRER C : Travelers Prop Cas Co of America INSURER D INSURER E INSURER F REVISION NUMBER: (253) 272-1225 NAIC # 25623 25658 25674 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IIJSURED 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 130003000 �/ CLAIMS -MADE /� OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 300,000 $ MED EXP (Any one person) $ 101000 A Y Y DTCOOJ154095COF21 12/31/2021 12/31/2022 PERSONAL &ADV INJURY $ 13000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 PRODUCTS-COMP/OPAGG $ 230002000 POLICY ❑X ECT LOC OTHER: WA StopGap/Empl Liab $ 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 11000,000 X ANYAUTO BODILY INJURY (Per person) $ B OWNED X SCHEDULED AUTOS ONLY AUTOS Y Y BA1L6589552126G 12/31/2021 12/31/2022 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,0001000 C EXCESS LIAB CLAIMS -MADE Y Y CUPOJ4039462126 12/31/2021 12/31/2022 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N X STATUTE ORH ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA WASHINGTON STATE FUND 12131/2021 12131/2022 E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 LIMIT- EACH JOB SITE LOC. C INSTALLATION FLOATER 630-9S118521-TIL-21 12131/2021 12131/2022 100,000 LIMIT - IN TRANSIT 1001000 LIMIT -TEMP. LOCATION DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Project: 2019 Sewage Pump Station CW-4 Replacement Blanket Primary Non -Contributory Additional Insured, including completed operations and Blanket Waiver of Subrogation applies in favor of any person or organization if called for by written contract or agreement, per policy forms and conditions; #CGD316 02/19, CGD246 04/19, CGD211 01/04, CGT100 0/19, CAT353 02115 - City of Bremerton is included as additional insured t^FRTI FI(:ATF H()I r1FR 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 AUTHORIZED REPRESENTATIVE Suite 100 Bremerton WA 98337 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD