Loading...
HomeMy WebLinkAbout5857 original and mod 1A oR CERTIFICATE OF LIABILITY INSURANCE DAT8/23/ 2D/ YYYY) 8/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND, 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 SilverStone Group 11516 Miracle Hills Drive Suite 100 CONTACT NAME: Sher Allen PHONENo- Ext). 402-964-5644 FAX No): E-MAILADDRESS: Certificates SS i.com INSURER(S) AFFORDING COVERAGE NAIC# Omaha NE 68154 INSURER A: Travelers Property & Cas Of Am 36161 n nnnnnMnTlnAl All rlr. LFc rncnrlrnrl INSURED INSURER B: St. Paul Fire And Marine Ins. INSURER C : Varsity Contractors, Inc. dba Varsity Facility Services DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 PO Box 1692 INSURERD: Pocatello ID 83204 INSURER E : INSURER F GUVtRAI3tJ %.,FF%I IIiMIL IN -l- 1. - I ---v-, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN, 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. IN RILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS l' A X COMMERCIALGENERALLIABILITY CLAIMS -MADE rX ] OCCUR n nnnnnMnTlnAl All rlr. LFc rncnrlrnrl TC2JGLSA1761B754 9/1/2017 9/112018 EACH OCCURRENCE $1,000;006' DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ /C PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000 00,%' GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS $2,000,000 '"^ RO F LOCPOLICY PRO-CT A OTHER: AUTOMOBILE LIABILITY X ANY AUTO TC2JCAP1761B742 9/1/2017 9/1/2018 COMBINED SINGLE LIMIT $1,000, 0Eaaccident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident)$ B X UMBRELLALIAB X OCCUR ZUP21N2602417NF 9/1/2017 9/1/2018 EACH OCCURRENCE $19,00g0 ,!"' AGGREGATE $ 19,000,000EXCESSLIABCLAIMS -MADE X PER OTH- STATUTE ERA N/A TC2JUB1761B698 9/1/2017 9/1/2018 DED X RETENTION $10 nno WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,000 j E.L. DISEASE - EA EMPLOYEE $ 1,000,utV/' Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder has 30 days' Notice of Cancellation provided with respects to General Liability (Automobile Liability, Workers Compensation and/or Umbrella) as required by written contract. j jCityofBremertonislistedasadd'(tiojrA insured on a primaryen¢ non-contributory basis with respect to General Liability including completed operations asrequiredbywrittencontract. Waiv6f of subrog idn applies in m,Vor of City of Bremerton as required by written contract. GERTIFICA It t1ULUt:K SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton 345 6th Street, Suite 100 Bremerton WA 98337 AUTHORIZED REPRESENTATIVE ip n nnnnnMnTlnAl All rlr. LFc rncnrlrnrl V IJVV-GV IJ I"Ivvl v vv.• v........ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2JGLSA1761B754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED,. - CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", property damage" or"personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) b) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". TniS endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: L The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring Insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the written contract requiring insurance" specifically requires that this insuranc apply on a primary basis or a primary a non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG 02 46 08 05 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii_ The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: I. Immediately record the specifies of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the Bairn or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5_ The following definition is added to SECTION V. DEP'INtTIONS: written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 ® 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 000826 POLICY NUMBER: TC27GLSA176IB754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Any person or entity with whom you have agreed in a written contract, executed prior to loss to name as an additional insured, but only for the limits agreed to in such contract or the limits of insurance of this policy, whichever is less. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", "personal injury" or advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG D411 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: TC2JGLSA176113754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primai4 to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All riahts reserved. Paae 1 of 1 G(2191-1 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 8/31/2018 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: She Allen SilverStone Group PHONE 11516 Miracle Hills Drive 402-964-5644 a No E-MAILADDRESS: sallen@ssgi.comSuite100 INSURERS AFFORDING COVERAG NAIC# Omaha NE 68154 INSURER A: Travelers Property Casualty Co. of America 36161 CLAIMS -MADE X OCCUR INSURED INSURERB-:- Varsity Contractors, Inc. dba Varsity Facility Services INSURERC: pINSURERD: f BremartnirPOBox1692 RiskINSURERE : Risk ManPocatelloID83204 INSURER F: COVERAGES CERTIFICATE NUMBER: 2026618640 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. INSRLTR OF INSURANCE ADDLSUBRPOLICTYPEIVSDWVDPOLICYNUMBEREFFYYYY MMIDDY POLICY EXP MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TC2J-GLSA1761B754-TIL18 9/1/2018 1/2019 EACH OCCURRENCE $1,000 0 DAMAGE TO RENTEDCLAIMS -MADE X OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,00 0 POLICY PRCOT [ LOC PRODUCTS - COMP/OP AGG $ 2,000 000. OTHER: A AUTOMOBILE LIABILITY TC2J-CAP1761 8742-TIL18 9/1/2018 9/1/2019 COMBINED SINGLE LIMIT $1,000; ooEaaccident BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLALIAB X OCCUR ZUP21N26024-18-NF 9/1/2018 9/1/2019 EACH OCCURRENCE $19,00 00. AGGREGATE $ 19,000,000EXCESSLIABCLAIMS -MADE DED I X I RETENTION $ 10000 I A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N TC2JUB-176113698-18 9/1/2018 9/1/2019 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,00 o0 OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000MandatoryinNH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / HICLES (ACORD 101, Additional marks Schedule, may be attached if more space is required) City of Bremerton is listed as addoefial insuro on a primary non-contributory basis with respect to General Liability including completed operations as required by written contract. Waiver of 4ub gation applies in favor of City of Bremerton as required by written contract. CERTIFICATE HOLDER CANCELLATION 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton 345 6th Street, Suite 100 Bremerton WA 98337 AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2JGLSA1761B754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you/ agree in a "written contract requiring insurance" // to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", property damage" or"personal injury'; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent ads or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or property damage" caused by "your work" and'included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the written contract requiring insurance" specifically requires that this insuranc apply on a primary basis or a primary ap non-contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. bj If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the Bairn or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions, d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5_ The following definition is added to SECTION V. DEFINtTIONS: Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and C. Before the end of the policy period Page 2 of 2 0 2005 The St, Paul Travelers Companies, Inc. CG D2 46 08 05000eze POLICY NUMBER: TC2JGLSA176113754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Persons) or Organization(s): l Any person or entity with whom you have agreed in a written contract! executed prior to loss to name as an additional insured, but only for the limits agreed to in such contract or the limits of insurance of this policy, whichever is less. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", "persanal injury" or advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG D411 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: TC2JGLSA1761B754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE -- ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary an on -contributory basis, this insur- ance is pri ry to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. GG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Paoe 1 of 1 b) r% 4fac4 ek p1 f1 d '?'S, 1 61 l 6b CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/30/2019 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 SilverStone Group 11516 Miracle Hills Drive RECEIVESSuite100 CONTACT NAME: Sherry Allen PHONE FAX402-964-5644 No): A/c E-MDRAILADEss: sallen@ssgi.com INSURER(S) AFFORDING COVERAGE NAIC# Omaha NE 68154 INSURER A: Travelers Property Casualty Co. of America 36161SEPINSURED032019 Varsity Contractors, Inc. 3605 Ocean Ranch Blvd, Ste 200 Oceanside CA 92056 CRY of Bremertorp Risk Management INSURER B: INSURER C INSURERD: INSURER E: INSURER F: PRODUCTS - COMP/OPAGG $2,0 COVERAGES CERTIFICATE NUMBER: 340693667 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. INSRLTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE CUR TC2J-GLSA1761B754-TIL19 9/1/2019 9/1/2020 EACH -OCCURRENCE $1,000,000: DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a PRO- LOC OTHER: GENERAL AGGREGATE $ 2,00 PRODUCTS - COMP/OPAGG $2,0 A AUTOMOBILE 1X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY TC2J-CAP1761B742-TIL19 9/1/2019 9/1/2020 COMBINED SINGLELIMIT $1,0 0Eaaccident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident A X UMBRELLA LIAB EXCESS LIAB X I OCCUR CLAIMS -MADE ZUP-21N26024-19-NF 9/1/2019 9/1/2020 EACH OCCURRENCE $19,00,0, 0 AGGREGATE $ 19,00 ,000 DED I X RETENTION $ in nnn A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVEF—]E.L. OFFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A UB -3N21 0059 -1 9-51-R 9/1/2019 9/1/2020 X SPER TATUTE OERH EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,00 0 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS IVEHI ES (ACORD 101, A'Oditional RerpOks Schedule, may be attached if more space is required) City of Bremerton is listed as additionq!,insured on a pr andUprl-contributory basis with respect to General Liability including completed operations as required by written contract. Waiver oflubrogation applies in favor of City of Bremerton as required by written contract. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton 345 6th Street, Suite 100 r' Bremerton WA 98337 AUTHORIZED REPRESENTATIVE 0 ACORD 25 (2016/03) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2JGLSA1761B754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART t. WHO IS AN INSURED -- (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", property damage" or"personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance' applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance'. This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or property damage" caused by "your work" anc Ancluded in the "products -completed op- erations hazard" unless the "written contract requiring insurance' specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance' requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG 02 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; it. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: L Immediately record the specifies of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the Bairn or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a toss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5_ The following definition is added to SECTION V. DEFINfTIONS: Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05oone2e POLICY NUMBER: TC2JGLSA1761B754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(sI or Organization(s): Any person or entity with whom you have agreed in a written contract, executed prior to loss to name as an additional insured, but only for the limits agreed to in such contract or the limits of insurance of this policy, whichever is less_ Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", "persanal injury" or advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG D411 04 08 © 2008 The Travelers companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. August 6, 2019 Public Works and Utilities Department 100 Oyster Bay Ave. N • Bremerton, WA 98312 • (360) 473-5920 • FAX (360) 473-5360 Misker Arefeayne Varsity Facility Services 1502 Pike Street NW Suite #1 Auburn, WA 98001 Dear Mr. Arefeayne Work contract # 21801 for janitorial services is scheduled to expire on 08/05/2019. Under the automatic extension option, we are extending work contract # 21801 for twelve (12) months, per city PSA # 5857, Section II Term. The extension is subject to existing prices, terms, conditions and specifications, and will have a new expiration date of 08/05/2020. Should you have any questions, please call me at (360) 473-2316 or e-mail me at Chris. Mottner@ci.bremerton.wa.us. Thank you for your continued interest in doing business with the State of Washington and the City of Bremerton. Sincerely, 1 Chris Mottner Facilities/Inventory Supervisor Cc: Contract File Monya Tabor, Office of State Procurement Angela Woods, City Clerk Wayne Hamilton, Utility Operations Manager POLICY NUMBER: TC2JGLSA176113754 POLICY TERM: 09/01/2017 - 09/01/2018 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE -- ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverag Part must apply on a primary basis, or a prirn y and norV!nthbutory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All dahts reserved. Paae 1 of 1 DATE(MM/DD/Yl'YY) CERTIFICATE OF LIABILITY INSURANCE 04/022020 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)5 AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. us 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). CONTACT PRODUCER NAME: Aon Risk Services Central, Inc. PHONE (g66) 283-7122 FAX (800) 363-0105 Chicago IL office ( ac. No. Ext): (NC. No.): 200 East Randolph ADDRESS: Chicago IL 60601 USA INSURER(S) INSURED IZCVCI Y CL varsity Contractors Inc. dba Varsity Facility Services 3605 ocean Ranch Blvd, Suite 200 APR 0 8 2020OceansideCA92056USA AFFORDING COVERAGE NAIC # INSURER A: Zurich American Ins CO 16535 INSURER B: American Zurich Ins CO 40142 INSURERC: Travelers Property Cas Co of America 25674 INSURER D: INSURER E City of Bremerton INSURER F: 1 I COVERAGES CERTIFIF.i116i A F1 6 081301712 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN, 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. Limits shown are as requested LTSRIR TYPE OF INSURANCE I SD WVD POLICY NUMBER MMJDD/YYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 5 4 04/01/2021 EACH OCCURRENCE $2 , 000 , 000 DAMAGE TO RENTED $500 , 000 CLAIMS -MADE X OCCUR PREMISES Ea occurrence MED EXP (Any one person) $10 , 000 PERSONAL& ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY PRO LOC PRODUCTS-COMP/OPAGG $4,000,00000 JECT OTHER: A AUTOMOBILE LIABILITY BAP 6510032-30 04/01/2020 04/01/2021 COMBINED SINGLE LIMIT $5,000,000 Ea accident BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED Per accident ONLY AUTOS ONLY C X UMBRELLALIAB X OCCUR ZUP21P2450020NF 04/01/2020 04/01/2021 EACH OCCURRENCE $1010001000 SIR applies per policy terns & conditions AGGREGATE $1010009000 EXCESS LIAB CLAIMS -MADE DED X RETENTION B WORKERS COMPENSATION AND wc651003030 04/61/2626 04/51/2021 X PER STATUTE OTTH- ER EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1, 000, 000 OFFICERIMEMBER EXCLUDED? N N / A E.L. DISEASE -EA EMPLOYEE $1, 000 , 000 Mandatory In NH) If Yes, describe under E.L. DISEASE -POLICY LIMIT $1 , 000 , 000 DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If more space Is required) Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability evidenced herein is Primary and Non -Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, City Of Bremerton AUTHORIZED REPRESENTATIVE 345 6th Street, Suite 100 d a 0 2 N r M 0 u- i 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) AFRO CERTIFICATE OF LIABILITY INSURANCE I 04/02/2021 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 entlorsed. 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). PflODUCER t'iCl Cl V GL Aon Risk services Central, Inc. Chicago IL office 200 East Randolph Chicago IL 60601 USA APR 19 2021 INSURED City of Bremenon Kellermeyer Bergensons services, LLCRisk Management 3605 ocean Ranch Blvd. suite 200 Oceanside CA 92056 USA EMAIL ADDRESS: C866) 283-7122 INSURERS) AFFORDING COVERAGE INSURER A; ZUrICh AmerlCan IRS CO INSUFIERB: American zurich Ins co 800) 363-0105 NAIC # 16535 40142 INSURERC: ACE Property &Casualty Insurance Co. 20699 INSURER D: INSURER E: INSURER F: ES CERTIFICATE NUMBER: 570086840477 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 LO 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. Limits shown are as requested LTA TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY GL0651003131 EACH OCCURRENCE 2 , 000, 000 CLAIMS - MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence)$500, 000 MED EXP (Any one person) 10 , 000 PERSONAL & ADV INJURY 2,0001000 GENI AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT00GENERAL AGGREGATE 41000,000 PRODUCTS - COMP/OPAGG 4,000,000 OTHER: A AUTOMOBILE LIABILITY BAP 6510032-31 04/01/202104/01/2022 COMBINED SINGLE LIMIT Ea accident 5,000,000 X ANY AUTO BODILY INJURY ( Per person) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED AUTOS ONLY ONLYFI BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident C X UMBRELLALIAB EXCESS LIAR JX OCCUR CLAIMS-MADE G72514117001 SIR applies per policy terns 04 01/ 2021 condl 04 01/ 2022 ions I EACH OCCURRENCE 10,000,000 AGGREGATE 10, 000,000 DED X RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/ N ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory In NH) It as, describe under DESCRIPTION OF OPERATIONS below N / A wc651003031 04 O1 2021 04 Ol 2022 X PER STATUTE OTH• ER E.L, EACH ACCIDENT 1, OOO, OOO E.L. DISEASE -EA EMPLOYEE 1, 000 , 000 E.L. DISEASE -POLICY LIMIT 19000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) certificate Holder is included as Additional insured in accordance with the policy provisions of the General Liability policy. General Liability evidenced herein is Primary and Non -Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of certificate Holder in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clty Of Bremerton AUTHORIZED REPRESENTATIVE 345 6th Street, Suite 100 Brmerton wA 98337 u5A `Y i ` ea eSi F 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/ 03) The ACORD name and logo are registered marks of ACORD MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire, IL 60069 MDG2021 00001383 01 I I 1 1 11'II''I I1 1 1111 1 11 1 1 1'11111'I I City of Bremerton 345 6th Street, Suite 100 Brmerton WA 98337 A DAT 0(MWD20 2YYY) CERTIFICATE OF LIABILITY INSURANCE 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, No IMPORTANT: If the cercate 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 Aon Risk services Central, Inc. Chicago IL office 200 East Randolph Chicago IL 60601 USA INSURED Kellermeyer Bergensons 3605 ocean Ranch Blvd. Oceanside CA 92056 USA Ti1,U cf1eTeI 9 services, LLc suite 200 RECE'Ef: APR 12 City ofi Bremerton Risk Management EMAILADDRESS: 866) 283-7122 INSURERS) AFFORDING COVERAGE INSURER A: ZUrICh American Ins CO INSURERB: American Zurich Ins co 600) 363-0105 NAIC # 35 INSURERC: ACE Property &Casualty insurance co. 20699 INSURER D: INSURER E: INSURER F: 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. Limits shown are as requested INSRLTR TYPE OF INSURANCE ADULINSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EAP MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GLO EACH OCCURRENCE 2 , 000 , 000 PREMISES Ea occurrence)$ 500,000 MED EXP (Any one person) 10, 000 PERSONAL & ADV INJURY 290001000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO LOCJECT OTHER: GENERAL AGGREGATE 41000,000 X PRODUCTS - COMP/OPAGG 4,000,000 A AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY BAP 6510032-32 04/01/2022 04/01/2023 COMBINED SINGLE LIMIT Ea accident 5,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident C X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE XEUG72514117002 SIR applies per policy terns 04 01 2022 conditions 04 01 2023 EACH OCCURRENCE 10,0001000 AGGREGATE 109000,000 DED X RETENTION B WORKERS COMPENSATION AND EMPLOYE RS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICERWEMBER EXCLUDED? N Mandatory In NH) If as, describe under DESCRIPTION OF OPERATIONS below N / A WC6510 3032 04 1 2022 04 01 2023 X PER STATUTE OTRH- E,L. EACH ACCIDENT 1,0001000 E.L. DISEASE -EA EMPLOYEE 10000, 000 E. L. DISEASE -POLICY LIMIT 11000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate Holder is included as Additional insured in accordance with the policy provisions of the General Liability policy. General Liability evidenced herein is Primary and Non -Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of BrelllertOn AUTHORIZED REPRESENTATIVE 345 6th street, Suite 100 v 0 2 1988- 2015 ACORD CORPORATION. All rights reserved. ACORD 25 ( 2016/03) The ACORD name and logo are registered marks of ACORD