HomeMy WebLinkAbout3 - Legal Review Submission_ COI Prof Liability.ciAD'CERTIFICATE OF LIABILITY !NSURANCE o rE lirMn orYYm
9/23/202r
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMANO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGANVELYAMENO, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES
BELOW. TH|S CERTTFTCATE OF TNSURANCE DOES NOT COi{SnTUTE A CONTRACT BETWEEN THE TSSUTNG TNSURER(S), AUTHORIZED
REPRESENTANVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT lf tho cqrtificats holdsr is an ADDITIONAL INSUREO, the policy(ies) mult be endo6ed, lf SUBROGAnON lS WAIVEO, 3ubject to
tho to,m3 .nd conditions of the policy, cortaln pollcles may roquiG an endoEoment. A statement on thb ce ilicate does not confqr rlghts to the
ca(lllcate holder ln lieu of such endorBament(a).
PROOUCER
lot6n Agencies, Inc
P O Box 1554
Buckl€y tlA 98321
COf,TACI Diann€ Dain66
360-82 9-9{00
L ddaines0 tot€negenci€s . co[
INSI',RERIg) AEFORDING COVERAGE NA'C '
INSURERA: Continental Cesualtv CoEpanv
[{suREo
Pacific Foleat Rosourcea, Inc.
P. O. Box 395
EnuDcIer rfA 98022
IIISURERE
INSURERC
INSURER O
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:plof Iiab REVISION NUITIBER:
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUEO TO THE INSURED NAMEOABOVE FORTHE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO v\,t]ICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOU,,N MAY HAVE BEEN REDUCED 8Y PAIO CLAIMS,
SUBR POLICYIIUMBER POUCY EFF POUCY EIP UMIT9INSRLTRTYPE Of INSURAI{CE
IEACH OCCURRENCE
OAMAGE TO RENTEDPRFMTSFS IE.6. f,.n61 I
MEO EXP (Any on. pslon)I
PERSONAL T AOV INJURY I
GENERALAGGREGAIE t
PROoUCTS - COMP,OP AGG 5
t
COMI'ERCIAL GENERAL LlABlLITY
GEN'LAGGREGATE LIMIT APPLIES PER,
CLAIMS.MAOE OCCUR
LC]CPOLICY
COMBINEO SINGLE LIMIT I
BoDILY INJURY (P' FloN)I
IBOOILY INJURY (Ps .@dent)
s
5
SCHEDIJLEO
AUTOS
NONOWNEO
AUTOS
AUTOT'OBILE LAEIUTY
HIREDAUTOS
AT TOS
EACH OCCURRENCE $
AGGREGATE I
OCCUR
CLAIMS-MADE
UiI'RELIA LIAE
EXCESS UAB
IoEoRETEMTION I
OTH-
STATUTE
E.L, EACH ACCIOENT I
E.L, DISEASE , EA EMPLOYEE I
sE L OISEASE. POLICY LIMIT
woRKERS COitPEN6AT(t{
AND EMPLOYERS' LIABUTY
ANY PFOPRIETOR'PARINER/EXECUIIVE
OFFICER/iIEMBER EXCLUDEO?
OESCRIPTION OF OPERAIIONS b€ld
str25ao5906a sttl202t t2 @0,000 p.r@runa 91,000 d6dAPro!€.lion.I Lia.bilitl'
DESCRTPIIOT{ OF OPEFAIIO!{S
'
LOCAnONS i VEH|CLES IACORI ror, Addilool t drr. Sch.duh, dy b.bcr.d rl mo..p.c. r..qurr.d)
As resl)€cto olroration of tho na.D€d i.nsured.
III
III
CERTIFICATE HOLDER CANCELLATION
City of Bremerton
ACUn: Risk ManageDent
3{5 5tn Street *600
Bremerton, l{A 98337
SHOULD AI{Y OF I}IE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE
T}IE EXPIRATIOI{ OATE THEREOF,I{OTICE wlLL BE OELIVERED II{
ACGORDAI{CE wlTH THE POLICY PROVISIO S.
AUTIIORIZEO REPiE3EI{
@ 1988-2014 ACORD CORPORATION. All rights .eserved
The ACORD name and logo are registersd marks of ACORoACORD 25 (201/Uol)
lNS025 (20t4o1)
f-l pno. F--.lL I JECI L I
DocuSign Envelope ID: 6F5A45A7-1E46-4D18-A0DF-9336B6B7CB10