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Home My WebLink About2020-2021 INSURANCECERTIFICATE OF LIABILITY INSURANCE DATE(MM/laze/2020 Y) ozo 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. IMPOF4 CANT: 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 Aon Risk services Northeast, Inc. Boston Boston MA Office CONTACT NAME' PHONE (A/C, No. Ext): (866) 283-7122 FAX (800) 363-0105 53 state street Suite 2201 E-MAIL ADDRESS: Boston MA 02109 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: XL Specialty insurance Co 37885 American Tower Corporation 116 Huntington Avenue filth Floor INSURERB: Greenwich insurance Company 22322 INSURERC: Great American Insurance Company Of NY 22136 Boston MA 02116-5786 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570085047685 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. Limits shown are as requested L.TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM:DD.YVYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY RGD943761408 1 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X� OCCUR PREMISES (Ea occurrence $1, 000, 000 MED EXP (Any one person) $10, 000 PERSONAL& ADV INJURY $2,000,000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S20,000,000. X POLICY ❑ JECT PRO- ❑ LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: B AUTOMOBILE LIABILITY RAD943761508 12/01/2020 12/01/2021 COMBINED SINGLE LIMIT $2,000,000 BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRENON-OWNED ONLY AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE Per accidenti C X UMBRELLA LAB OCCUR UMB3414874 12/01/2020 1/01,'2021 EACH OCCURRENCE S10,000,000 EXCESS LIAS H CLAIMS -MADE AGGREGATE $10,000,000 DED X RETENTION$25,000 A A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? _(Mandatory in NH) _ If as, describe under DESCRIPTION OF OPERATIONS below N/A RWD943518608 workers Comp CAOS) RWR943547008 Workers Comp (Retro Ded.) 12 01. 2020 12/01/2020 _1T/71_/= 12/01/2021 X I PER STATUTE I OTH- E. L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1, 000, 006 DESCRIPTION OF OPERATIONS , LOCATIONS + VEHICLE5 (ACORD 1D1. Additional Aarnorka Schedule, may be attached if more space is required) site# 83092, RE: Site Name: west Bremerton, WA, Site Address: 1301 union Ave., Bremerton, WA 98312. The City of Bremerton and its elected and appointed officers, officials, agents, employees, representatives, engineers consultants and volunteers are included as Additional insured in accordance with the policy provisions of the General Liabillity policy. General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to 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, Automobile Liability and workers' Compensation policies. N 0 00 a`r w a m O CERTIFICATE HOLDER CANCELLATION ile— 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 Attn: Melinda Monroe, City Clerk 345 6th street, suite 100 Bremerton WA 98337 USA (i 421 i w-- JL 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD