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HomeMy WebLinkAboutCAG2021-353 - Insurance Certificate - Pacific Power Group, LLC - Liability Coverage - 07/01/2023 Al��® DATE(MM/DD/WW) V CERTIFICATE OF LIABILITY INSURANCE 6/28/2023 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: Marsh&McLennan Agency LLC PHONE FAX 1000 Corporate Dr Ste 400 A/c No Ext: A/C No): Ft Lauderdale FL 33334 ADDRESS: FLCertificates@MarshMMA.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Prop&Casualty Co of America 25674 INSURED MOTOR INSURER B:Travelers Casualty and Surety Company 19038 Pacific Power Group LLC 3190 SW 4 Ave INSURER C:American Lon shore Mutual Assoc Ltd. 99999 Ft Lauderdale FL 33315 INSURER D:Travelers Property Cas Co of America 25674 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:292158189 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY ZOL71N5288A23D 7/1/2023 7/1/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE I FYI OCCUR DAMAGE T REN D PREMISES Ea occurrence) $100,000 X MARINE GL MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 X JECT OTHER: $ D AUTOMOBILE LIABILITY 810587357A2343G 7/1/2023 7/1/2024 COMBINED Ea accident SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident COMP:1000 COLL:1000 $ A X UMBRELLALIAB X OCCUR ZOB71N5289123D 7/1/2023 7/1/2024 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 4,000,000 DED I X I RETENTION$9, .i nnn S B WORKERS COMPENSATION UB5T8901962343G 7/1/2023 7/1/2024 X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? FN] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 C USL&H ALMA09262208005701 10/1/2022 10/1/2023 AMOUNT INSURED 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) USL&H INCLUDES OUTER CONTINENTAL SHELF LANDS ACT COVERAGE. For Additional Insured as respects General Liability on a Primary and Non-Contributory basis see Form 80-02-2367 attached;for Separation of Insureds see form 80-02-2000 attached. For Additional Insured as respects Auto liability see Form 16-02-0292 attached;Primary coverage per form CA 00 01 10 13 attached. 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 Kent 220 Fourth Avenue South Kent WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD