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HomeMy WebLinkAboutCertificate of InsuranceDATE A 9/30/2020 Artisan Contractors Insurance, LLC. 1631 NE Broadway St #429 Portland, OR 97232 (866)960-5550 Security National Insurance Company Peacefield Construction Co 10606 Des Moines Memorial Dr Seattle, WA 98168 1,000,000.00 X NA168341900 6/4/2020 6/4/2021 100,000.00 X 10,000.00 X Blanket A.I. & WOS 1,000,000.00 X Blanket Primary 2,000,000.00 2,000,000.00 X X A 30 SPECIAL PROVISIONS below If yes, describe under OFFICER/MEMBER EXCLUDED? ANY PROPRIETOR/PARTNER/EXECUTIVE NAIC # $ $ $ CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE DOES NOT AMEND , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW . INSURERS AFFORDING COVERAGE INSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : COVERAGES 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 . AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE( MM / DD / YY ) ( MM / DD / YY ) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE( Any one fire )$ CLAIMS MADE OCCUR MED EXP( Any one person )$ PERSONAL && ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP / OP AGG $ PRO -POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ( Ea accident ) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS ( Per person ) HIRED AUTOS BODILY INJURY $ NON - OWNED AUTOS ( Per accident ) PROPERTY DAMAGE ( Per accident )$ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY :AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WC STATU - OTH -WORKERS COMPENSATION AND TORY LIMITS EREMPLOYERS ' LIABILITY E. L. EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE$ E. L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED ; INSURER LETTER :CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF , THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT , BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER , ITS AGENTS OR REPRESENTATIVES . ACORD 25 (2001/08) © ACORD CORPORATION 1988 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 49-0108 07 11 May Include Copyrighted Material of Insurance Services Offices, Inc. Used with permission Page 1 of 1 BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number: Endorsement Effective: 12:01 a.m. Named Insured Countersigned By: SCHEDULE Name of Person or Organization: Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B.With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The words “you” and “your” refer to the Named Insured shown in the Declarations. D.“Your work” means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. Primary Wording If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self-insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. NA168341900 6/4/2020 Peacefield Constructrion Corporation, DBA: Peacefield Constructrion Corporation Any person or organization that the named insured is obligated by virtue of a written contract or agreement to provide insurance such as is afforded by this policy.