052-14 - Cascade Natural Gas Corporation - Insurance Exp 1-1-2022-DATE (MMIDDIYYYY)
CERTIFI_.,TE OF LIABILITY INSURAN _ 1211712020
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 endorsernent(s).
PRODUCER CONTACT Marsh I U.S. Operations
Marsh USA Inc NAME. -
PHONE 866-966-4664 FAX 212-948-5382
333 South 7th Street, Suite 1400 / o x • AIC No : _
Minneapolis, MN 55402-2400 E-MAIL ADDRESS: MDU.CertReQ uest marsh,com
CN102299309-CASCA-GAWX-21- CNGC
INSURED
Cascade Natural Gas Corporation
8113 West Grandridge Blvd
Kennewick, WA 99336-7166
INSURERS AFFORDING COVERAGE
_ NAIC #
3190004
INSURER A: Associated Electric & Gas Ins Services Ltd
INSURER B
INSURER C : LibInsurance Corporation
42404
INSURER D :
INSURER E :
INSURER F :
/+/1\/COA2CC CFDTICICATI" All IIkftPPQ• CHI-0nA519AR7-71 RFVI.SION NtIMRFR:
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 _
POLICY EXP
INSR TYPE OF INSURANCE ADDL USR POLICY NUMBER MM/DD/YYYYY MWDD YYY LIMITS
TR
A
COMMERCIAL GENERAL LIABILITY
XL5063410P
01/01/2021
01/01/2022
EACH OCCURRENCE
—DA
$ 1,000,000
CLAIMS -MADE OCCUR
Excess General Liability
$
71
T RE
PRE E_^_ Ea occurrence
"$500,000 Self -Insured Retention"
MED EXP (Any oneperson)
$
PERSONAL & ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRODUCTS - COMPIOPAGG
$
PRO- LOC
POLICY El JECT
$
OTHER:
A
AUTOMOBILE LIABILITY
XL5063410P
01/0112021
01/01/2022
COMBINED SINGLE LIMIT
Ea accident
$ 1.000,000
_.-.
BODILY INJURY (Per person)
X ANY AUTO
Excess Auto Liability
$
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
"$500,000 Self -Insured Retention"
PROPERTYDAMAGE
$
$
UMBRELLALIAB
OCCUR
XL5063410P
01/01/2021
01/01/2022
EACH OCCURRENCE
$ 5,000,000
X
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DED RETENTION
S
C
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? �
(Mandatory in NH)
N / A
WA7-64D-005097-021 (Regulated)
() WA7-64D-005097-011 AOS
"INCLUDES "STOP GAP'"'
01101I2021
01 FO I
01/01/2022
X PEROTH-
ER
-�"-"
E-LEACH ACCIDENT
$ 1,000,000
E L DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
1,000,000
$
If yes, descr6a under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Excess liability applies to general liability, products and completed operations, automobile liability, and employers liability.
r�nnTc i..rr•i non rAIJrF1 1 ATIrI1J
City of Port Orchard
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn: City Clerk's Office
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
216 Prospect St.
ACCORDANCE WITH THE POLICY PROVISIONS.
Port Orchard, WA 98366
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherlee/-
V lauif-LUIb AL UKU l,VMYVMA I IVrv. All rig IILu rVtM!FVCU.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
44AFC 1S
Poky No. XL5063410P
(0) Currency
All amounts stated herein are expressed in United States Dollars and all amounts payable hereunder are,
payable in United States Dollars.
(P) Sole Agent
The NAMED INSURED first named in Item 1 of the Declarations shall be deemed the Sole agent of each
INSURED hereunder for, the purpose of issuing instructions for any alteration of this POLICY, making
premium payments and adjustments, receipting payments of indemnity or receiving notices, including
notice of cancellation from the COMPANY,
(Q) Cancellation
This POLICY may be cancelled:
(1) at any time by the NAMED INSURED by mailing written notice to the COMPANY stating when
thereafter canoellation shall be effective; or
(2) at any time by the COMPANY by mailing written notice to the NAMED INSURED stating when, not
less than ninety (90) days from the date notice was mailed, cancellation shall be effective; except,
in the event of cancellation for non-payment of premiums, such cancellation shall become effective
ten (10) days after the notice was mailed.
Proof of mailing of notice to the respective addresses in Items 7 and 8 of the Declarations shall be
sufficient proof of notice and the POLICY PERIOD shall end on the effective date and hour of
cancellation stated in the notice. Delivery of such notice either by the NAMED INSURED or the
COMPANY shall be equivalent to mailing.
In the event of cancellation by the INSURED, the premium retained by the COMPANY shall be
calculated in accordance with the COMPANY'S short rate table which shall be made available to the
INSURED upon request. In the event of cancellation by the COMPANY, the premium retained by the
COMPANY shall be calculated on a pro-rata basis.
The offer by the COMPANY of renewal on terms or premiums different from those in effect during the
POLICY PERIOD shall not constitute cancellation or refusal to renew this POLICY,
(R) L)ispvte Resolution and Service of Suit
Any controversy or dispute arising out of or relating to this POLICY, or the breach, termination or validity
thereof, shall be resolved in accordance with the procedures specified in this Section IV.(R), which shall
be the sole and exclusive procedures for the resolution of any such controversy or dispute.
(1) Negotiation. The INSURED and the COMPANY shall attempt in good faith to promptly resolve any
controversy or dispute arising out of or relating to this POLICY by negotiations between executives
who have authority to settle the controversy. Any party may give the other party written notice of
any dispute not resolved in the normal course of business. Within fifteen (15) days the receiving
party shall submit to the other a written response. The notice and the response shall include: (a) a
statement of each party's position and a summary of arguments supporting that position; and (b)
the name and title of the executive who will represent that party and of any other person who will
accompany the executive. Within thirty (30) days after delivery of the disputing party's notice, the
executives of both parties shall meet at a mutually acceptable time and place, and thereafter as
often as they reasonably deem necessary, to attempt to resolve the dispute. All reasonable
requests for information made by one party to the other will be honored. If the matter has not been
resolved within sixty (60) days of the disputing party's notice, or if the parties fall to meet within
thirty (30) days, either party may initiate mediation of the controversy or claim as provided
hereinafter.
8100 (08/2019)
[19 of 21]
PRINT - iZi(IM2020 17:3132
NOTICE OF CANCELLATION TO THIRD PARTIES
A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or
organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at
least 10 days, or the number of days listed below, If any, before cancellation becomes effective. In no event
does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to
provide such advance notification will not extend the policy cancellation date nor negate cancellation of the
policy.
Schedule
Name of Other Person(s)1 Email Address or mailing address: Number Days Notice:
Organization(s):
Per Schedule on file with the Per Schedule on file with the g0
Company Company
All other terms and conditions of this policy remain unchanged.
Issued by Liberty Insurance Corporation 21814
For attachment to Policy No. WA7-64D-005097-011 Ef%drve Date Premium $
Issued to Centennial Energy Holdings, Inc. Endorsement No.
WC 99 20 75 ® 2016 Liberty Mutual Insurance Page 1 of 1
Ed. 12/0112016
NOTICE OF CANCELLATION TO THIRD PARTIES
A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or
organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at
least 10 days, or the number of days listed below, If any, before cancellation becomes effective. In no event
does the notice to the third party exceed the notice to the first named insured.
B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to
provide such advance notification will not extend the policy cancellation date nor negate cancellation of the
policy.
Schedule
Name of Other Person(s)1 Email Address or mailing address: Number Days Notice:
Organization(s):
Per schedule on file with the Per schedule on file with the 90
Company Company
All other terms and conditions of this policy remain unchanged.
Issued by Liberty Insurance Corporation 21814
For attachment to Policy No. WA7-64D-005097-021 Ef%ctive Date Premium $
Issued to MDU Resources Group, Inc. Endorsement No.
WC 99 20 75 ® 2016 Liberty Mutual Insurance Page 1 of 1
Ed. 12/01/2016
Dear Certificate Holder:
As many companies have moved to a remote working environment, mailing Certificates of
Insurance to a physical address can cause unnecessary delays in providing you proof of
insurance. To streamline delivery and in are effort to support our firm's commitment to
sustainability, going forward, we would like to distribute your Certificates of Insurance
electronically if possible.
We are kindly requesting Certificate Holders provide us an email address where we can deliver
your COI in the future.
Please send your response to: USo erations.e rna€i @rnarsh.cor°I and provide the following
information so that we can expediteyourC0l delivery,
• Certificate (Shown. below insured Dame e, .. ABC- t23A56789-01)
• E-flail for future delivery.
For undeliverable emad addresses, our system is configured to autosrnatically redirect the
Certificate for deIiveryvia USP'S.
Lastly, if you no longer creed this COI please respond to U50rae,=.aticsi ernailcaftarsh.c ern with
the Certificate number and we will inactive the record in our system to avoid future. automatic
delivery.
Thank you,
US Operations, harsh USA, Inc.
0000515 SP 0696-001-P00515-1
City of Port Orchard
Attn: City Clerk's Office
216 Prospect St.
Port Orchard, WA 98366�