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HomeMy WebLinkAboutPD04-277 - Insurance Certificate - Valley Medical Center - Liability Coverage - 11/01/2005 Keenan HealthCare got CalleAmanecer 949940-r76o Suite200 949-369-0324 fax San Clemente, CA 92673 www keenana,soc com License No 0451271 November 2, 2005 City of Kent FlIm 1230 South Central Avenue RE Kent,WA 98032 DEC 5 2005 ReZPubhc Hospital District No. 1 of King County KENT LEGAL DEPT.`�a�leIta-& - enter Excess Healthcare Professional and General Liability Insurance Policy No. HPC 5916900-00* To Whom It May Concern. Enclosed is a certificate of healthcare professional and general liability insurance coverage for Public Hospital District No 1 of Ding County dba- Valley Medical Center for the period of November 1, 2005 to November 1, 2006 The certificate holder the City of Kent is made additional insured,but only for legal liability arising out of the acts and otrussions of the named insured Coverage is provided by Steadfast Insurance Company, a member of the Zurich Insurance Group, for limits of liability of$5,000,000 each occurrence/ $5,0000,000 General Aggregate, excess of a Self Insured Retention of$1,500,000/$8,500,000 aggregate Should you have any questions regarding the enclosed,please contact our office. Y Cc: Karrie Dosch Valley Mechcal Center Risk Management Department TE ACORDTM CERTIFICATE OF LIABILITY INSURANCE--- "' '''i'" °111/02/22005Y' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan Healthcare AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE 901 Calle Amanecer, Suite 200 AFFORDED BY THE POLICES BELOW. San Clemente, CA 92673 Phone (949) 940-1760 Fax (949) 369-0324 INSURERS AFFORDING COVERAGE INSURED INSURER Steadfast Insurance Company (Zurich Ins Group) Public Hospital District # 1 of King County INSURERS Dba. Valley Medical Center INSURER C 400 South 43rd Street INSURER D Renton, WA 98055 INSURER COVERAGES THIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY POLICY INSR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LT LTR DATE DATE MM/DD/YV MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE s included Below ® COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any onefire) $ ❑E CLAIMS MADE —_ _ - MED EXP(Any one person) $ _ A ❑ HPC 5916900-00' 11/01/05 11/01/06 PERSONAL&ADV INJURY $ ❑ GENERAL AGGREGATE s Included Below GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ ❑ POLICY ❑ PROJECT❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Each accident) $ ❑ ❑ ALLOWNEDAUTOS BODILY INJURY ❑ SCHEDULEDAUTOS (Per person) $ ❑ HIREDAUTOS BODILY INJURY $ ❑ NON-OWNEDAUTOS (Peraccident) ❑ PROPERTY DAMAGE $ ❑ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ EA ANY AUTO OTHER THAN ACC $ ❑ AUTOONLY AGO $ EXCESS LIABILITY EACH OCCURRENCE $ 1 5,000,000' ❑ OCCURR ® CLAIMS MADE AGGREGATE $ 5,000,000' A HPC 5916900-00' 11/01/05 11/01/06 $ 11 DEDUCTIBLE ® RETENTION $ 1,500,000 SIR WC STATU- OTH- WORKERS COMPENSATION AND TCP.v"P^TS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE-EA EMPLOYEE $ EL DISEASE-POLICY LIMIT $ OTHER A Healthcare Professional HPC 5916900-00' 11/01/05 11/01/06 $1 5 Mil $8 5 Mil Agg Included Above Liabilit Insurance Self-Insured Retention DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS . Excess of$1,500,000/$8,500,000 Aggregate Self-Insured Retention Evidence of Healthcare Professional Liability and General Liability Insurance for Valley Medical Center with respects to the Occupational Health Services CERTIFICATE HOLDER I ® ADDITIONAL INSURED,INSURED LETTER A CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE City of Kent TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS 1230 South Central Avenue OR REPRESEN PATPoES Kent, WA 98032 AUTHO IZED REPRESENT IVE ACORD 25-S(7-97) ©ACORD CORPORATION 1988