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HomeMy WebLinkAboutLW11-029 - Insurance Certificate - Friendship Diversion Services - 07/01/2011-07/01/2012 Liability Coverage - 07/01/2011 �44J ri 09 Client#•45970 FRIEDIV ACORI CERTIFICATE OF LIABILITY INSURANCE 7/12/20°""'' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bell-Anderson Ins-Renton C/L ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 600 SW 39th Street, Suite 200 HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Renton,WA 98057 425 291-5200 INSURERS AFFORDING COVERAGE # INSURED INSURERA Houston Casualty Co Friendship Diversion Services,Inc INSURER B PO Box 11215 INSURER C Olympia,WA 98508 INSURER INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTA D 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 INSIR LTR NSR TYPE OF INSURANCE POLICY NUMBER PATE MEFDDCTYYY DATE IVE YMWDU YTION LIMITS A GENERAL LIABILITY H51150538 07/01/2011 07/01/2012 EACH OCCURRENCE $1000000 COMMERCIAL GENERAL LIABICTfY -- DAMAGE TO RENTPREMISES(Ea UccEDords, $100 00-0 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $1 090 PERSONAL B ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $2000000 17 POLICY 7 PRO LOC JECT 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 $ (Par accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ RRDEDUCTIBLE $ ETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY DRY LIMITS I I FIR ANY CP�ROPRIETORIPARTNER/EXECUTIVE -E-L-EACH ACCIDENT nCE=1 E.BHFV EXCLUDED EL DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ A OTHER Professional H51150538 07/01/2011 07/01/2012 $1,000,000 Occurance Liability $2,000,000 Aggregate $5,000 Deductible DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The certificate holder is additional Insured for general liability, but only if required by written contract or written agreement per Form CJ111 01/09endorsement form to be Issued by Insuring company CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Kent,Chief Prosecutor, DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0 DAYS WRITTEN City of Kent Law Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 220 Fourth Ave South IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Kent,WA 98032 REPRESENTATIVES AUTHORIZED REPRESENTATIVE " ACORD 25(2009/01)1 of 2 #S336127/M334649 © 1988-2009 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD PLJ IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) 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) DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25(2009101) 2 of 2 #S336127IM334649 Client#.45970 FRIEDIV ACORDTM CERTIFICATE OF LIABILITY INSURANCE 07//16/2012YYY' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bell-Anderson Ins-Renton C/L ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 600 SW 39th Street,Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Renton,WA 98057 425 291-5200 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Houston Casualty Co Friendship Diversion Services,Inc. INSURER B P. 0 Box 11215 INSURER c AT Olympia,WA 98508 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 RNW ii POLICYEFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY H51250739 07/01/12 07/01/13 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMIETORENTED $100000 CLAIMS MADE 7 OCCUR MED EXP(Anyone person) $1 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG s2000000 POLICY 7 JEC 7 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 amdent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY E L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? OFFICER/MEMBER EXCLUDED EL DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT I$ A OTHER Professional H51250739 07/01/12 07101113 $1,000,000 ded$5,000 Liability $2,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Kent is additional insured for general liability, but only if required by written contract or written agreement per attached endorsement#CA 11 0109 CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Kent DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL AS DAYS WRITTEN Chief Prosecutor NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of Kent Law Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 220 Fourth Avenue S REPRESENTATIVES Kent,WA 98032 AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #S393651IM393649 SMA © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) 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) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon ACORD 25S(2001/08) 2 of 2 #S393651/M393649 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement# effective 07/01/12 forms a part of Policy # 1-15-12-50739 Issued To Friendship Diversion Services ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following CRIMINAL JUSTICE SYSTEM OPERATIONS LIABILITY POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Port Townsend—City Attorney, 250 Madison Street, Suite#2, Port Townsend WA 98368 Clallam County Prosecuting Attorney 223 E 41h St, Suite 11, Port Angeles, WA 98362 Kitsap County Prosecutor, Civil Division 614 Division Port Orchard WA 98368 Jefferson County Prosecutor, Jefferson County Courthouse, 1820 Jefferson, Port Townsend, WA 98368 Mr Jim Emacio, Chief Civil Deputy of Spokane, 1115 W Broadway, Spokane, WA 99201 Yakima County Prosecutor, Attn Mr Ron Zirkle Yakima County Courthouse, 128 N 2ntl St . Yakima, WA 98901 City of Port Angeles,Attn Dennis Dickson, City Attorney, PO Box 1150, Port Angeles, WA 98362 Clallam County Jail Superintendent, Attn Ron Sakert, 223 E 41" St , Suite 12, Port Angeles, WA 98362 Town of Gig Harbor, Attn Paul Nelson, Court Administrator, 3510 Grandview St , Gig Harbor WA 98335 Grant County, Attn Mr D Angus Lee, Prosecuting Attorney, PO Box 37, Ephrata, WA 98823 Thurston County, Attn Jon Tunheim, County Prosecutor, 2000 Lakeridge Dr Olympia, WA 98502 City of Kent, Chief Prosecutor, City of Kent Law Dept , 220 Fourth Ave , S, Kent, WA 98032 City of Seqwm, Attn Craig Ritchie, City Attorney, 152 W Cedar St , Sequim, WA 98381 Information required to complete this Schedule, if not shown above, will be shown in the Declarations SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s)shown in the Schedule, but only with respect to liability caused, in whole or in part, by you or those acting on your behalf 1. In the performance of your ongoing operations, or 2. In connection with your premises owned by or rented to you ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED CJ111-0109 Includes copyrighted material of Insurance Services Office, Inc Page 1 of 1 with its permission Client# 45970 FRIEDIV ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 D 6/27/UDDIYYYY) /27/2013 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 pollcy(les)must 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 Bell-Anderson Ins PHONE 425291-5200 4252915100 AIC,No,Eat C No 600 SW 39th Street,Suite 200 E-MAIL ADDRESS Renton,WA 98057 INSURER(S)AFFORDING COVERAGE NAIC R 425 291.5200 INSURER A Underwriters at Lloyds, London INSURED INSURER B Friendship Diversion Services, Inc. PO Box 11215 INSURER C Olympia,WA 98508 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 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 TYPE OF INSURANCE DL UBR POLICY EFF POLICY EXP LIMITS LTR IN WIND POLICYNUMBER MMIDDIYYYY MWDMYYYY A GENERAL LIABILITY X CJ1009713 D710112013 07/0112014 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES EsEIZI D rence $100,000 CLAIMS-MADE aOCCUR MED EXP(Any one person) $1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $2,000,000 POLICY JE RCOT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $— ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ H?RED AUTOS AUTOS Per accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN T RY LIMITS I IER ANY PRO PRIETOR/PARTNER/EXECUTIVE EL EACHACCIDENT $ OFFICERWEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A PROFFESIONAL CJ1009713 7/01l2013 07l01l201 1,000 000 LIABILITY 2,000,000 -AGGREGATE DEDUCTIBLE 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddItImal Remarks Schedule,if mom space is required) City of Kent is additional insured for general liability,but only if required by written contract or written agreement per attached endorsement#CJ111 0109. CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Chief Prosecutor;City of Kent Law Dept ACCORDANCE WITH THE POLICY PROVISIONS 220 Fourth Avenue S Kent, WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION All rights reserved ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S453391/M453369 NLC