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HomeMy WebLinkAboutLW11-029 - Insurance Certificate - Friendship Diversion Services - 07/01/2015-07/01/2016 Liability Coverage - 07/01/2015 �' DATE IMMJDDIYYYY) tl.__--- CERTIFICATE OF LIABILITY INSURANCE 1/27/2016 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 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 AmyMisterek NAME: Bell Anderson Agency, Inc. laa�;Mo,Extl (425)291 .5200 [AfC,Nol_(42s)291-s100 600 SW 39th St, Suite 200 E-MAIL ADDRESS: @bell-anderson.cam -_-- _ .............-.. INSURERS APFORDING COVERAGE NAI'C 9 Renton WA 98057 INSURER A Underwriters At L1ords�Loncton, ,..._ INSURED INSURER B Friendship Diversion Services, Inc. INSURERc. i PO BOX 11215 INSU RER D: INSURER E Olympia WA 98508 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1612714.193 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 EE . _.... ...... _. TYPEOF INSURANCE P POLICY EXP LTR POLICY NUMBER 110IDDfYYYY MMIDDyt LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 000 __b;WA6E TO REMTE.D.. -_._ ..,__.. ............_. ........._....... A CLAIMS-MADE EI OCCUR PREMISES(Ea occurrence. $ 100,000 $5,000 DEDUCTIBLE CJ1009715 7/1/2015 7/1/2016 MED EXP)Arty one person) $ 1,000 _.._.. ..PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PLICY THER' JE p LOC PRODUCTS-COMP/OP AGGGG I S m 2,000,000 O AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _..{Ea accident} $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODtlLY INJURY(Per accident)i$ ....... .._......_..... .. P NON-OWNED PROPERTY DAMAGE.... �HIRED AUTOSAUTOS _Tff accwdenl) ...... _.. $ UMBRELLA LfAB OCCUR '..... EACH OCCURRENCE $ EXCESS LIAB --.-_, __.._._.__._.._...._._...- CLAIMS-MADE AGGREGATE $ DED I, � RETENTION$ WORKERS COMPENSATION PER I I OTH- AND EMPLOYERS'LIABILITY YIN 3TAT_UTE EAR ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA __...--.. . .., A (Mandatory in NH) CJ1.009715 7/1/2015 7/1/2016 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under ..._.... ....... ............ r__ ............ DESCRIPTION OF OPERATIONS blow E..L DISEASE-POLICY LIMIT $ A, CRIMINAL JUSTICE (LIABILITY CJ1009715 7/1/2015 7/1/2016 EACH CLAIM $1,000,000 $5,000 DEDUCTIBLE AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached i9 more 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Chief Prosecutor ACCORDANCE WITH THE POLICY PROVISIONS. City ©f Kent Law Dept 220 Fourth Avenue S AUTHORIZED REPRESENTATIVE Kent, WA 98032 � James Hunt/AIM rJ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I NS025(201401)