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HomeMy WebLinkAboutCAG2019-158 - Insurance Certificate - Project Feast - Commercial General Liability Coverage - 04/23/2019 From: Ka]tlyn Larson Fax:14254348842 To:253-856-60700rcfax.com Fax:(253)856-6070 Page:2 of 3 06/0412019 2:56 PM 45 DATE(MMIDDIYYYY) '`��Q��` CERTIFICATE OF LIABILITY INSURANCE 6/4/2019 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 policyiles)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 endorsement(s). PRODUCER NAME: Brian Roberts Blue Lion Insurance.LLC AIC Na Exty: 800-665-5154 {AIC,Ha]: 888-221-9537 10224 Airport Way Ste C ADMML DRESS: brian(u,bluelioninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Snohomish WA 98296 INSURER A; Travelers Cas Ins CO of America 19046 INSURED INSURER B; Project Feast INSURER C; 202 W Gowe St Ste C INSURER D INSURER E: Kent WA 98032 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE iNSU RED 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 17000-000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 1.000,000 ME EXP(Any one person) $ 10.000 A Y Y 680-8K590287 04/23/2019 04/23/2020 PERSONAL&ADV INJURY $ 1.000-000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 21000,000 NPOLICY �� �LOC !PRODUCTS-COMPIOPAGG $ 2,000.000 OTHER: Liquor Liability $ $1.000-000 AUTOMOBILE LIABILITY $ {Ee eccidenl] ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS ONLY AUTOS ) HIRED NON-OWNED AUTOS ONLY AUTOS ONLY (per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ NORXERS COMPENSATION AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PRO PRIETORIPARTNERlEXECUTIVE DFFICERIMEMBER EXCLUDED? El N I A E L EACH ACCIDENT $ Mandatory in NH) 171 DISEASE-EA EMPLOYEE $ f yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate Holder is listed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Ave S AUTHORIZED REPRESENTATIVE Kent,WA 98032r'i RfTr {�r4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD From:Kaitlyn Larson Fax:14254348842 To: 253-856-6070®rcfax.com Fax:(253)856-6070 Page: 3 of 3 0610412019 2:56 PM POLICY NUMBER: 680$1<590287 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR- ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City_0TKent Housing and Human Services 220 Fourth Ave S. Kent, WA 98118 (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 (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions (2) That portion of"your work"out of which the injury or damage arises has been This insurance does not apply to "bodily in- put to its intended use by any person or jury"or"property damage"occurring after: organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 ISO Properties, Inc., 2000 Page 1 of 1 13