HomeMy WebLinkAboutCAG2019-207 - Insurance Certificate - Somali Youth & Family Club - 05/20/2019-05/20/2020 Liability Coverage,ACORD"\--'
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CER TIFICATE OF LIABILITY INSURANCE
DATE (MM'DDIYYYY}
CERTIFICATEONLYFICATE
TIVELY
CERTIFICATE
ICATEREPRESENTATIVE
THISHOLDER.U THEPONNORIGHTSCONFERSTIONANDRMAINFOTTERMAOFAASISSUEDls E POLICIESTHCERTIBYTHISEAFFORDEDCOVERAGTHETERORALEXTENDYTIVELEND,AMEGAORNRMAAFFIESNOT RIZEDTEFICADOAUTHOUCERTIlNsISSUINGTHERER(S),BETWEENCONTRACTACONSTITUTENOTDOESINSURANCEOFTHISBELOW.HOLDER.THEAND CERTIFPRODUCER,OR
IMPORTANT: lf the certificate
or be endorsed.
A statement on
NSUREDADDITIONAL provisionshavemusttheLADDITIONApolicy(ies)NSURED,antsholder endorsement.anesclrequiremaycertainpolitheofconditionspoltermstheandto
tn lieu ofthetoBROGATIONWAlsIVED,stf U confer Ptwrd,
lnsurance Go of Am
ns
PRODUCER
HUB INSURANCE AGENCY
1102 Bronson WaY North
P. O. Box 796
Renton. WA 98057-0796
i{uttr HuUUarO, CISR' CPIW
06
LIMITS
POLICY NUMBERTYPE OF INSURANCE
X 1
1,000,000
05t201202005t201201985xX
COMMERCIAL GENERAL LIABILIW
LIMIT
PRO-
JECT
CLAIMS-MADE OCCUR
PER:
LOC
IT
XX
0512012020o5t201201985
AUTOMOBILE LIABILIW
ANY AUTO
O\ANED
AUTOS ONLY
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SCHEDULED
AUTOS
NON.O\A/NED
AUTOS ONLY
OCCUR
CLAIMS-MADE
UMBRELLA LIAB
EXCESS LIAB
DED $
1
1
051201202005t2012019LA20597351 85
STOP GAPN/A
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ANY PROPRIETOR/PARTNER/EXECUTIVE
oFFrcaR/MEMBER EXcLUoED?
[Mandatory in NH]
describe
Agg Limit
lnc
LIABILITY
ts required)moreattachsd space
uct
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
irii-exprnlrtoN DATE iienqgr-,.,.L9r1cE wlLL BE DELIvERED lN
lC-con'rilnce vurH THE PoLlcY PRovlsloNs'
,4,&
TIVEREPRESENTAAUTHORIZED
City of Kent
Attn: LoriGuilfoYle
220 4thAvenue South
Kent, WA 98032-5895
CITYKEN
o 1988-201 5 ACORD CORPORATION.
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of AGORD
All rights reserved.
-" ReftclcT&sFltoM ?llE FoRMs L'8RARY"-
COMMERCIAL GENERAL LIABILITY
sG e0 16 07 04
poltcyNUMBEfi: 8LA2059735185
THIS FNDORSFMfrNT CTIANGES T}IE POLICY- FLf;A$H RFAD IT CARHFUTLY.
ADOITIONAL INSURED * DESIGNATED
PERSON CIR OHGANIZATION
This enrlorsement modiiies insurance provided under tlre {ollowing:
COMMERCIAL GENERAL LIABILITY COVEHAGE PART
SCHEDULE
Namo Of Additiunal lnsured Person(s) Or Organization(s)
City of Kent
lnformation required to comP fete this $chedule, il not shown above, wilf be ehown in the Declarations.
$ection ll * Who ls An lnsuted is amended to
include as an additional insured the person(s) or
organizalionis) shown in lhe $chedule, but only with
rs$psct to liability for "bodily injury"', Sroperty
da{Fags" or *personal and adverlising injury" caussd,
in whote or ln pan, by your ads or omissions ot lhe
acts or omissione of those acting on your behalf:
A. ln the performance ol your ongoing operations;
or
B. ln ecnnection with your premises cwned by or
renl*d to you,
$:$CI Prapertie$, lnc., 2004
cG 20 25 0r 0,r
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