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HomeMy WebLinkAboutCAG2019-169 - Insurance Certificate - 2019 to 2020 - Providing Case Management, Advocacy and 24/7 Access to Crisis Line for DV Victims ` c CERTIFICATE OF LIABILITY INSURANCE 7ATE(MMIDDIYYYY) 2/28/2018 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 NAME:CONTACT Tiffany Brewster PLC Insurance, LLC PHONE (425)712-3664 FAX (425)712-37e6 19401 40th Ave W, Suite 440 EMAIL tiffan @ lcins.com ADDRESS: y p INSUR ASIAFFORDING COVERAGE NAIC# Lynnwood WA 9803fi _ INSURER A:Philadel hia Insurance Co ...INSURED INSURER B: Domestic Abuse Women's Network, DBA: DAWN INSURERC: PO Box 1449 INSURER D INSURER E Kent WA 98035 1 INSURERF: COVERAGES CERTIFICATE NUMBER:19/19 GL/Auto/Umb/Prof 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 ----- _-- 156f 5U LTft �. TYPE OF INSURANCE POLICY NUMBER � MM(ODIYYYY � MM%�I DlVYYY LIMITS X I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE o OCCUR A AG U _N LGO 100,000 PREMISE Ea occurr $ PHPK1902205 1/l/2019 1/1/2020 MED EXP LAr one person) $_ 5,000 _._ _ _- hX� i PERSONAL&ADV INJURY $ 1,000,000 'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $ 2,000,000 POLICY I—PRO- 1 LOC -- PRO- JECT - PRODUCTS-COMPlOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY Ea COMBINED SINGLE LIMIT II $ 1,000,000 A _ ANY AUTO j BOD!LY INJURY(Per person) $......... . ALL OWNED (( �I SCHEDULED ----- AUTOS I AUTOS I PHPK1902205 1/1/2019 1/1/2020 BODILY INJURY(Per accident) $ X X NON OWNED II PROPERTY DAMAGE _ - _ HIRED AUTOS AUTOS I Pef �) $ Uninsured motorist combined $ 1,000,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1 000 000 EXCESS LAB E A _� ___-___._..T_ CLAIMS-MADE I AGGREGATE $ 1 000 000 DED X RETENTIONS 10 000 PHUB656662 1/1/2019 1/1/2020 �aaxa��tKe�xama�a AixiXEMPLOYERS'LIABILITY Y!N I i _A-u TE. i ri .w ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT EASE OFFICER/MEMBER EXCLUDED9 NIA �. A (Mandatory in NH) I PHPK1902205 1/1/2019 1/1/2020 E.L DISEASE-EA EMPLOYE $ It yes,describe under --- -. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 18 A Professional Liability PHPK1902205 1/1/2019 1/1/2020 I Per Occurrence $1,000,000 No Deductible Aggregate $2,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured as respects the operations of the named insured when required by written contract with regard to General Liability per form CG2026 04/13. Coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer' s liability. 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 Attn: Lori Guilfoyle ACCORDANCE WITH THE POLICY PROVISIONS. 220 4th Avenue S Kent, WA 98032 AUTHORIZED REPRESENTATIVE Darwin Rieck/TIFFAN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS025(201401) CP0zo►11— IL01 CERTIFICATE OF LIABILITY INSURANCE DAT /272D/YYYY) 12/28l2018 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 NAME: Parker,Smith&Feek,Inc. PHONE 425-709-3600 FAX 425-709-7460 E-MAIL2233 112th Avenue NE No,-EXSJ IA/C�Nof E-M Bellevue,WA 98004 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERn Health Providers Insurance Reciprocal INSURED Sound INSURER B: Allmerica Financial Benefit Insurance — - 6400 Southcenter Blvd INSURER C Tukwila,WA 98188 INSURERD: _ 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. ILTR''—v� TYPE OF INSURANCE_— WISDAfO POLICY P LIC EXP v�� - LTR E POLICY NUMBER MM! MMIDDIYYYY LIMITS A GENERAL LIABILITY i HCL191144 01/01/2019 01/01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED K COMMERCIAL GENERAL LIABILITY X P Ea e cep $ 500,000 ,.._._.__. CLAIMS-MADE OOCCUR MEDEXF(Any one personj S 5,000 X Retro Date:1/1/1986 PERSONAL&AOVINJURY $ Included K Deductible:$,50,000 GENERAL AGGREGATE S 5,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/DP AGG $ Included X POLtCY 7 PRO 1 LOC U _�-- e ATOMOBILE LIABILITY AW2D79012000 SINGLE LMNT- ovol/zo19 olrovzoz0 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $` NON-OWNED - AUTOS p� RTY HIRED AUTOS S ( 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE 7" EXCESS LIAB CLAIMS-MADE. AGGREGA?E I a D RETENTION$ a WORKERS COMPENSATION WC STATU- I 1OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERJEXECUTIVE Y/N ------ OFFICER/MEMBER EXCLUDED? IN/Al E,L,EACH ACCIDENT (Mandatory in NH) E,L.DISEASE-EA EMPLOY4E .1,' If yes,describe under i t I ---.----- ..__.. _.._ . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LI MI' A Professional Liability HCL 191144 01/01/2019 01/01/2020 $1.000,000 Each Claim/$5,000,000 Aggregate/$50,000 Retention I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES )Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Kent is included as an additional insured on the general liability policy per attached endorsements/forms, CERTIFICATE HOLDER CANCELLATION CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Parks Dept./Housing&Human Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Dinah R,Wilson,CDBG Coordinator 220 4th Avenue S. AUTHORIZED REPRESENTATIVE Kent,WA 98032-0000 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD (RA000) {SKI l— Oca�