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HomeMy WebLinkAboutCAG2019-106 - Insurance Certificate - Asian Counseling and Referral Services - 2019-2020 Coverage - 04/15/2019 A�?�® CERTIFICATE OF LIABILITY INSURANCE DATE( TE( )11/2019 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 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 N Annie Santorelli NAME: Degginger McIntosh and Associates a N CNo Ext: (425)740-5200 FAAJCX, No: t4251740-5201 PO Box 1400 E-MAIL Annie@dmainsurance.com ADDRESS: 3977 Harbour Point Blvd SW INSURER(S)AFFORDING COVERAGE NAIC# Mukilteo WA 98275 INSURERA:Granite State Insurance Co INSURED INSURER B Asian Counseling & Referral Service, Inc. , DBA: ACRS INSURERC: 3639 Martin Luther King Jr Way INSURER D: INSURER E Seattle WA 98144 INSURER COVERAGES CERTIFICATE NUMBER:19-20 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �X OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ X 02LX0664171343 4/15/2019 4/15/2020 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ❑ PRO- JECT 7 LOC PRODUCTS-COMP/OPAGG $ 3,000,000 X OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident A X ANYAUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED OICA0699690602 4/15/2019 4/15/2020 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 29UD0428666674 4/15/2019 4/15/2020 1 S XXAKN)0C0WXK KX PER X OTH- XNXEMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA A (Mandatory in NH) 02LX0664171343 4/15/2019 4/15/2020 E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Sexual Abuse and 02LX0664171343 4/15/2019 4/15/2020 Each Occurrence $1,000,000 Molestation Aggregate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Kent is included as Additional Insured per attached forms 2026(07/04) and 86571 (0804) with respect to any and all operations of the Named Insured. All endorsements apply per required Written Contract. CERTIFICATE HOLDER CANCELLATION lguilfoyle@kentwa.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 220 4th Ave S. ACCORDANCE WITH THE POLICY PROVISIONS. Kent, WA 98032 AUTHORIZED REPRESENTATIVE L David Tyner, III/AN ,,_2 7�oic ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) C1'1hlei — ►04 POLICY NUMBER: 02LX066417134-1 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Blanket as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance.- on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY EXTENSION ENDORSEMENT FOR HUMAN SERVICES PROGRAMS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. DEFENSE EXTENSION finding of guilt that is held in abeyance for any reason, pending the completion of any remedial The following is added to COVERAGE A — activity such as community service or BODILY INJURY AND PROPERTY DAMAGE counseling; or LIABILITY, 2. Exclusions, a. Expected Or Intended Injury and COVERAGE B — 3. For any type of civil charge(s)whatsoever. PERSONAL AND ADVERTISING INJURY The most we will pay for defense under this LIABILITY, 2. Exclusions, a. Knowing violation defense extension is$25,000. Of Rights Of Another B. LEGAL LIABILITY EXTENSION However, we will reimburse you for the sums that you voluntarily reimburse to an "employee" of yours 1. The last paragraph of Section I — Coverages for the reasonable and necessary defense costs A — 2. Exclusions, is deleted and replaced by that he or she incurs in order to defend himself or the following: herself against criminal charges made against him Exclusions c.through n.do not apply to: or her, but this insurance only applies if: 1. The alleged acts out of which such criminal a. damage by fire, lightning, explosion, smoke charges arise are alleged to have: or leaks from automatic fire protective g g systems; and a. Arisen out of and in the course of your b. damage caused by a "resident' ; employment of the "employee"; and b. Been committed by your "employee" to premises rented to you or temporarily against a client of our Human Services occupied by you with the permission of the g Y owner. facility: and 2. Paragraph 6. of Section I11 — Limits of c. Taken place during that period of time that the "employee"was employed by you; and Insurance is deleted and replaced by the following: d. Taken place during the policy period and in 6. Subject to 5. above, the Damage To the"coverage territory"; and Premises Rented To You Limit is the most 2. All the criminal charges are either dismissed we will pay under COVERAGE A for without prejudice or your "employee" is found damages because of"property damage": not guilty of all criminal charges by a court of a. resulting from fire, lightning, explosion, law. smoke or leaks from automatic fire This exception does not apply to any protective systems, or any combination reimbursement of sums that you voluntarily thereof; and reimburse to your "employee' for the reasonable b. caused by a"resident"; and necessary defense costs that he or she incurs in order to defend himself or herself against to premises, rented to you or temporarily criminal charges made against him or her: occupied by you with the permission of the 1. For any criminal charge(s) arising out of the owner. Damage To Premises Rented To ownership, maintenance, use or entrustment to You Limit is the greater of: others of any aircraft, "auto"or watercraft; or a. $200,000 for damages due to fire, 2. For any criminal charge(s) where your lightning, explosion, smoke or leaks "employee" receives anything less than either a from automatic fire protective systems, g or any combination there of; or complete dismissal with prejudice or a not guilty verdict on all charges, including without limitation, any deferred adjudication or similar 86671 08/04 -1- b. The Damage To Premises Rented To q. Fines or penalties assessed by a court or You Limit shown in the Declarations; regulatory authority. and r. Liability arising out of any act or omission c. $25,000 for damages caused by a in the furnishing or failure to furnish "resident" . professional services in the medical 3 Paragraph 4.b.(b) of Section IV — Commercial treatment of"residents'. General Liability Conditions — Other insurance, is 3. As respects the violation of "Rights of deleted and replaced by the following: Residents" Coverage the following definition is (b) That is property insurance for premises added to Section V-- Definitions: rented to you or temporarily occupied by "Rights of residents" means: you with the permission of the owner; a. Any right granted to a resident under any 4. Paragraph a., "Insured Contract", of state law regulating your business as a paragraph 9. of Section V — Definitions is health care facility. deleted and replaced by: b. The "rights of residents" as included in the a. A contract for a lease of premises. United States Department of Health and However, that portion of the contract for a Welfare regulations governing participation lease of premises that indemnifies any of Intermediate Care Facilities and Skilled person or organization for damage by fire, Nursing Facilities, regardless of whether smoke, or leaks from sprinklers to premises your facility is subject to those regulations. while rented to you or temporarily occupied E. WAIVER OF IMMUNITY by you with the permission of the owner is not an "insured contract." We will waive, both in the adjustment of claims and in the defense of "suits" against the insured, any 5. The following is added to SECTION V. charitable or governmental immunity of the insured, Definitions: unless the insured requests in writing that we not do "Resident" means a person who is disabled and so. placed by the insured. Waiver of immunity as a defense will not subject us C. LIQUOR LIABILITY EXCLUSION — EXCEPTION to liability for any portion of a claim or judgment in FOR FUND RAISING EVENTS excess of the applicable limit of insurance. Paragraph c. of 2. Exclusions, COVERAGE A F. WHO IS AN INSURED (SECTION 1) is amended by adding the following Paragraph 2. of Section ll —Who Is An Insured is subparagraph: deleted and replaced by the following: This exclusion does not apply to "bodily injury" or 2. Each of the following is also an insured, but "property damage" arising out of the selling, serving only while working within the scope of their or furnishing of alcoholic beverages at any fund- duties for the insured: raising events. a. "Employees"; D. VIOLATION OF RIGHTS OF RESIDENTS COVERAGE (PATIENT'S RIGHTS) b. "Volunteer Workers"; 1. The following is added to Section I — However, no "employees" or"volunteer Coverages — Coverage A, paragraph 1. workers"are insureds for: Insuring Agreement: (1) "Bodily injury" or"personal and "Bodily injury" damages arising out of the advertising injury": violation of "Rights of Residents" shall be (a) To you, to your partners or deemed an "occurrence." members(if you are a partnership 2. As respects the coverage provided in or joint venture),to your members paragraph A.I. of this endorsement, the (if you are al limited liability following exclusions are added to Section I — company), to a co-"employee" Coverages—Coverage A—2. Exclusions: while in the course of his or her This insurance does not apply to: employment or performing duties related to the conduct of your p. Liability arising out of the willful or business, or to your other intentional violation of "Rights of "volunteer workers"while Residents." 86571 08/04 -2- performing duties related to the (2) Premises they own, maintain or control conduct of your business; while you lease or occupy these (b) To the spouse, child, parent, premises. brother or sister of that co- This insurance does not apply to structural "employee" or"volunteer worker" alterations, new construction and as a consequence of Paragraph demolition operations performed by or for (1)(a) above; that person or organization. (c) For which there is any obligation to g. Any State or Political Subdivision subject to share damages with or repay the following provision: someone else who must pay This insurance applies only with respect to damages because of the injury the following hazards for which the state or described in Paragraphs(1)(a) or political subdivision has issued a permit in (b) above; or connection with premises you own, rent, or (d) Arising out of his or her providing control and to which this insurance applies: or failing to provide professional (1) The existence, maintenance, repair, health care services. construction, erection, or removal of (2) "Property damage"to property: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, (a) Owned, occupied or used by, manholes, marquees, hoistaway (b) Rented to, in the care, custody or openings. sidewalk vaults, street control of, or over which physical banners, or decorations and similar control is being exercised for any exposures: or purpose by you, any of your (2) The construction, erection. or removal "employees', "volunteer workers", of elevators; or any partner or member(if you are a partnership or joint venture), or (3) The ownership, maintenance, or use of any member(if you are a limited any elevators covered by this liability company). insurance. c. An Independent Contractor is an Insured However, the insurance afforded for any only for the conduct of your business and organization and subsidiary thereof not solely while performing services for a client named in the Declarations as a Named of the Named Insured; Insured, does not apply to injury or damage with respect to which an insured under this d. Medical directors and administrators, endorsement is also an insured under including professional persons, another policy, or would be an insured e. If you are an organization other than a under such policy but for its termination or partnership orjoint venture, your managers the exhaustion of its limits of insurance. and supervisors are also insureds; h. Students in training, but not for "bodily d. If you are a limited liability company your injury" or "property damage' arising out of members are insureds, but only with his or her rendering or failure to render respect to their duties related to the professional services to patients; conduct of your business; i. Your members but only with respect to their e. Any organization and subsidiary thereof liability for your activities or activities they which you control and actively manage on perform on your behalf; the effective date of this endorsement; j. Your trustees or members of the board of f. Any person or organization that has governors while acting within the scope of financial control of you or owns, maintains their duties as such on your behalf; or controls premises occupied by you and k. Any entity you are required in a written requires you to name them as an additional contract (hereinafter called Additional insured but only with respect to their liability Insured) to name as an insured is an arising out of: insured but only with respect to liability (1) Their financial control of you; or arising out of your premises, "your work"for 86571 08/" -3- the Additional Insured, or acts or omissions With respect to Additional Insured(s) who are of the Additional Insured in connection with architects, engineers, or surveyors, this the general supervision of "your work" to insurance does not apply to "bodily injury," the extent set forth below: "property damage" or"personal and advertising (1) The Limits of Insurance provided on injury" arising out of the rendering or failure to behalf of the Additional Insured(s) are render any professional services by or for you, not greater than those required by such including: contract. (1) The preparing, approving, or failing to (2) The coverage provided to the prepare or approve, maps, shop drawings, Additional Insured(s) is not greater than opinions, reports, surveys, field orders, that customarily provided by the policy change orders, or drawings and forms specified in and required by the specifications; and contract. (2) Supervisors, inspection, or engineering (3) All insuring agreements, exclusions, services. and conditions of this policy apply. Any coverage provided under this provision (4) In no event shall the coverages or shall be excess over any other valid and Limits of Insurance in this endorsement collectible insurance available to the Additional be increased by such contract. Insured(s)whether primary, excess, contingent, or on any other basis unless a contract Except when required otherwise by contract, specifically requires that this insurance be this insurance does not apply to: primary or you request that it apply on a (1) "Bodily injury" or "property damage" primary basis. occurring after: Paragraph 4.a. of Section II — Who Is An (a) All work on the project (other than Insured is deleted and replaced by the service, maintenance, or repairs) to be following: performed by or on behalf of the Additional a. Coverage under this provision is, subject to Insured(s) at the site of the covered (1) and (2) below: operations has been completed; or (1) Effective on the acquisition or (b) That portion of"your work" out of which formation date; and the injury or damage arises has been put to its intended use by any person or (2) Afforded only until the end of the policy organization other than another contractor period of this Coverage Part or the next or subcontractor engaged in performing anniversary of its inception date, operations for a principal as a part of the whichever is earlier. same project. 86671 08104 -4-