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Home My WebLink AboutCAG2019-208 - Insurance Certificate - Glover Empower Mentoring (GEM) - 04/10/2019-04/10/2020 Coverage - 04/10/2019StateFarm&,STATE FARM FIRE AND CASUALTY COMPANY A STOCK CQMPANY WITH HQME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED APR 3 2019 E?"F ?la#rt: ?* z s o B s - s s 2 s 001838 3123 Addl lnsured-Section ll Only CITY OF KENT HUHAN SERVICES220 4-TH AVE S KENT t,lA 98032-5858 Businessowners Policy Policy Number 98-CJ-Y659-0 Policv Period Effective Dats Exoiration Date 12 Mbnths APR 10 2019 APR 1 0 2020 Ihe poliov period beqins and ends at 12:0.l am standard time'at th6 ilremises Tocation. M-15-61o7-FACD F N Named lnsured GLOVER EHPOi,|ERHENTORING PROGRAH P0 Box 6471 KENT WA 98064-547r Automatic Renewal - lf the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums. rulers and forms in effect for each succeeding policy period. lf tris policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance witr the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended APR 3 2019 ADDITIONAL INSURED ADDED ADDITIONAL INSURED DELETED PREMIUM ADJUSTMENT FORM CMF-4786 ADDED FORM CMF.486O DELETED Other items shown are effective with the policy's 2019 renewal Endorsement Premium lncrease Discounts Applied: Renewal Year Years in Business Claim Record $ eg.oo Prepared APR 05 2019 cMP-4000 015600 290 Al N @ Copyrigh1 State Fnrm Mutual Automobile lnsurance Company.2008 lncludes copyrighted material of lnsurance Services 0ffice. lnc,, with its permission. Continued on Reverse Side of Page Page 1 of 6, EQn-AnA tr t n[-Cl-tnl t lrlfCt[1.1 DECLARATTONS (CONT| NU ED) Businessowners Policv for CITY OF KENT HUMAN 9ERVICES Policy Number 9g-c.l-Yosg-o SF(:TION I. PHOPFRTV SEHFTTIII F Location Number Location of Described Premises Limit ol lnsurance* Coveraoe A - Buildings Limit ol lnsurance* Coveraoe B' Business Fersonal Property Seasonal lncrease- Business Personal Property 001 827 CENTRAL AVE N STE 8109 KENT WA 98032-3095 No Coverage $ 52,500 25To *As s suranoe as s any ncrease n to e SECTION I.INFLATION AGF INNFX'FSI Cov A - lnflation Coverage lndex: Cov B - Consumer Price lndex: SFETION I. DFDIICTIBLES NiA 252.9 Basic Deductible $pecial Deductibles: Money and $ecurities $'1,000 Other deductibles may apply - refer to policy. $250 Equipment Breakdown $1,000 Prepared APR 05 2019 cMP,4000 01 5600 @ Copyright, State Fnrm Mutual Automobile lnsurance Compony,2008 lncludes copyrighted material of lnsurance Services Office, lnc,, with its permission, Continued on Next Page Page 2ot 6 StateFarm&, Businessowners Pol Policy Number DECLARATTONS (CONTT NU ED) icv for CITY OF KENT HUMAN SERVICES 98-cJ-Y65$,0 SECTION I. EXTENSIONS OF COVERAGE. LIMIT OF I RAN(1tr. trA(lI.I NFqNRIRtrN PRFMIStrR The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "$ee Schedule." ll a coverage does not have a corresponding limit shown below, but has "lncluded" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF INSURANCECOVERAGE Accounts Receivable On Premises Off Premises Arson Reward Collapse Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses lncreased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildlngs (applies only if this policy provides Coverage A - Buildings) $10,000 $5,000 $5,ooo lncluded Coverage B Limit 25o/o of covered loss lncluded 92,500 $s,ooo $10,000 lncluded 10o/o Prepared APR 05 2019 cMP-4000 015601 290 N @ Copyright, State Farm Mutuol Automobile lnsurance Company,2008 lncludes copyrighted material of lnsurance Services 0ffice, lnc,, with its permission Continued on Reverse Side of Page $2,000 $5,000 $1,000 $100,000 $250,000 Page 3 of 6 DECLARATTONS (CONTt NU ED) Businessowners Policv for CITY OF KENT HUMAN SERVICES Policy Number 9g-C.J-Y0sg-o Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage lncluded $5,ooo $2,500 $t s,ooo $1o,ooo 30 Days $2,500 $2,500 $r o,ooo $5,000 lncluded SECTION I. EXTENSIONS OF COVERAGE - LIMIT OF INSU RANEF. PFB POLIEY The coverages and correspondlng limits shown below are the most we will pay regardless of tho number ol described premises shown in these Declarations. COVERAGE Loss Of lncome And Extra Expense SFETION II - I IAEII ITY LIMIT OF INSURANCE Actual Loss $ustained - 't2 Months GOVERAGE Coverage L - Business Liability LIMIT OF IN$URANCE $2,000,000 Prepared APR 05 2019 cMP-4000 01 560 1 @ Copyright, State Farm Mutu6l Automobile lnsurance Company. 2008 lncludes copyrighted material of lnsurence Servicss 0ffice, lnc.. with its permission. Continued on Next Page Page 4 ol 6 StateFarm&, Businessowners Policy Number DECLARATTON$ (CONT|NU ED) Po|icv |or CITY OF KENT HUMAN SERVICES 98-CJ-Y659.0 Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGHEGATE LIMITS Products/Completed Ope rations Aggregate General Aggregate $5,000 $300,000 LIMIT OF INSURANCE $4,000,000 $4,000,000 Each paid claim lor Liability Co_verage reduces the amount of insurance we provide during the applicable annual period. Please refer to Seclion ll - Liability in the Coverage Form and any attached endorsements Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND FNDORSFMENTS cMP-4102 cMP-4786 cMP-4804 FE-6999.2 cMP-4247.1 FE-3650 cMP-4572 cMP-4561.1 cMP-4745.2 cMP-4709 cMP-4860 cMP"4787 cMP-4779 cMP-4788 FD-6007 Businessowners Coverage Form.Addl lnsd Owners Lessee Sched Addl lnsd Club Members Terrorism lnsurance Cov Notice Amendatory Endorsement Actual Cash Value Endorsemet Amendment of Premium Cond Policy Endorsement Loss of lncome & Extra Expnse Money and Securities Al Design Person Org Waiver of Trans Rgt of Recov Employers Liability Addl lnsd Mgrs Lessor ol Prem lnland Marine Attach Dec* New Form Attached Prepared APR 05 2019 cMP-4000 015602 290 N @ Copyright, State Farm Mutuol Automobile lnsurance Compony.2008 lncludes copyrighted material of lnsurance Services Office. lnc., with its permission. Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS (CONTI NU ED) Businessowners Policv for CITY OF KENT IIUMAN SERVICES Policy Number 9s-cJ-Y659-0 This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of lncorporation, as amended. ln Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, lllinois..PqP yn n.a$Q,*; Prepared APR 05 2019 cMP-4000 015602 290 N President @ Copyright, Stote Farm Mutual Automobile lnsurance Company,2008 lncludes copyrighted material of lnsurance Services Office, lnc.. with its permission. Page 6 of 6 StateFarm Named lnsured GLOVER EMPOWERMENTORING PROGRAM PO BOX 647I KENT WA 98064-5471 ATTACHING I NLAND. MARI NE M-15-6107-FACD F N &,STATE FARM FIRE AND CASUALTY COMPANY A SroCK CoMpANy wtrH HIME OFFTCES tN BLooMtNGroN, zuNas INLAND MAFINE ATTACHING DECLAHATIONS E?"F s ragTf,: ?9 7 s o I s. s s z 5 Policy Number 98-CJ-Y659-0 Policv Period Ellective Date Expiration Dats 1 2 Mbnths APR 10 2019 APR 1 A 2020 The oolicv oeriod beoins and ends at 12:01 am standard time'at t'r6 premises Iocaton. L Automatic Renewal - lf the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period.lf tris policy isterminated, we willgive you and the Mortgagee/Lienholderwritten notibe in compliance widr the policy provisions or as required by law. Annual Policy Premium lncluded The above Premium Amountis included in the Policy Premium shown on the Declarations, Your policy consists of these Declarations, the INLAND MABINE C0NDITI0NS shown below, and any other forms and endorsements that apply, including drose shown below as well as $ose issued subsequentto the issuance of this policy. Forms, 0ptions, and Endorsements FE-8724 FE-8744.1 lnland Marine Conditions lnland Marine Computer Prop See Reverse for Schedule Page widt Linits Prepared APR 05 201 9 FD-6007 01 5603 @ Copyright, State Farm Mutual Automobile lnsurance Company,2008 lncludes copyrighted material of lnsurance Services 0ffice. lnc., with its permission, 530-600 a.2 [b-31'201 I lolfU32c) 98.CJ-Y659-0 ATTAC HING II'IIAND MARINE ATTACHING INTAND MARINE SGHEDUTE PAGE ENDORSEMENT NUMBER FE-8744.1 COVERAGE lnland Marine Computer Prop Loss of lncome and Extra Expense LIMIT OF INSUHANCE DEDUCTIBLE AMOUNT $ 500 ANNUAL PREMIUM $ I 25r000 25,000 Included Included Prepared APR 05 2019 FD-6007 01 5603 0THERLlMlTsANDEXcLUsl0NsMAYAPPLY-HEFERT0Y0URP0LlcY- @ Copyriqht, State Farm Mutual Automobile lnsuranoe Company.2008 lncludes copyrighted moterial of lnsurance Services 0ffice. lnc.. with its permission. $30-68$ a.? 05-31"?01 I (otfgZSScl I st t"F"r,98-CJ.Y659-0 015604 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, CMP.4786 ADD|IIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS (Scheduled) &.cMP-4786 Page 1 of 1 This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 9O.CJ,y6sg-0 Named lnsured: GLOVER EMPOWERMENTORING PROGRAM PO BOX 6471 KENT WA 98064.6471 Name And Address Of Additional lnsured Person Or Organization: CITY OF KENT HUMAN SERVICES 220 4TH AVE $ KENT WA 98032-5895 1. SEGTION ll - WHO lS AN INSURED of SECTION ll - LIABILITY is amended to in- clude, a$ an additional insured, any person or organization shown in the $chedule, but only with respect to liability for "bodily inju- ry", "property damage", or "personal and ad- vertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or cMP-4785 b. Products-Completed Operations "Your work" performed for that additional insured and included in the "products- com pleted operations hazar d" . 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage, 3. Primary lnsurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you, There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. @, Copyright, State Farm Mutual Automobile lnsurance Company, lnoludes copyrighted material of lnsurance $ervices ffice, lnc., with its 2008 permission. 98.CJ-Y659-0 015604