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HomeMy WebLinkAboutPK18-260 - Insurance Certificate - YMCA at Morrill Meadows-6/1/2018 to 6/1/2019 A R CERTIFICATE OF LIABILITY INStr,IRANCE DAT7117/2018 YI 07/17J2018 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 endomement(s). PRODUCER T CT NAME: Parker,Smith&Feek,Inc. PHoIUE 425-709 3600 FAX 425-709-7460 2233 112th Avenue NE .fit.. .__ ___ ,. _.,.,__ t0VC No Bellevue,WA 98004 ADotSs INSURERISI AFFORDING COVERAGE NAIC 0 �_...............-...._.... _. v_...._.__..._....._ ._,...__._....,...,..._,............._....... . ... m ."...•.::.:...:,,..,:..,.................. :a INSURERA: United States Fire Ins,CO, INSURED INSURER a YMCA of Greater Seattle ...... ..... ............:.... .._. _._ ..... 909 4th Avenue INSURER C Seattle,WA 98104 INSURER o __.._ ........................ .------- 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 VVHICH 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` Kt11�C 3(1ii"Iti :.:-POLICY EFF �DO>YY xPi Y _..... _.__. ................ LTR TYPE OF INSURANCE wca wvn: POLICY NUMBER rMMmnrrvrv_) LIMITS GENERAL LIABILITY 5068939203 6/1/2018 6t1/2079 A EACH OCCURRENCE $ 1.000,000 COMMERCIAL GENERAL LIABILITY X X O . 100D,NOSF e9 I CLAIMS-MADE X OCCUR MED EXP(Any one person) ; 10 000 PERSONAL BADVINJURY $ 1,000,000 _. .._.. ---._ .... ......_..----- --..------------- M,,,.•,..,m.:,••• •,••,•_.,,.,.., .......:•:• GENERAL AGGREGATE S 3,000,000 G£N L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1 0O0 OQO POLICY' X I � $ .. . _.. (LQC AUTOMOBILE LIABILITY 5068939203 COMBINER SINGLE LNIT A I6t1J2018 6!1l2019 a 1,000,000 X i ANY AUTO I BODILY INJURY(Per person) S ___..__._._............—._ e. .-._... .....__.__. ALL OWNED SCHEDULED BODILY INJURY Per acddenl S AUTOS AUTOS I ( ) HIRED AUTOS tT.. NON-OWNED -.. I ._ AUTOS-- C s A UMBRELLA LIAO X I OCCUR 5821104015 I 4,000,000 �._ _.. 6/1/2018 16/1/2019 EACH OCCURRENCE ; EXCESSLIAO ._..,.:.»,..,»,....•...,...::........__._..._...._____..._........-----...---------._.._.._.._ X CLAIMS-MADE - AGGREGATE $ 4,Q0O,D0(1 .. nFp X RFTFNTIn is NIL .-....-.._. . .................._.._... -- A WORKERS COMPENSATION 50689392Q3 VYCSTAIU X OTH- AND EMPLOYERS'LIABILITY YIN Tn17V Li. rrC FR ANY PROPRIETORIPARTNER/EXECUTIVE ��WA Stop Gap 6/1/2018 6/1/2019 ..._.__ ..�.� _.._... OFFICERIMEMBER EXCLUDED? ❑ NIA E L EACH ACCIDENT ; 1,000,000 (Mandatory in NH) E L DISEASE-EA EMPLOYE S 1'000,000 I yes,describe under ----------..............._.. ............ ._....... DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S 1,000 QOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 5a'I,Additional Remarks Schedule,if more space Is required) All Operations.City of Kent is an additional insured and Coverage is primary and non-contributory on the general liability policy per the attached endorsements/forms.Waiver of subrogation applies on the general liability policy per attached endorsements/forms:$25,000 GL Bl/PD Deductible.Notice of Cancellation for the general liability policy applies per the attached form CANCELS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE, 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:Parks, Recreation and Community ACCORDANCE WITH THE POLICY PROVISIONS. Services Director 220 Fourth Ave S AUTHCRi2E3 REPRESENTATIVE Kent,WA 98032 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1 of 4 (SBK01) 5068939203 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY EARLIER NOTICE OF CANCELLATION AND NON-RENEWAL. PROVIDED BY US This endorsement modifies insurance provided under the following: BUSINESS ALTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL INLAND MARINE COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM CRIME AND FIDELITY COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Number of Days'Notice for Canoellation 6 C Number of Days'Notloe for Nonrenewal 60 For any statutorily permitted reason other than nonl)ayrrlent Of premium, the number of days re<juired for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Covirn€ of Poficy C(jndilion or as arr?('nded by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. For any statutorily permitted reason, the number of days required for notice of nonrenewal is increased to the number of days shown in the Schedule above, or to the number of days required by an applicable state cancellation and/or nonrenewal endorsement, whichever is greater. If no entry appears in a blank above,,);, d 1hQkr6orrviak(m i�not rhbwn_in lhtg aarptio 5,the number of days for cancellation or nonrenewal shall be governed by the applicable state requirement,if any, FM 303.0.14 08 07 Page 1 of 1 POLICY NUMBER: 5016 9 9 3 91,0 3 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): Any person or organization whom you are required to add as an Addtiona': Insured to this policy by written contract or agreement, unless such contract or agreement is executed after the date of loss I information required to complete this Schedule, if not shown above, will be shown in the Declarations. s A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforced to these include as an additicnei insured the persor(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of insurance: E 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 cortract 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 Insurance shown in the Dec'arations: 2. In connection with your premises owned by or rented to you. whichever is less, However: This endarsetrent shall not 'rtcrease the applicable Lim;ts of Insurarce shmNin in the 1. The insurance afforded to such additional Declarafions. 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 provice for such additional insured. f GG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 5068939203 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVER' AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF KENT ATTN: PARKS, RECREATION AND COMMUNTTY SERVTCES DIRECTOR 220 FOURTH ANTE S KENT, WA 98032 Information reauired to complete this Schedule. if not shown above. will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work" done under a contract with that person or organization and included in the "products- completed operations hazard", This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 ❑