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HomeMy WebLinkAboutCAG2019-071 - Insurance Certificate - Nexus Arcadia HouseA1� V® CERTIFICATE OF LIABILITY INSURANCE 78/9/2019 (MM/DDYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS '.ERTIFICATE 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(les) 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: Rebecca Christian Leavitt Group Northwest PHONE AIC NExt : (253) 833-5140 FAX (253)939-9356 A!C No 201 Auburn Way N Suite C E-MAILo ADDRESS rebecca-christian@leavitt.com IN5URER(SI AFFORDING COVERAGE Auburn WA 98002 — — INSURER A: Philadelphia Indemnity Insurance Compar INSURED Nexus Youth and Families INSURERS: Auburn Youth Resources INSURER C: 1000 Auburn Way S INSURER D: Auburn WA 98002 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CL198928185 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. VSR POLIC_TR TYPE OF INSURANCE I SD POLICY NUMBER MM/DDYfYYYY MM/DD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A CLAIMS -MADE I—XI OCCUR N DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is included as additional insured per the attached endorsement. Coverage is primary & non-contributory CERTIFICATE HOLDER j City of Renton 1055 South Grady Way Renton, WA 98057 I ACORD 25 (2014/01) INS025 (201401) CANCELLATION NAIC 8 18058 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000.000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ly Hursh/RECHRI © 1988-2014 ACORD The ACORD name and logo are registered marks of ACORD TgUwJ , TION. All rights reserved. X PREMISES Ea a rrence$ PHPK2021950 8/10/2019 8/10/2020 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLI ES PER: X POLICY [:] PRO LOC GENERAL AGGREGATE $ JECT PRODUCTS-COMPlOPAGG $ OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciden $ A ANY AUTO BODILY INJURY (Perperson) $ ALL OWNED SCHEDULED JX PHPK2021950AUTOSAUTOS 8/10/2019 8/10/2020 BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS PROPERTYDAMAGE Per accidents $ X UMBRELLA LAB X OCCUR $ EXCESS LIAB EACH OCCURRENCE $ A CLAIMS -MADE X AGGREGATE $ DED RETENTION $ 10,000 PHU8688962 8/10/2019 8/10/2020 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY PER X OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N NP. STOP GAP STATUTE ER A EXCLUDED? ❑NIA E.L. EACH ACCIDENT $ (MandaOFFICEtory (Mantlatoryin NH) in NH) PHPK2021950 8/10/2019 8/10/2020 If yes, describe under E.L DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liab PHSD1470910 8/10/2019 8/10/2020 $1M OccI$2M Agg DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is included as additional insured per the attached endorsement. Coverage is primary & non-contributory CERTIFICATE HOLDER j City of Renton 1055 South Grady Way Renton, WA 98057 I ACORD 25 (2014/01) INS025 (201401) CANCELLATION NAIC 8 18058 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000.000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ly Hursh/RECHRI © 1988-2014 ACORD The ACORD name and logo are registered marks of ACORD TgUwJ , TION. All rights reserved. AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) x/9/2019 Thus CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ,,ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ImrUIN I AIV 1 : IT me certlncate 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). YKUUUUCK Leavitt Group Northwest 201 Auburn Way N Suite C Auburn WA 98002 INSURED Nexus Youth and Families Auburn Youth Resources 1000 Auburn Way S Auburn WA 98002 NAME: Rebecca Christian PHONE (253)833-5140 FAx AIC No. Exti- AIC No); (253) 939-9356 E-MAIL rebecca-christian@leavitt.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 r iladel hia Indemnity Insurance Compar 18058 L:UVEKAGES CERTIFICATE NUMBER:CLI98928185 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 JADDL SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I POLICY NUMBER MM/DD/YYYYiiMMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000 , 000 CLAIMS -MADE ❑X OCCUR DAMA4 ., REN ED PREMISES Ea occurrence $ 100,000 X PHPK2021950 8/10/2019 8/10/2020 MED EXP (Any one person) $ 5,000 •- PERSONAL &ADV INJURY $ 1,000,000 GREGATELIMITAPPLIES PER : GENERAL AGGREGATE $ � 2,000,000 CY JET LOC PRODUCTS-COMP/OPAGG E 2,000,000 JAEMERCIAL R: a ILE LIABILITY COMBINED SINGLE LIMIT Ea acciden $ UTO BODILY INJURY (Per person) $ 1,000,000 WNED SCHEDULED pHPK2021950SAUTOS 8/10/2019 8/10/2020 BODILY INJURY (Per accident) $ D AUTOSX NON-0WNEDPROPERTY DAMAGEAUTOS $Per accidentELLA LIAR X OCCUR EEXCES EACH OCCURRENCE $ 2,000,000 LIAB A CLAIMS -MADE AGGREGATE $ 2,000,000 DED X RETENTION $ 10,000 PHM688962 8/10/2019 8/10/2020 $ WORKERS COMPENSATION PE AND EMPLOYERS' LIABILITY Y / N STATUTE X ERS ANY PROPRIETOR/PARTNERIEXECUTIVE WA STOP GAP E.L. EACH ACCIDENT OFFICERIMEM13ER EXCLUDED? ❑ N!A $ 1,000,000 A (Mandatory in NH) PHPK2021950 8/10/2019 8/10/2020 E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liab PHSD1470910 8/10/2019 8/10/2020 $1M Occ/$2M Agg DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is named as Additional Insured, per attached Endorsement. 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 220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS. Kent, WA 98032 AUTHORIZED REPRESENTATIVE Emily Hursh/RECHRI © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 8/9/2019 I His CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS "ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ,3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. rinr•vrc I Hlv I: IT the Certincate voider 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). NKUUUCER Leavitt Group Northwest 201 Auburn Way N Suite C Auburn INSURED WA 98002 Nexus Youth and Families Auburn Youth Resources 1000 Auburn Way S Auburn WA 98002 NAME: Rebecca Christian =Philadelphia (253)833-5140 FAX : A/C, Nor (253)939-9356 ebecca-christian@leavitt.com INSURER{S) AFFORDING COVERAGE NAIC N INSURERPPhiladel hia Indemnity Insurance Compar 18058 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: CL198928185 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES WITH RESPECT TO WHICH THIS DESCRIBED HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED IS SUBJECT TO ALL THE TERMS, INSRRJ----- BY PAID CLAIMS. �SUBR- LTR I YPE OF INSURANCE IN POLICY EFF POLICY NUMBER MM/DD POLICY EXP MM/DD LIMITS ERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 LAIMS-MADE ❑X OCCUR D;,MA., T EN' PREMISES 'Ea occurrence: $ 100,000 X PHPK2021950 6/10/2019 6/10/2020 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 REGATELIMITAPPLIESPER: Y ❑PRO- GENERAL AGGREGATE $ 2,000,000 JECT LDC V PRODUCTS -COMPlOPAGG $ 2,000,000 R: $ LE LIABILITY COMBINED SINGLE LIMIT Ea soddent $ 1, 000, Goo UTO BODILY INJURY (Per person) $ WNED SCHEDULED AUTOS PHPK2021950 8 10/2019 / 8/10/2020 BODILY INJURY (Per accident) $ AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per acciden X UMBRELLA LIAB X OCCUR $ 2,000,000 A EXCESS LIAB CLAIMS -MADE X $ 2,000,000 DED RETENTION $ 10,000 PHUB688962 8/10/2019 8/10/2020 WORKERS COMPENSATION %EAENCE $ AND EMPLOYERS' LIABILITY Y / N H X ER ANY PROPRIETOR/PARTNER/EXECUTIVE IA STOP GAP OFFICER/MEMBER EXCLUDED? ❑ N / AA DENT $ 1,000,000 {Mandatory in NH) PEPK2021950 8/10/2019 8/10/2020 If yes, describe under I EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 A Professional Liab PHSD1470910 8/10/2019 8/10/2020 $1M OwI$2M Agg DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is named as Additional Insured, per attached Endorsement. CERTIFICATE HOLDER CANCELLATION City of Covington 16720 SE 271st Street Ste. 100 Covington, WA 98042-4964 ACORD 25 (2014/01) INS025 (201401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Hursh/RECHRI ©1988-2014 ACORD The ACORD name and logo are registered marks of ACORD Hrowsk TION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) F8/9/2019 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 3ELOW. 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(les) 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- LUNTACT Rebecca Christian NAME: Leavitt Group Northwest PHONE (253)833-5140 FAx A/C. No. Ext: A!C NO : (253)939-9356 201 Auburn Way N Suite C E-MAIL ADDRFRR rebecca-Christian@leavitt.com Auburn WA 98002 INSURED Nexus Youth and Families Auburn Youth Resources 1000 Auburn Way S Auburn WA 98002 COVERAGES INSURERS) AFFORDING COVERAGE NAIC 0 INSURERA:Philadel hia Indemnity Insurance Compar 18058 INSURER B: INSURER C : INSURER D: E: F: CERTIFICATE NUMBER: CL198928185 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED TO WHICH THIS HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IS SUBJECT TO ALL THE TERMS, INSR DL SU LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MMlDDffYY`Y)I [MM/DDJYYYYJ X COMMERCIAL GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DA T RENT PREMISES Ea occurrence $ 100,000 X PHPK2021950 8/10/2019 8/10/2020 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: X POLICY � PRO- ❑ LOC GENERALAGGREGATE $ 2,000,000 JECT PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X Ea accident $ 1, 000, 000 ANY AUTO A BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED PHPK2021950 8/10/2019 8/10/2020 AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accide $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE X AGGREGATE $ 2,000,000 DED RETENTION $ 10,000 PHUB688962 8/10/2019 8/10/2020 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY ,f! N PER STATUTE X ER ANY PROPRIETOR/PARTNERIEXECUTIVE NA STOP GAP OFFICERIMEMBER EXCLUDED? ❑ N/A A E.L. EACH ACCIDENT $ 1,000,000 If yes, toryin NH) PHPK2021950 8/10/2019 8/10/2020 If yes, describe under E.L. DISEASE -EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liab PHSD1470910 8/10/2019 8/10/2020 $1M 0=I$2M A99 DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is additional insured for general liability per endorsement PJ -GL -RS (10/11), CERTIFICATE HOLDER CANCELLATION City of Auburn 25 West Main Auburn, WA 98001 ACORD 25 (2014/01) INS025 (201401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y Hursh/RECHRI ©1988-2014 ACORD The ACORD name and logo are registered marks of ACORD Mtruwsk 'ION. All rights reserved.