HomeMy WebLinkAboutPK15-002 - Insurance Certificate - Stewart MacNichols Harmell, Inc. P.S. - Liability Coverage - 02/16/2020 ,4cofz,o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMID01/0712000YYY)
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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 have ADDITIONAL INSURED provisions or 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:
HUB INTERNATIONAL NORTHWEST LLC PHONE FAX
(A/C,No,Ext): (888)661-3938 (A/C,No): (877)872-7604
PO BOX 3018 E-MAIL
BOTHELL, WA 980413018 ADDRESS: service.center@travelers.com
(888) 661-3938 L INSURER(S)AFFORDING COVERAGE NAK:A
INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
INSURED INSURER B:THE TRAVELERS INDEMNITY COMPANY OF AMERICA
STEWART MACNICHOLS HARMELL,
INC., P.S. INSURER C
655 W SMITH ST# 210 INSURER D:
KENT, WA 98032 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 872033709130800 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS
A X 680-8676HO93-20 '02/16/2020 02/16/2021 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO REN
CLAIMS-MADE �OCCUR PREMISES+Ea occurrence $30O,oO0
X HIRED AUTO MED EXP(Any oneperson) $5,000
X NON OWNED AUTO PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
( POLICY PRO-
JECT LOC PRODUCTS-COMP:OP AGG $2,000,000
OTHER:
S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO
BODILY INJURY(Per person) $
OWNED SCHEDULED
., AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED
AUTOS ONLY HAUTOS ONLY PROPERTY DAMAGE
(Per accident) $
$
A X UMBRELLA LIAB X OCCUR CUP-8676HO93-20 02/16/2020 02/16/2021 EACH OCCURRENCE $2,000,000
EXCESS LIAB CLAIMS-MADE
DED X RETENTION$ 5,000 AGGREGATE $2,000,000
$
WORKERS COMPENSATION NIA PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Employer's Overhead Liability 680-8676HO93-20 02/16/2020 02/16/2021 — $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space is required)
AS RESPECTS TO GENERAL LIABILITY, CERTIFICATE HOLDER IS ADDITIONAL INSURED-BLANKET ADDITIONAL
INSURED OWNERS, LESSEES OR CONTRACTORS, CIS D1 05, BUT ONLY AS RESPECTS TO WORK PERFORMED BY THE
INSURED.
CERTIFICATE HOLDER CANCELLATION
CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
220 4TH AVE S. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
KENT, WA 98032 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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