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HomeMy WebLinkAboutPK18-260 - Insurance Certificate - YMCA at Morrill Meadows-6/1/2020 to 6/1/20211 of 8 (ANS00) CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 05/29/2020 Parker, Smith & Feek, Inc. 1707 Dock Street Tacoma, WA 98402 253-359-9700 Great American Insurance Company YMCA of Greater Seattle 909 4th Avenue Seattle, WA 98104 Great American Alliance Ins. Co. A X 1,000,000 8 X 8 8 PAC313246701 General Liability 06/01/2020 06/01/2021 1,000,000 20,000 1,000,000 3,000,000 3,000,000 A 1,000,000 8 CAP313246801 Auto 06/01/2020 06/01/2021 B 8 4,000,000 8 4,000,000 8 NIL UMB313246901 Umbrella 06/01/2020 06/01/2021 A 806/01/2020 06/01/2021 WA Stop Gap 1,000,000 PAC313246701 WA Stop Gap ** WA Stop Gap 1,000,000 1,000,000 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 BI/PD Deductible. Notice of Cancellation applies per the policy provisions. City of Kent Attn: Parks, Recreation and Community Services Director 220 Fourth Ave S Kent, WA 98032 2 of 8 (ANS00) indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of e.(2) of this endorsement, such payments will not be deemed to be damages for "personal and advertising injury" as described in paragraph e.(2)(c) above and will not reduce the Limits of Insurance. Our obligation to defend an Insured's indemnitee and to pay for attorneys fees and necessary litigation expenses as Supplementary Payments ends when: 1. we have used up the applicable Limit of Insurance in the payment of judgments or settlements; or 2. the conditions set forth above, or the terms of the agreement described in paragraph 2.f. above, are no longer met. S. LIMITED PROPERTY DAMAGE TO PROPERTY OF OTHERS The following is added to paragraph (4) of Exclusion j. Damage To Property of Section I -Coverage A -Bodily Injury And Property Damage Liability: 4. However, this exclusion does not apply to personal property of others while in the temporary care, custody or control of an insured. For the purpose of this coverage extension, loss shall mean damage or destruction but does not include mysterious disappearance or loss of use. In the event of a theft, a police report must be filed. This supplementary payment does not apply if: a. Coverage is otherwise provided by the Property Coverage Part (if any) of this Policy; or b. The loss is covered by any other insurance you have or by any insurance of such person who causes such loss. We will pay up to $5,000 for loss under this coverage extension. These payments will not reduce the Limits of Insurance. T. ADDITIONAL INSURED-ATHLETIC ACTIVITY PARTICIPANTS 1. Section II -Who Is An Insured is amended to include as an additional insured any person representing you while participating in amateur athletic activities that you sponsor. The insurance provided by this provision does not apply to: (a) "Bodily injury" to: (i) another participant, your "volunteer worker" or your "employee"; or (ii) you, or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company); or (b) "Property damage" to property; (i) owned, occupied or used by; CG 91 23 (Ed. 05/18) (Page 9 of 16) 3 of 8 (ANS00) (ii) rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by: any of your "employees", "volunteer workers", or any partner or member, (if you are a partnership or joint venture), or any member (if you are a limited liability company). U. ADDITIONAL INSURED • MANAGER OR LESSOR OF PREMISES 1. Section II -Who Is An Insured is amended to include as an additional insured any person or organization from whom you lease or rent property and which requires you to add such person or organization as an Additional Insured on this Policy under: (a) a written contract; or (b) an oral agreement or contract where a Certificate of Insurance showing that person or organization as an Additional Insured has been issued; but the written or oral contract or agreement must be an "insured contract", and: (i) currently in effect or become effective during the term of this Policy; and (ii) executed prior to the "bodily injury", "property damage", "personal and advertising injury". 2. With respect to the insurance afforded to the additional insured identified in paragraph 1. above, the following additional provisions apply: (a) This insurance applies only with respect to the liability ansmg out of the ownership, maintenance or use of that part of the premises leased to you. (b) The Limits of Insurance applicable to the additional insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions far this Policy. The Limits of Insurance applicable to the additional insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein is excess over any other valid and collectible insurance available to the additional insured whether the other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) This insurance applies only to the extent permitted by law. 3. This insurance does not apply to : (a) Any "occurrence" or offense which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured. CG 91 23 (Ed. 05/18) (Page 10 of 16) 4 of 8 (ANS00) V. ADDITIONAL INSURED • FUNDING SOURCES 1. Section II • Who Is An Insured is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of: a. your premises; or b. "your work" for such additional insured; or c. acts or omissions of such additional insured in connection with the general supervision of "your work" and only to the extent set forth as follows : a. The Limits of Insurance applicable to the additional insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the additional insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. b. The insurance afforded to the additional insured only applies to the extent permitted by law. c. 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. d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. W. ADDITIONAL INSUREDS· BY CONTRACT 1. Section II • Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured that are subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the offense resulting in "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or b. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or c. The additional insureds financial control of you; or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 91 23 (Ed. 05/18) (Page 1 1 of 1 6) 5 of 8 (ANS00) 2. If coverage provided to the additional insured is required by 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 such additional insured. With respect to paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials , parts or equipment furnished in connection with such work, on the project (other than service , maintenance or repairs) to be performed for or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage" occurs, or prior to when any offense resulting in "personal and advertising injury" is committed . 2. With respect to the insurance provided by this endorsement, the following are added to paragraph 2. Exclusions under Section I -Coverage A -Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs. b. "Bodily injury", "property damage" or "personal and advertising injury" arrsmg out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings , opinions , reports, surveys, field orders , change orders or drawings and specifications ; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal or advertising injury", involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. c. "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repa irs) to be performed for or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 91 23 (Ed. 05/18) (Page 12 of 16) 6 of 8 (ANS00) (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. d. Any person or organization specifically designated as an additional insured for ongoing operations by a separate additional insured endorsement issued by us and made part of this Policy. 3. With respect to the insurance afforded to these additional insureds , the following is added to Section Ill • Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less . This endorsement shall not increase the applicable limits of Insurance shown in the Declarations. X. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of Section IV • Commercial General Liability Conditions is amended as follows : As respects any additional insured, this insurance is excess unless: a. the additional insured is a named insured under such other insurance; or b. you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Y. ADDITIONAL INSUREDS • PROTECTION OF YOUR LIMITS This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable : a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; as soon as practicable; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and CG 91 23 (Ed. 05/18) (Page 1 3 of 1 6) 7 of 8 (ANS00) c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured . Z. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (SUBROGATION) Under Section IV • Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others to Us: If required by a written contract or written agreement, we waive any right of recovery we may have against a person or organization because of payment we make for injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products-completed operations hazard" provided that the injury or damage occurs subsequent to the execution of the written contract or written agreement. AA. PROPERTY DAMAGE EXTENSION WITH VOLUNTARY PAYMENTS 1. The following is added to paragraph 1. Insuring Agreement of Section I • Coverage A • Bodily Injury And Property Damage Liability: At your request we will pay for "property damage" to property of others caused by your business operations. Such payment will be made without regard to your legal obligation to do so. The "property damage" must occur during the policy period and must take place in the "coverage territory". 2. With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions of Section I • Coverages A • Bodily Injury And Property Damage Liability is amended as follows: Exclusions j.(3), j.(4), J.(5) and j.(6) are deleted. 3. With respect to the coverage afforded under paragraph 1. above, Section Ill • Limits of Insurance is replaced by the following: 1. Subject to 2. below, the most we will pay for any one incident is $1,000. 2. The most we will pay for the sum of all "property damage" in the policy period is $5,000. This aggregate amount is part of and not in addition to the General Aggregate Limit described in paragraph 2. of Section Ill • Limits of Insurance. BB. LIMITED FUNGI OR BACTERIA COVERAGE I. The following are added to SECTION Ill • LIMITS OF INSURANCE : a. Subject to paragraphs 2. and 3. of SECTION Ill • LIMITS OF INSURANCE, as applicable, a Fungi and Bacteria Liability Aggregate Limit of $30,000 is the most we will pay under Coverage A for all "bodily injury" or "property damage" and Coverage C for Medical Payments arising out of one or more "fungi or bacteria incidents". CG 91 23 {Ed. 05/18) (Page 14 of 16) 8 of 8 (ANS00)