HomeMy WebLinkAboutCAG2019-107 - Insurance Certificate - Children's Home Society of Washington - Liability Coverage - 06/01/2020Client#:573815 CHILDHOM2
ACORD* CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
6t15t2020
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 COVER,AGE AFFORDED BY THE POLICIES
BELOW. TH|S CERTTFTCATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE ISSU|NG TNSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
lf 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
USI lnsurance Services NW
601 Union Street, Suite 1000
Seattle, WA 98101
lilSNS" .*', 206 441'6300 610-362-8s30
INSURER(S) AFFORDING COVERAGE NAIC #
tNsuRERA : Philadelphia lndemnity lnsurance Co.18058
INSURED
Children's Home Society of Washington
P.O. Box 15190
Seattle, WA 98115
tNsuRER B : Landmark American lnsurance Company 33138
INSURER C :
INSURER D:
INSURER E :
INSIJRER F :
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD
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 INSUMNCE 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.
TYPE OF INSURANCE POLICY NUMBER LIMITS
A COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
Professional Liab
Abuse/Molestation
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
OTHER:
f__-l PRo-| | lecr x LOC
PHPK2137599
Retroactive Date
Retroactive Date
Retroactive Date
0610112020
06/01/1997
D6/01/1997
06/01/1997
0610112021 EACH OCCURRENCE $1.000.000
$ 1.000.000
MED EXP (Anv one oereon)s20.000
PERSONAL & ADV INJURY $ 1.000.000
GENERAL AGGREGATE s2.000.000
PRODUCTS - COMP/OP AGG s2.000.000
$
A AUTOMOBILE LIABILITY
ANYAUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLYx
PHPK2137s99 06t01t2020 06t01t2021 s1,000,000
BoDILY INJURY (Per peEon)$
BODILY INJURY (Per a@id€nt)$
$
$
A
B
x UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE
PHU8723876
LHAo90130
06t01t2020
06t01t2020
06t01t2021
06t01t2021
EACH OCCURRENCE $10.000.000
x x AGGREGATE $10.000.000
DED $
A WORKERS COMPENSATION
AND EMPLOYERS'LtABtLtTY Y/ N
ANY PROPRIETOFYPARTNEFYEXECUTIVE r--I
oFFTCERyMEMBER EXCLUDED? L J(Mandatory in NHI
lfyes, describe under
DESCRIPTION OF OPEMTIONS below
N/A
PHPK2137599
WA Stop Gap
06t01t2020 06t01t2021 PERCTATI ITE OTH.EP
E.L. EACH ACCIDENT s1.000.000
E L. DISEASE - EA EMPLOYEE s1.000.000
E.L. DISEASE - POLICY LIMIT s1.000.000
DESCRIPTION OF OPERATIONS / LOCATIONS , VEHICLES (ACORD 101, Additional Remarks Schsdule, may be aftach€d if more space is roquirod)
RE: South King County Family Resource Center.
The General Liability and Automobile policy(s) includes an Additional lnsured endorsement that provides
additional insured status to The City of Kent with regard to the to the above referenced and as required by
written contract.
c TE HOLDER
AGORD 25 (2016/03) 1 of 1
#s29044858/M28926283
CANCELLATION
@ 1988-2015 ACORD CORPORATION. All rights reserved
The AGORD name and logo are registered marks of ACORD
PYBZP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN
ACCORDANCE wlTH THE POLICY PROVISIONS.
City of Kent
Housing and Human Services
Aftn: Lori Guifoyle
220 4lh Avenue South
Kent, WA 98032
I tx-r- a*/
AUTHORIZED REPRESENTATIVE