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HomeMy WebLinkAboutCAG2019-180 - Insurance Certificate - King County Bar Association - 07/01/2020-07/01/2021 Liability Insurance Coverage - 07/07/2020ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 7/7/2020 (425) 489-4500 (425) 485-8489 44393 King County Bar Association King County Bar Foundation 1200 - 5th Avenue, Suite 600 Seattle, WA 98101 24074 A 1,000,000 X BKW56688527 7/1/2020 7/1/2021 1,000,000 15,000 2,000,000 2,000,000 1,000,000B BAO56688527 7/1/2020 7/1/2021 3,000,000B USO56688527 7/1/2020 7/1/2021 10,000 A BKW56688527 7/1/2020 7/1/2021 1,000,000 1,000,000 2,000,000 A Liquor Liability BKW56688527 7/1/2020 Each Cause $1M; Agg 2,000,000 The City of Kent its officials, employees and volunteers is an additional insured if required by written contract or written agreement subject to the General Liability Blanket Additional Insured Provision. City of Kent 220 Fourth Avenue South Kent, WA 98032 KINGCOU-02 DFOLINO Hub International Northwest LLC PO Box 3018 Bothell, WA 98041 now.info@hubinternational.com West American Insurance Co Ohio Casualty Insurance Company X 7/1/2021 X X X X X X X 83220of56688527002350290POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION -PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 20 12 04 13 Insurance Services Office,Inc.,2012 Page 1of1 SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A.Section II -Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or politi- cal subdivision shown in the Schedule,sub- ject to the following provisions: 1.This insurance applies only with respect to operations performed by you or on your behalf for which the state or gov- ernmental agency or subdivision or po- litical subdivision has issued apermit or authorization. However: a.The insurance afforded to such addi- tional insured only applies to the ex- tent permitted by law;and b.If coverage provided to the addition- al insured is required by acontract or agreement,the insurance afforded to such additional insured will not be broader than that which you are re- quired by the contract or agreement to provide for such additional in- sured. 2.This insurance does not apply to: a."Bodily injury","property damage" or "personal and advertising injury" arising out of operations performed for the federal government,state or municipality;or b."Bodily injury"or "property dam- age"included within the "products- completed operations hazard". B.With respect to the insurance afforded to these additional insureds,the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by acontract or agreement,the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the ap- plicable Limits of Insurance shown in the Dec- larations.