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HomeMy WebLinkAboutCAG2019-356 - Insurance Certificate - Puget Sound Training Center - 07/25/2020-07/25/2021 CoveragePUGET-3 OP ID: CERTIFICATE OF LIABILITY INSURANCE I °A�`MM'°°'YYYY' 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 endorsements . PRODUCER 425-255-2486 CONTACT Ruth Hubbard, CISR, CPIW HUB INSURANCE AGENCY PHONE 425-255.2486 Fax 425-235-8674 1102 Bronson Way North fAlr, No, Ext): Arc, No): P. O. Box 796 E© AI s r u ar u In Insuremal .net �+ Renton, WA 98057-0796 Ruth Hubbard, CISR, CPIW I NSURERISI AFFORDING COVERAGE uerr x I INSURER A; Ohio Security Insurance Co THIS ]S 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. IILTRNSR TYPE OF INSURANCE ➢DL; UBR POLICY NUMBER POLICY EFF POLICY E%P LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X BKW57913345 07/2512020 07/25/2021 EACH OCCURRENCE 1,000,000 DAMAGE TORaoNTEDnc 1,000,000 MED EXP fAny onePerson) 15,000 PERSONAL & ADV INJURY Excluded GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I j,8T [K LOC GENERAL AGGREGATE 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 7-H =R: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ BODILY )NJ URY Per arson S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTWS ONLY AUTOS ONLY BODILYINJURYPer accident PPer0PEcandenl AMAGE $ A UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE ES057913345 0712512D20 07/2512021 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 DEC) RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY OFRANY CEWM2ETOR'PARLUDEDJCECUTIVE Y r N EXCLUDED? (Mandatory (Mandatory In and If yes, describe under DESCRIPTI N CF OPERATIONS below PER OTH- FR BKW57913345 0710212020 07/02/2021 L N f A E.L. EACH ACCIDENT WA STOP GAP I E.L. DISEASE - EA EMPLOYE E.L. DISEASE - P LI Y LIMIT I 1 000,000 1,000,000 $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is named as an additional insured as respects to their i nterest in all operations of the named insured subject to policy terms and conditions. Form CG8810 attached. City of Kent Human Services Dept 220 4th Avenue South Kent, WA 98032-5895 ACORD 25 (2016103) CITYKEN 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 c0 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD