Loading...
HomeMy WebLinkAboutCAG2019-207 - Insurance Certificate - Somali Youth & Family Club - 09/03/2020-09/03/2021 Liability Coverage----1 SOMAL-2 A� ORD CERTIFICATE OF LIABILITY INSURANCE °A:E;':M;° " 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 )B INSURANCE AGENCY 02 BWay North PHONE 425.255.2486 FAX 425-235-8674 IAIC, NO. Eat): IAIC, Nel: O. Booxx 796 796T S'MA.6S. rhubbard.hubin0l@insuremall.net POOR Inton, WA 98057-0796 Ith Hubbard, CISR, CPIW INSURERISIAFPORDING COVERAGE NAICV INSURER A', American Fire & Casualty .24066 sURED INSURERS General Insurance Cc of Am mall Youth � FamilY Club 550 International Blyvd OB106 alac, WA 98188 INSURERC. INSURER D INSURER E cnveonr_oe rcoTlcln ..�.,, Lae�m. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BCFN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMFNT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH:S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE() HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ ILT R TYPE OF INSURANCE ADOI SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY . EACH OCCURRENCE � f_ _. 1A00,000 cL:•^s-!.1ACE X I)!=l:uu BKA2162110088 09/03/2021 X 09/031202D DAMAGE TO RENTED PREMISES lEu 1,000,000 A-eu EXP v'P' one Pet.) 15._. _ 15,000 PERSONAI. A ACV INJURY 1 1.000,000 GENt AGGRCG\11; LILII I APPLIP:J I'EH GENERA!A(}GREGArE 1 3.000,000 Pfllp' P�;l-'; X l0: PROOUrITS COLIPIOPAGG S 3,000,000 OTHIR A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT lea accgcnlJ. __— _. . $ 1.000.000 ANY All r+ BAA2162110086 09/03/2020 OW03120211 RnDILYIN URYIP.,P ,.rt) S OWNtP vCnl:UUIED - AUTOSI1%, A01U5 UODILYINJUHY;Po imc!Nnl)I S X AUI OS X aU, CS 641Il11. _ ON.LAGE ONLY ICROPERTY 1 UMBRELLA LIAR "I T. FACIA Ilf,:'UeRUU:E $ EXCESS LIAR I A:!.0 M., I: nccREaaF , s DED RETENTIP!.a A WORKERS COMPENSATION PER OTN AND EMPLOYERS' LIABILITY STATUTE YIN ANY PRCPIF ICH'Anl NEq..aEI;U'IVe I,BKA2162110066 09/03120200910312021 'r:"GI.IAItn'Fnr�rluCcD' EL FAf,HAf,CIOENT IS 1,000,000 NIA )MenUalorym TINT 'WA STOP GAP EI. DISEASE - EA EMPLOYrF:$ 1,000,000 Il vos Ufec9LrnN OF n 3f,RIPiION DE PfHAIIONti tieVe, fi PIS ASF - Pflt If.V LI.MIT < 2,000,000 B PROFESSIONAL LP77453790 0910312020 09103/2021 Incident 1.000.000 LIABILITY Agg Linlit 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Adddlaml Remarks SCM1sdeN, may be attached If more space Is required) American Fire & Casualty Policy #BKA2162110086 includes Sexual Misconduct with limits of $1,000,000 Each occurrence / $3,000,000 Aggregate Certificate holder is named as an additional insured subject to policy terms and conditions. Form CG2026 attached e POT'Irtr ATP uni nPO rnrurla I ATlnu CITYKEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CityOf Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Lori Guilfoyle 220 4th Avenue South Kent. WA98032-5895 AUTHORIZEDREPRESENTATNE /� ACORD 25 (2016)03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organlzation(s): ANY AND ALL F"XMISG SOURCES AS RESFECTS TO THE INSJREWS O?ERAT:OSS C!0 19590 IA.ERNAT:ONAL BLVD S-E E: SE1':TAC, MA 98188 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage" or 'personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing oper- ations; or 2. In connection with your premises owned by or rented to you. However; 1. The insurance afforded to such additional insured only applies to the extent permit- ted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, 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. 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 a contract 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. CG 20 26 04 13 ? Insurance Services Office; Inc.. 2012 Page 1 of 1