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Home My WebLink AboutCAG2021-199 - Insurance Certificate - Melissa Ponder Consulting - Business Liability Coverage 12/18/2020-12/18/2021@4lJpJnt*, CUSTOMER NUMBER z 2072787 HOWARD BURKHO],Z r.351 N HWY 89 #16 FARM]NGTON, UT 84025 C]TY OF KENT 220 ATH AVE S KENT, WA 98032-5838 RUN DATE z 02-24*21 ffi BU'114-3 1 000021 0224648837286020400001 0001 006 @4Fktn, Policy Number 648837286 SCHEDULE OF LOCATIONS Allstate lnsurance Company Named lnsured MELISSA pONDER Effective Date: 92 -23-21_ 12:01 A.M., Standard Time Agent Name HOWARD BURKHOLZ Loc. No. Brdg No. Designated Locations (Address, Citv, State, Zip Code)Occupancy 001 001 I16Ts tnTH AVE s # l-, DEs MorNES, wA 981_98 -82]-4 ffi 8U114-3 DM CW 14 01 10 Allstate lnsurance Gompany @qHE*n Policy Number: 649837285 BUSINESSOWNERS POLICY DECI.ARATIONS Allstate I nsurance Company Named lnsured: MELISSA PONDER AgentName: HOWARD BURKHOLZ Eftuclive Dab: 12 -1-8-2020 12:01 A.M., Standard Time Described Premises: Moftsase Holder Name and Address: See Schedule of Locations See Schedule Of [(..:iltltffi SECTION I. PROPERW Blanket lnsurance Blanket #Tvpe of Propertv Limit of lnsurance THESE DECLARATIONS ARE PART OFTHE POLICY DECLAMTIONS CONTAINING THE NAME OFTHE INSURED AND THE POLICY PERIOD. DB CW 01 01 16 Copyright, lnsurance Services Office, lnc', 2009 Allstate lnsurance ComPanY Deductibles (Applv per location, per occurrence) Prem. No. Proper$ Deductible Optional Coverage (Other Than Equipnent Breakdown Protection Coverage) Deductibb Windstorm or Hail Percenbge Deductible 001 $ soo $ 500 For Addilional Deduclible Informalion: See Schedule of Deductibles AddilionalCoverages - Optional Higher Limits / Exbnded Number Of Days (Per Policy) Coveraqe Addilional Premium Limit of lnsuranoe / Exbnded Number of Davs Fqqery or Albralion Business lncorne - Exbnded Number of Days for Ordinary Pavroll Expense Days Exbnded Business lncome -Exbnded Number of Davs Davs Electronic Data - lncreased Limit (Section I Property) lnbrruption of Conrpubr Operations - lncrcased Limit AddilionalCoveraoes - Ontional Hiqher (Per Premises) Coverage Prem No. Addilional Premium Limit of lnsurance other: See Schedule of AdditionalCoverages'Per Prcmises Prem No. Optional Dductibb Oplional Revised Tirc Deduclible Equipnpnt Breakdown Probction Goverage BUlt4-3 @4rskt*, SECTION ll-LIABILITY AtlD MEDICAL EXPENSES Each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to Section ll - Lhbility in the Businessowners Coverage Form and any attached endorsements' Coveraqe Limit of Insurance Lkrbilitv And Medical Expenses $ 1,oo0,oo0 Per Occurrence Ittledical Expenses $ 1-0, 000 Per person Damaqe To Prcmises Renbd To You $ so,00o Any One Premises OtherThan Products / Gomplebd Operalions Aggregab s 2,000,000 Products/Complebd Operations Aqgregab $ 2,000,000 Oplional Coverages - Applicable only if an 'X'is shown in the boxes below: Coverage Limit of lnsurance Broadened Coverage For Danuge to Premises Renbd to You Per Occunence Self-storage Facilities - Custonpr Goods Legal Liability (Oplional lncreased Limits) Per Occunence Mobls -Liability for Guesb' Property (Oplionat Lin$ts) Per Occurrence Per Guest Mobls -Liabilityfor Guests'Propefi ln Sab Deposit Boxes Per Occurrence Deductible Property Damage Liability Deductible: Per Claim Per Occurrence o Fiir,{Jt ffiE Forrre and Endorsements: See Schedule of Forns and Endorsements Premium for lhis Businessowners Policy: $ 21 . 0 0 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. DB CW 01 01 16 Copyright, lnsurance Services Office, lnc., 2009 Allstate lnsurance ComPanY 8U114-3 @,eilstate Propertv Details Property Corcrage Limits of lnsurance Premises Number Building Number Type of Property (Building Or Business And Personal Propertv Actual Cash Value of Building Oplion (Y/N) Auto lncrease Limit (w** Business Personal Property - Seasonal lncrease (/"1 Blanket # tf applicable Limit of lnsurance* Buildino 001 0 01_ Business Personal PropertV N )25 +L5,606 *lncludes Automatic lncrease Building andlor Business Personal Property Limit Percentage **This percentage can only vary by premises, not by building. Coverage Limit of lnsurance Oudoor Siqns Per Occurrence Money And Securilies lnside the Premises Outside tlre Premises Emnlovae Dlshonesfu Per Occ.urrence X Eouionent Breakdown Probction Coveraqe lncluded Burglary tud Robbery (Narned Peril Endorsement only) Money And Securitibs (Amount included uvhen Burqlarv and Robbery Oplion is selecbd) lnside the Premises Outside the Prem'ises Other (specify): Please see the Schedub of OptionalCoverages Additional Coverages / Coverage - Ontional Hiqher {Per Ghssifcation) Coverage Class Code Additional Premium Llmit of lnsurance Business lncome - Dependent Properfies Accounts Receivable Valuable Paners and Records Outdoor Propertv Business Personal Propefi Temporarily ln Portable Storage Units AdditionalGoverage - Business lnconre From Dependent Secondary Dependent Properties Yes No Theft Limihtions - Optional Higher Limils (Per Policy Description of Property Addllional Premium Limit of lnsurance ffi Act Deduclible: THESE DECLAMTIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. DB CW 02 01 16 Copyright, lnsurance Services Office, lnc',2012 Allstate lnsurance Company8U114-3 @4l"tklg, POLICY NUMBER: 6 48837 286 BUSINESSOWNERS BP 04 48 07 13 THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under lhe following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Narne Of Addilional lnsured Person(s) Or Organization(s): C]TY OF KENT lnlormation reouired to complete this Schedule, if not shown above,will be shown in the Declarations. ffi Section ll - Liability is amended as follows: A The following is added to Paragraph C. \ltlho ls An lnsured: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "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 in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. lf coverage provided to the additional insured is required by a contract or agreernent, the insurance afforded to such additional insured will not be broader than thal 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 Paragraph D. Liability And Medical Expenses Limits Of Insurance: lf 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 lnsurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Ol lnsurance shown in the Declarations. BU1r4-3 BP04€0713 @ lnsurance Services Office, \nc.,2012 PageI ofl @4Fkts' notwitlstanding any requirement, term or cond ilion of any conlracl or olher docunent wilh res perlain. Theiniuranceaffordedbythepoliciesdescribedhereinissubjecttoall theterms,excl TYPE OF INSURANCE AND UMITS CERTIFICATE OF INSURANCE - COMMERCIAL ALLSTATE INSURANCE COMPANY. NORTHBROOK IL THIS CERTIFICATE IS ISSUED AS A NIATTER OF INFORMAT]ON ONLYAND CONFERS NO RIC+ITS UPON THE CERTIFICA]E HOLDER. THIS CERTIFICATE DOES NOTAMEND, EKIEND OR ALTER THE COVEBAGE AFFORDED BYlHE POLICIES BELOW, Description of Operation: This is to rance below have to named above su to indicated pect to uhich this certilicaie nay be issued or may usions, and conditions of such policies. ffi NAIvIED INSUREDCERTIFICATE HOLDER Name and Addressol lnsuredName and Address ol Party lo Whom this Certiticate is lssued MELISSA PONDER 276r-s l0TH AVE S * 1 DES MOTNES, WA 98198-8214 Location Address (il different than above) CITY OF KENT 220 4TH AVE S KENT, WA 98032-5838 Number: 648837286 Effeclive Date: 12-r8 -2020 Date: t2-18-2021 SUMMARY BUSINESS LIABILITY COMPBEHENSIVE LIABILIW I r, 000, 000 Per Occurrence DAMAGE TO PBEMISES BENTED TO YOU $ so,ooo.oo AnyOnePremises MEDICAL PAYMENTS s 10, 000 Per Person OTHERTHAN PRODUCTS / COMPLETED OPERATIONS AGGREGATE s 2,000,000.00 PRODUCTS / COMPLETED OPERATION AGGREGATE $ 2, 000, 000 .00 PROPERTY POLICY TYPE lTl specrr ronHa BROAD FORM l_-l anstc ronilI Fleplacsment Cost l-l Rctual Cash Value l-l eurloens RrsK sPEqAL FoRM [_l eutLorNc lil corurrrurs $ Deductible $ 1"5, 606 500 Fl Replacement Cost Wrnd Deductible % o [-l ectuat cash Value n Blanket Limit Blanket Limit El *oExclude Wind YES EQUIPMENT BREAKDOWN,MlSCELLANEOUS PROFESSIONAL LIABILITY,ADDITIONAT' INSURED - The contains a Clause in lavor ol Address CERTIFICATE PEBIOD THIS CERTIFICATE WILL REMAIN IN FORCE FROM THE INCEPTION OF THE POLICY UNTIL THE POLICY IS CANCELLED OR EXPIRES. poltcytNcEpTtoNDATE: 12_18_2020 X tz,otnu [-l te,ootrtoott StandardTimeatthelocationof thelnsuredPre PROVISIONS Thisformisnottheconlractolinsurance,butaltestslhatapolicyasidentiliedabovehasbeenissued. Tieprovisionsofthepolicyshall prevail in all THE ABOVE DESCRIBE D P OL ICY BE D BEFORE THE EXPIRAIION THEREOF, NOTICEWILL BE DEL ACCORDANCE WTH lHE P OL ICY PR OV ISIONS. IN HOWARD BURKHOI,Z 02-24-2\ Authorized Re presentalive Daie Bti114-3 ctcw01 01 14 Ceriilicate Copy @+p,te** CUSTOMER NUMBER : 2072787 HOWARD BURKHOLZ 136r N HWY 89 #r5 FARM]NGTON, UT 84025 CITY OF KENT 220 ATH AVE S KENT, WA 98032-5838 RUN DATE z A2-24-27 [r^.;FJtffi 8U114-3 1 00002 1 022 4648837 286020900001 0001 002 Certilicate Copy