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Home My WebLink AboutCAG2021-130 - Insurance Certificate - Bridge of Promise - Liability Coverage - 04/21/2021AC REP CERTIFICATE OF LIABILITY INSURANCE DATE S/11/2021Y) 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 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). PRODUCER NAME: Tara Singer pH6i11J x (253) 833-5140 AX. G NO: (253)939-9355 Leavitt Group Northwest 201 Auburn Way N Suite C E-MML tara-singer@leavitt.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A:Philadel hia Indemnity Insurance Co aT A18058 Auburn WA 98002 INSURED INSURER B INSURER C: Bridge of Promise, Inc INSURER D: PO BOX 1053 INSURER E : INSURER F: Carnation WA 98014 COVERAGES CERTIFICATE NUMBER:21/22 Master REVISION NUMBER: 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 CONTRACTOR 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. INSR R TYPE OF INSURANCE ,ADDL 8UEIR POLICY NUMBER IMMn3DIYXM [MM10DfYYYYJ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGETORENTED PREMISES Ea eccwrence $ 100,000 MED EXP (Any one person) $ 5,000 X PHPK2239678 4/21/2021 4/21/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ❑ , LOC PRODUCTS - COMP/OP AGG $ 3,000,000 Professional Liability $ 1,000,000 OTHER: AUTOMOBILE LIABILITY 0 91 ED 1 GLE LIMIT a BE Jdant $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS PHPK2239678 4/21/2021 4/21/2022 BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ MediralpaymFnls $ 5,000 X UMBRELLA LIAB OCCUR NCLAIMS-MADE EACH OCCURRENCE $ 4 000 000 AGGREGATE $ 4,000 000 AEXCESS LIAB DED I X I RETENTION $ 10,000 $ PRUS757067 4/21/2021 4/21/2022 WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Gap PER To,, STATUTE X ER E.L. EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A PHPK2239678 4/21/2021 4/21/2022 EL DISEASE - EA EMPLOYEE $ 1,000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate Holder is an additional insured as required by written contract and per the terms and conditons of attached form PI-GLD-HS (10/11). CERTIFICATE HOLDER CANCELLATION City of Kent 220 Fourth Ave South Kent, WA 98032 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 Bush/TASING 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) INS025 (201401) The ACORD name and logo are registered marks of ACORD