HomeMy WebLinkAboutCAG2021-111 - Insurance Certificate - Jewish Family Services - Liability Insurance - 02/18/2022OP lD: SR--.ACORD"V CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
0211712022
CERTIFICATE
CERTIFICATE
THISHOLDER.UPONRIGHTS CERTIFICATETHEYONLDANNOCONFERSATTERMAINOFFORMATIONtsFICATEASISSUEDCERTITHIS POLtCIESRDEAFFOEBYTHDORTERALCOVERAGETHEYEXTENTIVELAFFIRMAORYEGATIVELAMEND,NNOTDOES ORlZEDAUTHrssurNGTHEABETWEENCONTRACTrNsuRER(S),OFTHISBELOW
REPRESENTATIVE OR
NSURANCE DOES NOT CONSTITUTE
AND THE CERTIFICATE HOLDER.
the terms and conditions of the
certificate holder in lieu of such
totsTIONendorsed.be SUlf subjectwAlvED,BROGAthemustisholderADDITIONALanINSURED,policy(ies)thetf certificateANT:PORTIM to thecertificatethisnotdoesconferAendorsement,on rightsstatementancertainrequirepolicy,maypolicies
AFFORDING
SDraque lsrael Giles
1501-Fourth Avenue, Suite 730
Seattle, WA 98101-3225
Robert Karl
PRODUCER
18058lndcmnlty ln3,INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E:
Seattle Association for Jews
with Disabilities
Home Care Associates
1601 16th Ave
Seaftle, WA 98122.4000
INSURED Jewish ce
TE NUMBER:REVISION
PERIODABOVENAMEDPOLICYFORTHEISSEUTODTHEREDNSUBELOWLISTEDBEENHAVETHETHATLICIESPOOFNSURANCEtsTHISCERTIFYTOTHISWHICHRESPECTTOWTHDOCUMENTOROTHERORoCONDITIONANYFCONTRACTNGREQUANYTERMIREMENTNOTWTHSTANDID.TEINDICA BJECT ALLTO THERIBEDDESCREIHEISNSU TERMS,FORDEDAF THBY POLtCIESEPERTAITHINSURANCEEMAYTEBEORSSUEDMAYN,CERTIFICA REDUCEDBEEN PAIDBY CLAIMS.SHOWNLIMITS HAVEMAYDsDITIONSUOFPOLICIES.CHLUSIOEXCANcoNNS
LIMITSTYPE OF INSURANCE
1$EACH OCCURRENCE
1$x
$MED EXP one
1$PERSONAL & ADV INJURY
$GENERAL AGGREGATE
$PRODUCTS - COMP/OP AGG
$
o2t1812022 02t18t2023XPK2381547ACOMMERCIAL GENERAL LIABILITY
X
GEN'L AGGREGATE LIMIT APPLIES PER:
CTAIMS-IUADE OCCUR
LOC
GENERAL LIABILITY
$1COlilBINED SINGLE LIMIT
(Ea accident)
X $BODILY INJURY (P€r Person)
$BODILY INJURY (Per accident)
x $PROPERTY DAMAGE
(PER ACCIDENT)x
$Ded
$,iDed
02t18t2022 02t18t2023547
A ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
AUTOMOBILE LIABILITY
$EACH OCCURRENCE
$AGGREGATE
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE
$
DEDUCTIBLE
x
,|
$E.L. EACH ACCIDENT
1$E,L. DISEASE - EA
1
02t1812023
DISEASE. POLICY
02t1812022
N/A PK2381547
STOP GAP
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
PROPRI ETOR/PARTNER'EXECUTIVE
Y/N
describe under
ln NH)
EXCLUDED?
0211547
l0l, Addlllonal Remarks Schedule, lf more space is required)
bv written contract or
nhl insured provision
DESCRIPNON
City of Kent
Human Services
220 Alh Avenue 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 REPRESENTATIVE4a nn
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reserved.