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HomeMy WebLinkAboutCAG2021-114 - Insurance Certificate - Sound - Liability Coverage - 01/01/2022DATE(MM/DDATYY) 12/30/2021ACORDCERTIFICATE OF LIABILITY INSURANCE 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 pollcy(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). CONTACT NAME:PRODUCER Parker, Smith & Peek, Inc. 2233 112th Avenue NE Bellevue, WA 98004 FAXPHONE <A/C. No. Exn E-MAIL ADDRESS; .425-709-3600 .425-709-7460lA/C. No) INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Health Providers Insurance Reciprocal INSURED INSURER B: Allmeilca Financial Benefit Insurance Sound 6400 Southcenter Blvd Tukwila, WA 98188 INSURER c: Ironshore Specialty Ins. Co. INSURER D : INSURER E: INSURER F: CERTIFICATE NUMBER:REVISION NUMBER:COVERAGES 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 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. ADDL jNsa sDBPi JBQdL POLICY EFF {MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) INSR UMITSTYPE OF INSURANCE POUCY NUMBERLTR HCL221144GENERAL LIABILITY $ 1,000,000EACH OCCURRENCE bAMAGEToRENteO PREMISES (Ea occurrence) A 01/01/2022 01/01/2023 $ 500,000XCOMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR Deductible: $50,000 X $ 5,000MED EXP (Any one person) $ IncludedXPERSONAL & ADV INJURY 5,000,000XGENERAL AGGREGATE $ $ IncludedPRODUCTS • COMP/OP AGGGEN'L AGGREGATE LIMIT APPLIES PER: PRO- JECTX LOCPOLICY S COMBINED SINGLE LIMIT lEa accident) BODILY INJURY (Per person) S 1,000,000AW2D79012003AUTOMOBILE UABILITY 01/01/2022 01/01/2023B X SXANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident)S PROPERTY DAMAGE (Peracddent)S $ HC7TAB5Z4N002 s $2,000,000UMBRELLA DAB EACH OCCURRENCEc01/01/2022 01/01/2023OCCUR X CLAIMS-MADE 5 $2,000,000XEXCESS UAB AGGREGATE X RETENTIONS NIL SPEP y WC STATU-r TORY LIMITS. OTH-WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below HCL221144 ** Washington Stop Gap Employers Liability A EB01/01/2022 01/01/2023Y/N $ 1,000,000E.L. EACH ACCIDENT N/A E.L DISEASE-EA EMPLOYEE S 1.000.000 1,000,000E.L. DISEASE • POLICY UMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Safe and Sound Visitation Center. City of Kent is included as an additional insured and coverage is primary and non-contributory on the general liability policy per attached endorsements/forms, and additional insured on the excess liability and automobile liability per attached endorsements/forms. Waiver of subrogation applies on the general liability policy per the attached endorsements/forms. CANCELLATIONCERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. City of Kent 220 4th Avenue S. Kent. WA 98032 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2010/05) (DCPOO)1 of4 THIS PAGE INTENTIONALLY LEFT BLANK Health Providers Insurance Reciprocal, RRG HealthPro" A BETA Healthcare Group Company ENDORSEMENT BLANKET WAIVER OF SUBROGATION PRIOR TO LOSS tf Policy Number: HCL-21-1144 Endorsement No: C369-01 Issued to: Sound Expiration Date: 01/01/22 at 12:01 a.m.Additional Premium: Per PolicyEffective Date: 01/01/21 at 12:01 a.m. It is understood and agreed that Section 7.13. - Transfer of Rights of Recovery Against Others to HealthPro- does not apply to any person(s) or organization(s) with whom the Named Insured or a Subsidiary agreed under a written contract prior to the loss to waive its right to subrogation against the person(s) or organization(s). ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. A Authorized Representative of HealthPro Page 1HCL-C369(01/19)Datels.sued: January 01, 2021 (Revised) (DCPOO)3 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. The following is added to SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured: Additional Insured if Required by Contract If you agree in a written contract, written agreement or written permit that a person or organization be added as an additional “insured” under this Coverage Part, such person or organization is an “insured”; but only to the extent that such person or organization qualifies as an “insured” under paragraph A.1.c. of this Section. If you agree in a written contract, written agreement or written permit that a person or organization be added as an additional “insured” under this Coverage Part, the most we will pay on behalf of such additional “insured” is the lesser of: (1) The Limits of Insurance for liability coverage specified in the written contract, written agreement or written permit; or (2) The Limits of Insurance for Liability Coverage shown in the Declarations applicable to this Coverage Part. Such amount shall be part of and not in addition to the Limits of Insurance shown in the Declarations applicable to this Coverage Part. Regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for the total of all damages and "covered pollution cost or expense" combined resulting from any one "accident" is the Limit of Insurance for Liability Coverage shown in the Declarations. B. The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B. General Conditions, subparagraph 5. Other Insurance: Primary and Non-Contributory If you agree in a written contract, written agreement or written permit that the insurance provided to a person or organization who qualifies as an additional “insured” under SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured, subparagraph Additional Insured if Required by Contract is primary and non contributory, the following applies: The liability coverage provided by this Coverage Part is primary to any other insurance available to the additional “insured” as a Named Insured. We will not seek contribution from any other insurance available to the additional “insured” except: (1) For the sole negligence of the additional “insured”; or (2) For negligence arising out of the ownership, maintenance or use of any “auto” not owned by the additional “insured” or by you, unless that “auto” is a “trailer” connected to an “auto” owned by the additional “insured” or by you; or (3) When the additional “insured” is also an additional “insured” under another liability policy. This endorsement will apply only if the “accident” occurs: 1. During the policy period; 2. Subsequent to the execution of the written contract or written agreement or the issuance of the written permit; and 3. Prior to the expiration of the period of time that the written contract, written agreement or written permit requires such insurance to be provided to the additional “insured”. Coverage provided to an additional “insured” will not be broader than coverage provided to any other “insured” under this Coverage Part. C. D. ALL OTHER TERMS. CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. Page 1 of 1 461-0478 12 12 Includes copyrighted material of ISO Insurance Services Office, Inc., with its permission (DCPOO)4 of 4 DATE (MM/DD/YYYY) 12/30/2021/KCORD CERTIFICATE OF LIABILITY INSURANCE 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 hoider in lieu of such endorsement(s). CONTACT NAME:PRODUCER Parker, Smith & Peek, Inc. 2233 112th Avenue NE Bellevue, WA 98004 FAXPHONE (A/C, No, Ext) E-MAIL ADDRESS: . 425-709-3600 . 425-709-7460(A/C. No) INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Health Providers Insurance Reciprocal INSURED INSURER B: Allmerica Financial Benefit Insurance Sound 6400 Southcenter Blvd Tukwila, WA 98188 INSURER C INSURER D INSURER E INSURER F CERTIFICATE NUMBER:REVISION NUMBER:COVERAGES 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 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. ADDLISUBR POLICY EFF POLICY EXP LIMITS(MM/DD/YYYYI (MM/DD/YYYY) INSR TYPE OF INSURANCE POLICY NUMBERLTRJMSRVWD HCL221144GENERAL LIABILITY S 1,000,000EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) A 01/01/2022 01/01/2023 500,000XCOMMERCIAL GENERAL LIABILITY CLAIMS-MADE [jfj OCCUR Deductible: $50,000 X 5,000 $ IncludedXPERSONAL & ADV INJURY 5.000,000XGENERAL AGGREGATE $ s IncludedPRODUCTS - COMP/OP AGGGEN’L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC1££I COMBINED SINGLE LIMIT iiaacddent) BODILY INJURY (Per person) 1,000.000AW2D79012003AUTOMOBILE LIABILITY 01/01/2022 01/01/2023B X $ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident)$ PROPERTY DAMAGE jPgraccident)HIRED AUTOS $ UMBRELLA LIAB EACH OCCURRENCE $OCCUR EXCESS LIAB AGGREGATE SCLAIMS-MADE SRETENTION $PEP WC STATU- TORY LIMITS OTH-WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNERyEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below £R Y/N E.L EACH ACCIDENT $ N/A E.L DISEASE-EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ $1,000,000 Each Claim / $5,000,000 Aggregate / $50,000 Retention Professional Liability HCL221144A 01/01/202301/01/2022 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Kent is included as an additional Insured on the general liability policy per attached endorsements/forms. CANCELLATIONCERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF KENT Parks Dept./Housing & Human Services Attn: Dinah R. Wilson, CDBG Coordinator 220 4th Avenue S. Kent, WA 98032-0000 AUTHORIZED REPRESENTATIVE /. © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2010/05) 1 of 2 (DCPOO) Health Providers Insurance Reciprocal, RRG HealthPro" A BETA Healthcare Group Company ENDORSEMENT ADDITIONAL INSURED - BLANKET - GENERAL LIABILITY FOR NAMED INSURED'S CONTRACTS ft Policy Number: HCL-22-1144 Endorsement No: C408-01 Issued to: Sound Expiration Date: 01/01/23 at 12:01 a.m.Effective Date: 01/01/22 at 12:01 a.m.Additional Premium: Per Policy It is understood and agreed that coverage afforded by Section 3 (Bodily Injury and Property Damage Liability) and Section 4 (Personal Injury, Advertising Injury and Discrimination Liability) of this Policy is extended to any person or organization for whom the Named Insured or Subsidiary is required by a written agreement to obtain and maintain insurance or other coverage as an Additional Insured pursuant to Section 7.2, but only for legal liability arising out of the acts, errors or omissions of the Named Insured or a Subsidiary solely in the performance of the written agreement between the Named Insured or Subsidiary and the Additional Insured. This Endorsement does not extend coverage for the acts, errors or omissions of third parties or their employees. This Endorsement extends protection to the Additional Insured prior to any applicable insurance, other coverage or self-insurance and will not seek the contribution from any insurance, other coverage or self-insurance available to the Additional Insured. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. Authorized Representative of HealthPro HCL-C408(01/19)Page 1 Date Is.sued: January 01, 2022 (Initial) 2 of 2 iDCPOO)