HomeMy WebLinkAboutCAG2021-384 - Insurance Certificate - St. Stephen Housing Association - Non Profit Insurance Program Certificate of Coverage - 06/01/2022Non Profit lnsurance Program
Certificate of Coverage
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT
BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
COMPANIES AFFORDING COVERAGEPRODUCER
Clear Risk Solutions
451 Diamond Drive
Ephrata, WA 98823
INSURED
GENERAL LIABILITY
American Alternative lnsurance Corporation, et al.
AUTOMOBILE LIABILITY
American Alternative lnsurance Gorporation, et al
PROPERTY
American Alternative lnsurance Corporation, et al.
MISCELLANEOUS PROFESSIONAL LIABILITY
Princeton Excess and Surplus Lines lnsuranGe Company
St. Stephen Housing Association
13055 S.E. 192nd Sireet
Renton, WA 98058
COVERAGES
THISISToCERTIFYTHATTHEPoLIoIESoFINSURANCELISTEDBELoWHAVEBEEN
INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF
CERTIFICAiE MAY BE ISSUED OR MAY PERTAIN. THE INSUMNCE AFFORDED BY
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN
ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD
CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS'
REDUCED BY PAID CLAIMS.
POLICY EFF
DATE
POLICY EXP DESCRIPTION
DATE
POLICY NUMBERTYPE OF INSURANCE LIMITS
GENERAL LIABILITY
PER MEMBER AGGREGATE
PRODUCT.COMP/OP
PERSONAL & ADV. INJURY
ANNUAL POOL AGGREGATE
$2,000,000
$1,000,000
$1,000,000
$50,000,000
61112022
ILITY IS SUBJECT TO A $25O,OOO SIR PAYABLE FROM PROGRAM FUNDS)
N1 occuRCIAL
OCCURRENCE FORM
INCLUDES STOP GAP
AUTOMOBILE LIABILITY
(LIABILITY IS SUBJECT TO A $25O,OOO SIR PAYABLE FROM PROGRAM FUNDS)
5ANY NONEANNUAL POOL AGGREGATE
COMBINED
EARTHOUAKE PER OCC
FLOOD PER OCC
ANNUAL POOL AGGREGATE
Excluded
Excluded
NONE
EQ&FL6t1t2022N
(PROPERTY IS SUBJECT TO A $25O,OOO SIR PAYABLE FROM PROGRAM FUNDS)
ALL RISK
MISCELLANEOUS PROFESSIONAL LIABILITY
IS SUBJECT TO A FROM
6t1t2023 PER
OF OPERATIONS / LOCATIONS / VEHICLES / SPECIAL ITEMSDESCRIPTION
Regarding 2019-2020 CDBG Agreement. City of Kent is named as Additional lnsured regarding this agreement only and issubject to policy terms, conditions, and
exclusions. Additional lnsured endorsement attached.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
CY
CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE
City of Kent
220 Fourth Ave South
Kent, WA 98032
///-) / -4,V2,--m- LZ"/
AMERICAN ALTERNATIVE
INSURANCE COMPANY
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION
(GENERAL LlABlLlrY)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
This endorsement modifies insurance provided under the following:
GENERAL LIABILITY COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated above'
Schedule
person orOrganization (Additional lnsured): As Per Schedule on file with Clear Risk Solutions, Underwriting Administrator
City
220
Kent, WA 98032
Regarding 2019-2020 CDBG Agreement. City of Kent is named as Additional Insured regarding this agreement only
anJ issubject to policy terms, conditions, and exclusions. Additional lnsured endorsement attached'
A. With respects to the General Liability Coverage Part only, the definition of lnsured in the Liability Conditions, Definitions and Exclusions
section of this policy is amended to include as an lnsured the Person or Organization shown in the above Schedule. Such Person or
Organization is an lnsured only with respect to liability for Bodily lnjury, Property Damage, or Personal and Advertising lnjury
causedinwholeorinpartbyyouractsoromissionsortheactsoromissionsofthose actingonyourbehalf:
1. ln performance of your ongoing operations; or
2. ln connection with your premises owned or rented to you.
B. The Limits of lnsurance applicable to the additional lnsured are those specified in either the:
1. Written contract or written agreement; or
2. Declarations for this PolicY,
whichever is less. These Limits of lnsurance are inclusive and not in addition to the Limits Of lnsurance shown in the Declarations.
All other terms and conditions remain unchanged.
of Kent
Fourth Ave South
Named lnsured
Non Profit lnsurance Proqram (NPIP)
Policy Number
N1-A2-RL-000001 3-1 3
Endorsement Effective
6t1t2022
lncludes copyrighted material of the lnsurance Services Office, lnc., with its permission