HomeMy WebLinkAboutCAG2021-239 - Insurance Certificate - Communities Rise - Liability Coverage - 05/19/2022CERTIFICATE OF LIABILITY INSURANCE DATE/08/2022 Y)
aCORO® 04/08/2022
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 have ADDITIONAL INSURED provisions or 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 endorsements .
PRODUCER
CONTACT
NAME:
CS&S/BROWN & BROWN NORTHWEST
PHONE
FAX
PO BOX 958489
( No, Ext):
A
(C, No):
EMAIL
ADDRESS:
Lake Mary, FL 32746-8989
INSURER(S) AFFORDING COVERAGE
NAIC #
1-866-883-7159
INSURER A: National Fire Insurance of Hartford
20478
INSURED
INSURER B:
INSURERC:
COMMUNITIES RISE
INSURER D:
3642 33RD AVE S STE C4
INSURER E:
SEATTLE, WA 98144
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDINGANY 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YY
POLICY EXP
MM/DD/YY
LIMITS
A
�/
X
COMMERCIAL GENERAL LIABILITY
Y
6025220284
05/19/22
05/19/23
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE X OCCUR
DAMAGE TO RENTED
PREMISES (Ea wcurence)
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 2,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
GEN'L
PRO -
POLICY JECT LOC
PRODUCTS - COMP/OP AGG
$ 4,000,000
OTHER:
A
AUTOMOBILE LIABILITY
6025220284
05/19/22
05/19/23
CO(EaM8INED SINGLE LIMIT
accident)
$ 1,000,000
BODILY INJURY(Per person)
$
ANY AUTO
OWNED AUTOS SCHEDULED
ONLY AUTOS
BODILY INJURY(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
HIRED AUTOS HNON-OWNED
X ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
PER
STATUTE
OTH-
ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N/A
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
OTHER
PER
STATUTE
IER
OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Acord 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is added as an additional insured as provided in the blanket additional insured endorsement as it pertains b work
being performed by the named insured under written contract.
CERTIFICATE HOLDER CANCELLATION
CITY OF KENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
220 Fourth Avenue South ACCORDANCE WITH THE POLICY PROVISIONS.
Kent, WA 98032 AUTHORIZED REPRESENTATIVE
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