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HomeMy WebLinkAboutCAG2023-171 - Insurance Certificate - Lutheran Community Services Northwest (LCSNW) - Liability Coverage - 07/31/2023 A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/31/2023 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 endorsement(s). PRODUCER CONTACT Brittany Wagner NAME: Brown&Brown of Washington,Inc. PHONE (253)396-5500 FAx A/C No Ext: AIC, No): 2106 Pacific Ave E-MAIL Brittany.Wagner@bbrown.com ADDRESS: Suite 501 INSURER(S)AFFORDING COVERAGE NAIC# Tacoma WA 98402 INSURERA: Alliance of Nonprofits for Insurance,Risk Retention Group 10023 INSURED INSURER B: North American Elite Insurance Company Lutheran Community Services NW INSURER C: 4040 S 188th St#300 INSURER D: INSURER E: SeaTac WA 98188 INSURER F: COVERAGES CERTIFICATE NUMBER: 2023-24 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 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 TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PRIM SES Ea oNcE ence $ 500,000 MED EXP(Any one person) $ 20,000 A X Professional Liability Y 2023-40171 07/31/2023 07/31/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X JECT LOC PRODUCTS-COMP/OP AGG $POLICY ❑ PRO 3,000,000 OTHER: Improper Sexual Condct $ $1M Occ/$3M Agg AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED �I SCHEDULED 2023-40171 07/31/2023 07/31/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /, AUTOS HIRED HNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LABCLAIMS-MADE 2023-40171-UMB 07/31/2023 07/31/2024 AGGREGATE $ 5,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1'000'000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ A OFFICER/MEMBEREXCLUDED? N N/A 2023-40171 WA Stop Gap 07/31/2023 07/31/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Commercial Property B CWB0020775-02 07/31/2023 07/31/2024 Employee Dishonesty $500,000 Deductible $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is additonal insured per attached forms and endorsements. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Ave So. AUTHORIZED REPRESENTATIVE Kent WA 98032 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD in T ALLIANCE OF NONPROFITS FOR A Need tar Insurance.a Heart for Nonprofits. POLICY NUMBER: 2023-40171 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. Section II—WHO IS AN INSURED is amended to include: 4.Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s)on your policy, but only with respect to liability for"bodily injury", "property damage"or "personal and advertising injury"caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. Section III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1)That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or ANI-RRG-E61 02 19 Page 1 of 2 rALLIANCE OF NONPROFITS FOR INSURANCE A Need far Insurance.A Heart for Nonprofits. POLICY NUMBER: 2023-40171 (2)The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)'own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1.Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for"your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for"property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I -COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1)When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s)against any"suit" if any other insurer has a duty to defend the additional insured(s)against that"suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2)When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (3)We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s)does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. ANI-RRG-E61 02 19 Page 2 of 2 inv POLICY NUMBER: 2023-40171 FORM: ANI-RRG-E25 12 15 ALLIANCE OF NAMED INSURED: Lutheran Community Services Northwest NONPROFITS FOR A Need far Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION - FOOD CONTRIBUTIONS OR CLIENT REFERRALS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy, in consideration of food contributions or client referrals you receive from them. A. Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ANI-RRG-E25 12 15 Page 1 of 1 POLICY NUMBER: 2023-40171 COMMERCIAL GENERAL LIABILITY Named Insured: Lutheran Community Services Northwest CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property damage" or"personal and advertising injury" If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by Insurance shown in the Declarations; or rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in insured only applies to the extent permitted the Declarations. by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2023-40171 COMMERCIAL GENERAL LIABILITY Named Insured: Lutheran Community Services Northwest CG 20 34 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT - AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II—Who Is An Insured is amended to A person's or organization's status as an include as an additional insured any person(s) or additional insured under this endorsement ends organization(s)from whom you lease equipment when their contract or agreement with you for when you and such person(s) or organization(s) such leased equipment ends. have agreed in writing in a contract or agreement that such person(s) or organization(s) be added B. With respect to the insurance afforded to these as an additional insured on your policy. Such additional insureds, this insurance does not person(s)or organization(s) is an insured only apply to any "occurrence"which takes place with respect to liability for"bodily injury", "property after the equipment lease expires. damage" or"personal and advertising injury" caused, in whole or in part, by your maintenance, C. With respect to the insurance afforded to these operation or use of equipment leased to you by additional insureds, the following is added to such person(s) or organization(s). Section III— Limits Of Insurance: However, the insurance afforded to such additional The most we will pay on behalf of the additional insured: insured is the amount of insurance: 1. Only applies to the extent permitted by 1. Required by the contract or agreement you law; and have entered into with the additional 2. Will not be broader than that which you are insured; or required by the contract or agreement to 2. Available under the applicable Limits provide for such additional insured. of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 34 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2023-40171 COMMERCIAL GENERAL LIABILITY Named Insured: Lutheran Community Services Northwest CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy. Additional Premium: Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s) or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability arising out of the will not be broader than that which you are ownership, maintenance or use of that part of required by the contract or agreement to the premises leased to you and shown in the provide for such additional insured. Schedule and subject to the following additional exclusions: B. With respect to the insurance afforded to these additional insureds, the following is added This insurance does not apply to: to Section III—Limits Of Insurance: 1. Any'occurrence"which takes place after you cease to be a tenant in that premises. If coverage provided to the additional insured is 2. Structural alterations, new construction or required by a contract or agreement, the most demolition operations performed by or on we will pay on behalf of the additional insured is behalf of the person(s) or organization(s) the amount of insurance: shown in the Schedule. 1. Required by the contract or agreement; or 2. Available under the applicable Limits However: of Insurance shown in the 1. The insurance afforded to such additional Declarations; whichever is less. insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 11 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2023-40171 COMMERCIAL GENERAL LIABILITY Named Insured: Lutheran Community Services Northwest CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization that you are required All insured premises and operations. to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II —Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury" or "property damage" caused, in whole or in part, If coverage provided to the additional insured is by"your work" at the location designated and required by a contract or agreement, the most described in the Schedule of this endorsement we will pay on behalf of the additional insured is performed for that additional insured and the amount of insurance: included in the "products-completed operations hazard". 1. Required by the contract or agreement; or 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable Limits of Insurance shown in the 2. If coverage provided to the additional insured is Declarations. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 2023-40171 COMMERCIAL GENERAL LIABILITY Named Insured: Lutheran Community Services Northwest CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations. add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s) or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for"bodily injury", "property will not be broader than that which you are damage" or"personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds, the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to "bodily injury" or the additional insured(s) at the location(s) "property damage" occurring after: designated above. 1.All work, including materials, parts or However: equipment furnished in connection with such 1.The insurance afforded to such additional work, on the project(other than service, insured only applies to the extent permitted maintenance or repairs)to be performed by by law; and or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of"your work" out of which the 2. Available under the applicable Limits of injury or damage arises has been put to its Insurance shown in the Declarations; intended use by any person or organization whichever is less. other than another contractor or subcontractor engaged in performing operations for a This endorsement shall not increase the principal as a part of the same project. applicable Limits of Insurance shown in the Declarations. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or CG 20 10 12 19 © Insurance Services Office, Inc., 2012 Page 2 of 2 ALLIANCE OF 1151 NON PROFITS FOR INSURANCE A Head fed Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNDRAISER AND EVENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This insurance applies to those sums that an insured becomes legally obligated to pay as damages because of "bodily injury","property damage",or"personal and advertising injury"arising out of a"fundraiser"or"event'. Except for a"fundraiser"or"event'that is specifically scheduled on the policy,this insurance does not apply to liability arising out of a"fundraiser"or"event'which involves,directly or indirectly,any of the following: • Any"fundraiser"or"event'with more than 500 people present at any one time • Animals(including, but not limited to,animals involved in rodeos, petting zoos, animal exhibitions) • Athletic activities or contests, not including golf or bowling • Carnivals, circuses, fairs,festivals, parades • Powered Rides or Amusement attractions (including, but not limited to, climbing walls, slides, mechanical bulls, bungee jumps) • Firearms or weapons • Water events(including, but not limited to,activities involving swimming pools, lakes, rivers or other bodies of water) • Trampolines, bounce houses, rebounding equipment, inflatable amusement or sports devices, moon walks, or inflatable wrestling or combatant suits. "Fundraiser" is any event sponsored or co-sponsored by"you"with the primary purpose of raising monetary contributions. "Event"is any activity sponsored or co-sponsored by"you"apart from your regular scope of operations AN I-RRG-E70 03 19 Page 1 of 1 POLICY NUMBER: 2023-40171 COMMERCIAL GENERAL LIABILITY Named Insured: Lutheran Community Services Northwest CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Any state or political subdivision that issues a permit or authorization to the named insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to 2. This insurance does not apply to: include as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political "personal and advertising injury" arising subdivision shown in the Schedule, subject to the out of operations performed for the federal following provisions: government, state or municipality; or b. "Bodily injury"or"property damage" 1. This insurance applies only with respect to included within the"products-completed operations performed by you or on your behalf operations hazard". for which the state or governmental agency or subdivision or political subdivision has issued B. With respect to the insurance afforded to these a permit or authorization. additional insureds, the following is added to Section III— Limits Of Insurance: However: a. The insurance afforded to such additional If coverage provided to the additional insured is insured only applies to the extent permitted required by a contract or agreement, the most we by law; and will pay on behalf of the additional insured is the b. If coverage provided to the additional amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such 2. Available under the applicable Limits of additional insured will not be broader than Insurance shown in the Declarations; that which you are required by the contract whichever is less. or agreement to provide for such additional insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 21 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VOLUNTEER WORKERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who Is An Insured is amended to in- For which there is any obligation to share clude as an insured any person(s) who are volunteer damages with or repay someone else who worker(s)for you, but only while acting at the direction must pay damages because of the injury of, and within the scope of their duties for you. How- described in Paragraphs 1.a. or b. above; or ever, none of these volunteer worker(s) are insureds a. Arising out of his or her providing or failing to for: provide professional health care services. 1. "Bodily injury" or"personal and advertising 2. "Property damage" to property: injury": a. To you, to your partners or members (if you a. Owned, occupied, or used by, are a partnership or joint venture), to your b. Rented to, in the care, custody or control of, members (if you are a limited liability com- or over which physical control is being exer- pany),to your other volunteer worker(s)or to cised for any purpose by your "employees" arising out of and in the you, any of your other volunteer workers, your course of their duties for you; "employees", any partner or member(if you are b. To the spouse, child, parent, brother or a partnership or joint venture), or any member sister of your volunteer worker(s) or your (if you are a limited liability company). "employees" as a consequence of Para- graph 1.a. above; CG 20 21 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑ NMALLIANCE OF POLICY NUMBER: 2023-40171 FORM: ANI-RRG-E26 11 17 NONPROFITS FOR NAMED INSURED: Lutheran Community Services Northwest INSURANCE A Need far Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. ANI-RRG-E26 11 17 Page 1 of 1 E1 ALLIANCE OF NON FROFITS FOR INSURANCE A Head for Insurance.A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: IMPROPER SEXUAL CONDUCT AND PHYSICAL ABUSE LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person, entity or organization that you are required to add as an additional insured for claims of "improper sexual conduct" or"physical abuse" under a written contract or agreement currently in effect or becoming effective during the term of this policy. Section 4—Who Is An Insured is amended to include as an additional insured the person,entity or organization shown in the Schedule,but only with respect to liability for"bodily injury",arising from"improper sexual conduct'or"physical abuse" caused solely by your operations; which "bodily injury" is caused by an act of"improper sexual conduct' or "physical abuse" committed within the coverage territory and which act of"improper sexual conduct' or "physical abuse"first takes place during the term of the policy to which this endorsement is attached. ANI-El31 ISC 05 20 Page 1 of 1 Al IIANCE OF ❑ NON PROF HS FOR INSURANCE Head for Msurance.A Heart-for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY - FOR DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for"damages" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations. The insurance extended by this endorsement is primary coverage when you have so agreed in a written contract or agreement and will be considered non-contributory with the additional insured(s) own insurance. ANI RRG-E02 01 17 Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization with whom you have a written contract currently in effect or becoming effective during the term of this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the"accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1