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HomeMy WebLinkAboutCAG2023-080 - Insurance Certificate - Institute for Family Development - Liability Coverage - 09/27/2023 INSTFOR-01 CSCOBBA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/14/2023 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 Janice Adams NAME: Davidson&Associates Insurance Inc PHONE FAX 11112 NE 51st Circle (A/C,No,EXt): (A/c,No): Vancouver,WA 98682 E-MAIL SS:janice@davidsoninsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Ins Co 18058 INSURED INSURER B: Institute For Family Development INSURERC: 34004 16th Ave S Ste 200 INSURER D: Federal Way,WA 98003 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK2587664 9/27/2023 9/27/2024 DAMAGE TO RENTED 100,000 X PREMISES Ea occurrence $ X Employer's Liability MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PECOT- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER:Liquor Liability included WA STOP GAP/EL $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED Eaaccident SINGLE LIMIT 1,000,000 $ ANY AUTO PHPK2587664 9/27/2023 9/27/2024 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X AUTOS ONLY X AUUTOS ONLDY PROPERTY acctlentDAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PHUB876508 9/27/2023 9/27/2024 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Directors&Officers PHSD1817952 9/27/2023 9/27/2024 D&O Liability 1,000,000 A Professional Liabili PHPK2587664 9/27/2023 9/27/2024 $1M/3M Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Kent is named as additional insured,subject to policy conditions,limitations,and exclusions,as per written contract with respect to covered operations of the named insured,per attached company endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Ave South Kent,WA 98032-5895 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) �/ ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PI-AI-SCH (08/20) Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK2587664 Additional Insured King County Department of Community & Human Services 401 5th Ave Ste 520 Seattle, WA 98104-2377 CG2026 - General Liability Additional Insured Allegheny County, its elected officials, officers, appointees and employees Allegheny County Dept. of Human Servs. One Smithfield St, Suite 300 Pittsburgh, PA 15222-2221 CA2048 - Commercial Automobile Per contract with regards to HNOA Additional Insured City of Kent 220 Fourth Avenue South Kent, WA 98032-5895 CG2010 - General Liability CG2026 - General Liability Additional Insured State Of Michigan Procurement Michigan Dept of Health and Human Services PO Box 30037 Lansing, MI 48909-7537 General Liability PI-AI-SCH (08/20) Page 1 of 2 PI-AI-SCH (08/20) Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK2587664 Additional Insured Howard E Maggard & Mike Swan dba: J & M Storage 501 N 20th Ave Yakima, WA 98902-1838 CG2011 - WA - Loc #6 - 334 (BLDG/PREMS-OFFICE-NOC-NFP) Additional Insured County of Ventura Insurance Compliance PO Box 100085-H8 Duluth, GA 30096 CG2026 - General Liability PI-AI-SCH (08/20) Page 2 of 2