Compass Health 9/12/2019 (2) - Laserfiche WebLink

A oDATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/1/2020 T18/2019 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 Lockton Companies CONTACT 8110 E Union Avenue (AIC.No.Ext): FAX No): Suite 700 E-MAIL Denver CO 80237 ADDRESS: (303)414-6000 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arch Specialty Insurance Company 21199 INSURED Compass Health INSURER B:Philadelphia Indemnity Insurance Co. 18058 1075167 4526 Federal Avenue INSURER C: Everett,WA 98203 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16203395 REVISION NUMBER: XXXXXXX 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 EFF POLICY EXP WM/ LIMBS LTR INSD VD POLICY NUMBER (MDD/YYYY),(MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y N FLP005371306 3/1/2019 3/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR WASHINGTON STOP GAP 3/1/2019 3/1/2020 PREMISES Ea occurrence) $ 100,000 MED EXP(My one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ B AUTOMOBILE LIABILITY N N PHPK1946688 3/1/2019 3/1/2020 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XXXXXXX X HIRED X NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXXXX A UMBRELLA LIAB OCCUR N N FLP005371306 3/1/2019 3/1/2020 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE PEROTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1 1 N/A E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ XX300XXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ )0X0000( A Professional Liability N N FLP005371306 3/1/2019 3/1/2020 $1M Each Claim/$3M Agg. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Cocoon House Youth Counseling and City of Everett Human Needs Grant.City of Everett,its officers,employees and agents are included as Additional Insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION See Attachment 16203395 City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3002 Wetmore Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett, tm e v ACCORDANCE WITH THE POLICY PROVISIONS. WAAUTHORIZED REPRESENTATIVE .r ©1988--20Y5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD