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Compass Health 3/26/2020
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Compass Health 3/26/2020
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Entry Properties
Last modified
4/13/2020 11:28:05 AM
Creation date
4/13/2020 11:27:39 AM
Metadata
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Template:
Contracts
Contractor's Name
Compass Health
Approval Date
3/26/2020
Council Approval Date
1/29/2020
Department
Neighborhood/Comm Svcs
Department Project Manager
Rebecca McCrary
Subject / Project Title
Human Needs Homeless Shelter Counseling
Tracking Number
0002264
Total Compensation
$20,000.00
Contract Type
Agreement
Contract Subtype
Grant
Retention Period
6 Years Then Destroy
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® DATE(MM/DD/YYYY) <br /> ,�'►�o%zo CERTIFICATE OF LIABILITY INSURANCE 3/1/2021 2/21/2020 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> p CONTACT <br /> PRODUCER <br /> Lockton Companies NAME: <br /> 8110 E Union Avenue PHONE FAX <br /> (A/C,No.Ext): (A/C,No): <br /> Suite 700 E-MAIL <br /> Denver CO 80237 ADDRESS: <br /> (303)414-6000 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Arch Specialty Insurance Company 21199 <br /> INSURED Compass Health INSURER B:Philadelphia Indemnity Insurance Co. 18058 <br /> 1075167 4526 Federal Avenue INSURER C: <br /> Everett,WA 98203 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 16203395 REVISION NUMBER: XXXXXXX <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ADDL SUBR POLICY EFF POLICY EXP <br /> INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y N FLP005371307 3/1/2020 3/1/2021 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> A CLAIMS-MADE X OCCUR WASHINGTON STOP GAP 3/1/2020 3/1/2021 PREMISES(Ea occurrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 <br /> POLICY JE? X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 <br /> OTHER <br /> B AUTOMOBILE LIABILITY N N PHPK2099915 3/1/2020 3/1/2021 COMBIaccideNEDnt)SINGLE LIMIT $ 1,000,000 <br /> (Ea <br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX <br /> AUTOHIRED <br /> S ONLY AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ XXXXXXX <br /> X AUTOS ONLY X AUTOS ONLY (Per accident) <br /> $ XXXXXXX <br /> A UMBRELLA LIAB OCCUR N N FLP005371307 3/1/2020 3/1/2021 EACH OCCURRENCE $ 5,000,000 <br /> X EXCESS LIAB X CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED RETENTION$ $ XXXXXXX <br /> WORKERS COMPENSATION NOT APPLICABLE PER <br /> STATUTE EERH <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETORIPARTNER/EXECUTIVE Y/N E L.EACH ACCIDENT $ XXXXXXX <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ XXXXXXX <br /> If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX <br /> A Professional Liability N N FLP005371307 3/1/2020 3/1/2021 $1M Each Claim/$3M Agg. <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE:Cocoon House Youth Counseling and City of Everett Human Needs Grant.City of Everett,its officers,employees and agents are included as Additional <br /> Insured as respects General Liability as required by written contract. <br /> CERTIFICATE HOLDER CANCELLATION See Attachment <br /> 16203395 <br /> CityOf Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 3002 Wetmore Avenue ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett,WA 98201 <br /> AUTHORIZED REPRESENTATIVE pep <br /> ®1988-20 ACORD CORK; TION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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