|
ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM.DDIYYYY)
<br /> 2/4/2020
<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 be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Debbie Cook
<br /> NAME:
<br /> Leavitt Group Northwest P(�-MONE Ext): (800)726-8771 (al No): (866)72e-9168
<br /> PO Box 65770 ADDRESS:debbie—cook@leavitt.corn INSURER(S)AFFORDING COVERAGE NAIC#
<br /> University Place WA 98464 INSURERA:Philadelphia Indemnity Insurance Cowper A18058
<br /> INSURED INSURER S:
<br /> Little Red School House Inc, DBA: Childstrive INSURER C:
<br /> 14 E Casino Rd INSURERD:
<br /> INSURER E:
<br /> Everett NA 98208 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:2020-21 Master REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POUCIES 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 /> INSR TYPE OF INSURANCE ADM SUBR POLICY EFF POLICY EXP
<br /> LTRINSO WVD POLICY NUMBER (MM/DD/YYYY) IMMIDDIYYYY) UNITS
<br /> I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTE
<br /> A CLAIMS-MADE I OCCUR PREMISES(Ea occurrence) 100,000
<br /> X PHPK2088018 1/23/2020 1/23/2021 MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN1 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000
<br /> I POLICY JJEE-CTT LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER- Sexual/Physical Abuse Aggregate $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A I ANY AUTO BODILY INJURY(Per person) $
<br /> — ALL OWNED SCHEDULED PHPK2088018 1/23/2020 1/23/2021 BODILY INJURY(Per accident) $
<br /> ._ AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS
<br /> (Per accident)
<br /> TOS
<br /> — Undennsured motorist combined sr $ 1,000,000
<br /> I UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ 3,000,000
<br /> A EXCESS UAB CLAIMS-MADE AGGREGATE $ 3,000,000
<br /> DED I I RETENTION$ 10,000 PHUB708512 1/23/2020 1/23/2021 $
<br /> WORKERS COMPENSATION PER I OTH-
<br /> AND EMPLOYERS'LIABILITY V/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE G. Stop Gap E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> A (Mandatory in NH) PH8E2088018 1/23/2020 1/23/2021 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,descnbe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A Professional Liability PHPE2088018 1/23/2020 1/23/2021 Aggregate$3,000,000/Occurrence 1,000,000
<br /> A Directors & Officers PHSD1503080 1/23/2020 1/23/2021 Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett, its officers, employees and agents are added as additional insureds as per CG 2026 0413
<br /> attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> 2930 Wetmore St., Suite l0A ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett, WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> Jeff Olsen/DECOOK �j O
<br /> I
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(201401)
<br />
|