|
2/10/2022
<br />Leavitt Group Northwest
<br />PO Box 65770
<br />University Place WA 98464
<br />Debbie Cook
<br />(800)726-8771 (866)728-9168
<br />debbie-cook@leavitt.com
<br />Little Red School House Inc, DBA: Childstrive
<br />906 SE Everett Mall Way STE 200
<br />Everett WA 98208
<br />Philadelphia Indemnity Insurance CompanyA18058
<br />22-23 Master
<br />A
<br />X
<br />X
<br />X
<br />X PHPK2355023 1/23/2022 1/23/2023
<br />1,000,000
<br />100,000
<br />10,000
<br />1,000,000
<br />3,000,000
<br />3,000,000
<br />Sexual /Physical Abuse Aggregate 1,000,000
<br />A X
<br />PHPK2355023 1/23/2022 1/23/2023
<br />1,000,000
<br />Underinsured motorist combined single limit 1,000,000
<br />A
<br />X X
<br />X 10,000 PHUB794986 1/23/2022 1/23/2023
<br />3,000,000
<br />3,000,000
<br />A
<br />WA Stop Gap
<br />PHPK2355023 1/23/2022 1/23/2023
<br />X
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />A Professional Liability PHPK2355023 1/23/2022 1/23/2023 Aggregate $3,000,000 / Occurrence 1,000,000
<br />A Directors & Officers Liability PHSD1690311 1/30/2022 1/23/2023 Aggregate 4,000,000
<br />City of Everett, its officers, employees and agents are added as additional insureds as per CG 2026 0413
<br />attached.
<br />City of Everett
<br />2930 Wetmore St., Suite 10A
<br />Everett, WA 98201
<br />Jeff Olsen/DECOOK
<br />The ACORD name and logo are registered marks of ACORD
<br />CERTIFICATE HOLDER
<br />©1988-2014 ACORD CORPORATION.All rights reserved.
<br />ACORD 25 (2014/01)
<br />AUTHORIZED REPRESENTATIVE
<br />CANCELLATION
<br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
<br />LOCJECT
<br />PRO-POLICY
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />OCCURCLAIMS-MADE
<br />COMMERCIAL GENERAL LIABILITY
<br />PREMISES (Ea occurrence)$
<br />DAMAGE TO RENTED
<br />EACH OCCURRENCE $
<br />MED EXP (Any one person)$
<br />PERSONAL &ADV INJURY $
<br />GENERAL AGGREGATE $
<br />PRODUCTS - COMP/OP AGG $
<br />$RETENTIONDED
<br />CLAIMS-MADE
<br />OCCUR
<br />$
<br />AGGREGATE $
<br />EACH OCCURRENCE $UMBRELLA LIAB
<br />EXCESS LIAB
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />INSR
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)LIMITS
<br />PER
<br />STATUTE
<br />OTH-
<br />ER
<br />E.L.EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />$
<br />$
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />If yes,describe under
<br />DESCRIPTION OF OPERATIONS below
<br />(Mandatory in NH)
<br />OFFICER/MEMBER EXCLUDED?
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />HIRED AUTOS
<br />NON-OWNED
<br />AUTOS AUTOS
<br />AUTOS
<br />COMBINED SINGLE LIMIT
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE $
<br />$
<br />$
<br />$
<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 />INSD
<br />ADDL
<br />WVD
<br />SUBR
<br />N / A
<br />$
<br />$
<br />(Ea accident)
<br />(Per accident)
<br />OTHER:
<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 />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
<br />INSURED
<br />PHONE
<br />(A/C, No, Ext):
<br />PRODUCER
<br />ADDRESS:
<br />E-MAIL
<br />FAX
<br />(A/C, No):
<br />CONTACT
<br />NAME:
<br />NAIC #
<br />INSURER A :
<br />INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />INSURER(S)AFFORDING COVERAGE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INS025 (201401)
|